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Background: Depressed patients commonly experience psychological pain. Research pointed to positive psychological interventions as an effective means of ameliorating psychological pain, although the exact effect is unclear. Based on the hope theory and solution-focused brief therapy (SFBT), this study combines hope theory with solution-focused brief therapy to develop a nurse-led psychological pain solution-focused (PPSF) intervention in depressed patients. Methods: This is an assessor-blinded randomized controlled trial following the SPIRIT guidance. A total of 84 depressed patients will be recruited from the inpatient wards of a psychiatric hospital and randomly assigned to the control and experimental groups. Patients in the control group will be treated as usual. In contrast, patients in the experimental group will receive 6 sessions of the PPSF intervention for two weeks on top of the routine care. Primary outcomes are psychological pain, hope, cognitive distortions. Secondary outcomes are depression and suicidal ideation. Data will be collected at 5-time points: baseline, 1 and 2 weeks (post-intervention), 1 month (follow up), and 6 months after baseline. Generalized equation evaluation will be used to assess the effectiveness of the PPSF intervention. Discussion: From a positive psychology perspective, there remains much room for developing psychological pain interventions in depressed patients. SFBT and hope theory are both based on positive psychology. With hope theory as the general framework and SFBT questions as the practical guide, the PPSF intervention program is designed that nursing staff can implement. If the intervention is effective, it will advance the development of psychological pain interventions for patients with depression. Trial registration: ChiCTR2100048223 [ABSTRACT FROM AUTHOR]

Aims and objectives: This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease. Background: Sleep quality is a common problem in older adults that may be affected by physical and mental status. Design: A cross‐sectional correlational design was employed. Methods: The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively. Results: Of the 120 older adults (age >65 years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain. Conclusion: Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease. Relevance to clinical practice: The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population. [ABSTRACT FROM AUTHOR]

Background: The conventional written tests and professional assessment have limitation in fair judgement of clinical competence. Because the examiners may not have total objectivity and may lack standardization throughout the assessment process. We sought to design a valid method of competence assessment in medical and nursing specialties. This work was aimed to develop an Objective Structured Clinical Exam (OSCE) to evaluate novice nursing practitioners' clinical competency, work stress, professional confidence, and career satisfaction. Methods: A Quasi-experimental study (pre-post). Fifty-five novice nursing practitioners received the OSCE three-months following their graduation, which consisted of four stations: history taking, physical examination, problem-directed management, interpersonal communication, and the required techniques of related procedures. The examiners had to complete an assessment checklist, and the participants had to complete a pre-post questionnaire (modified from a Nursing Competency Questionnaire, a Stress scale, and Satisfaction with Learning scale). Results: Among the novice nursing practitioners, 41 of them (74.5 %) passed the exam with a mean score of 61.38 ± 8.34. There was a significantly higher passing rate among nurses who were working in medical-surgical wards (85.7 %) and the intensive care unit-emergency department (77.8 %) compared to novice nursing practitioners working in other units. All the novice nursing practitioners at Station A had poor performance in assessing patients with a fever. OSCE performance was more associated with educational attainment and work unit, rather than the gender. Finally, the participants showed statistically significant increases in their clinical competency, confidence in their professional competence, satisfaction with the clinical practice, and decreased work stress after the OSCE. Conclusions: We found that the OSCE process had a positive educational effect, in providing a meaningful and accurate assessment of the competence of novice nursing practitioners. An appropriate OSCE program is vital for novice nursing practitioners, educators, and administrators. The effective application of OSCEs can help novice nursing practitioners gain confidence in their clinical skills. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors associated with resilience in primary caregivers of patients with advanced oral cavity cancer within the first 6 months post‐treatment. Design: A cross‐sectional study. Methods: We recruited patient–primary caregiver dyads from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed using a set of structured questionnaires to measure performance status and demographic and clinical characteristics. Primary caregivers were measured in their social support, resilience, and care characteristics. Results: Of the 148 dyads surveyed, 33.8% of primary caregivers reported moderately low to moderate resilience, and 61.5% reported low resilience. Greater resilience of primary caregivers was associated with the primary caregiver factors of younger age, lower educational level, and more affectionate social support; and greater resilience was associated with the patient factors of better performance status and older age. These factors explained 40.4% of the variance in resilience. Conclusions: Patients' performance status and primary caregivers' affectionate social support strongly influence overall resilience and each domain of resilience. Clinical Relevance: Providing primary caregivers with sufficient social resources and a support group can help them cope with the demands of caregiving for loved ones with oral cavity cancer. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the short-term effect of a virtual reality-based exercise program on fatigue in patients with end-stage renal disease (ESRD) who receive hemodialysis (HD). In this quasi-experimental study design, an experimental group (n = 32) received virtual reality training that promoted exercise, and a control group (n = 32) received routine care (advice on physical activities). Fatigue and physiologic parameters were assessed pretest (before intervention) as well as posttest (4 weeks after the onset of intervention). Our results showed that patients in the experimental group had significantly lower levels of overall fatigue, reduction in vigor and motivation, distress and loss of control in mood, and higher hemoglobin levels compared with the control group. ANCOVA revealed that there were no differences in overall fatigue and different domains of fatigue. Exercise only increased the blood urea nitrogen (BUN) and creatinine levels significantly in the intervention group. [ABSTRACT FROM AUTHOR]

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: Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. Research objectives: This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. Research design: Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an exploratory factor analysis was conducted. Participants: We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. Ethical considerations: This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. Findings: The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 – 'Understanding of the research', Factor 2 – 'Trust and confidence' and Factor 3 – 'Doubt and uncertainty'. The three factors accounted for is 52.954 of the total variance with Cronbach's α of.917. Discussion and conclusion: The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application. [ABSTRACT FROM AUTHOR]

Embelin exhibits the broad bioactivities such as antitumor, antifertility, antidiabetic, anti-inflammatory, antioxidant, anticonvulsant, anxiolytic, antimicrobial, and hepatoprotective activity. In order to further understand the pharmacokinetic characteristics and oral bioavailability of embelin in vivo, the concentration of embelin in rat plasma was determined by a sensitive high-performance liquid chromatography with diode array detector (HPLC-DAD). The preparation of samples was accomplished by a simple precipitating protein with methanol. Emodin was selected as the internal standard (IS). Embelin and IS were completely separated on an analytical column (Extend-C18, 4.6 × 250 mm, 5 μm) using 0.1% phosphoric acid in methanol and 0.1% phosphoric acid in aqueous solution (90:10, v/v) as the mobile phase. The lower limit of quantification was 0.15 μg/mL. Oral bioavailability of embelin was 30.2 ± 11.9%. This study could provide the information about pharmacokinetics and oral bioavailability of embelin, which was useful to assess the clinic efficacy and safety and promote further development of embelin. [ABSTRACT FROM AUTHOR]

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p <.001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p >.05) and critical thinking (β = 0.18, t = 3.143, p <.001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self‐reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self‐reflection and critical thinking. Methods: For this descriptive, correlational, cross‐sectional study, we recruited 293 fifth‐year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self‐reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q‐sort, and a Chinese version of the Self‐Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. Results: The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p < 0.001) and self‐reflection with insight (β = 0.54, t = 11.99, p < 0.001). Self‐reflection and insight significantly positively affected critical thinking (β = 0.34, t = 6.48, p < 0.001). Further, self‐reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self‐reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking. Conclusion: Caring behaviours directly affect self‐reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self‐reflection and insight. [ABSTRACT FROM AUTHOR]

Taiwan's indigenous population exhibits a higher mortality of cardiovascular disease, but current research has not reported any associations among ethnicities on the blood pressure (BP). We randomly selected representative samples in this population-based study. We measured height, weight, hip and waist circumferences, and blood pressure in a screening survey. Systolic BP and diastolic BP were significantly higher in the indigenous population. Among women, prevalence rates of DBP > 90 mmHg among indigenes (32.9 %) were significantly high than those in Han Chinese (17.4 %). Based on multivariate analysis adjusted for covariates, the results showed gender and ethnicity to be significantly correlated with systolic and diastolic BP. Gender was a modifier between ethnicity and BP. Furthermore, we found an additive effect between ethnicity and age on systolic and diastolic BP by gender. Our study showed independent additive effects on systolic BP and diastolic BP between ethnicity and age by gender. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to evaluate the psychometric properties, reliability, and validity of the Chinese-version Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ-C) and assess the behavioral nicotine dependence among community-dwelling adult smokers in Taiwan. Method: The methods used were survey design, administration, and validation. A total of 202 adult smokers completed a survey to assess behavioral dependence, nicotine dependence, depression, social support, and demographic and smoking characteristics. Data analysis included descriptive statistics, internal consistency reliability, t test, exploratory factor analysis, independent t test, and Pearson product moment correlation. Results: The results showed that (1) the GN-SBQ-C has good internal consistency reliability and stability (2-week test-retest reliability); (2) the extracted one factor explained 41.80 % of the variance, indicating construct validity; (3) the scale has acceptable concurrent validity, with significant positive correlation between the GN-SBQ-C and nicotine dependence, depression, and time smoking and negative correlation between the GN-SBQ-C and age and exercise habit; and (4) the instrument has discriminant validity, supported by significant differences between those with high and low-to-moderate nicotine dependence, smokers greater than 43 years old and those 43 years old and younger, and those who smoked 10 years or less and those smoking more than 10 years. Conclusion: The 11-item GN-SBQ-C has satisfactory psychometric properties when applied in a sample of Taiwanese adult smokers. The scale is feasible and valid to use to assess smoking behavioral dependence. [ABSTRACT FROM AUTHOR]

Background: Good nurses show concern for patients by caring for them effectively and attentively to foster their well-being. However, nurses cannot be taught didactically to be “good” or any trait that characterizes a good nurse. Nurses’ self-awareness of their role traits warrants further study. Objectives: This study aimed (a) to develop a strategy to elicit nurses’ self-exploration of the importance of good nurse traits and (b) to explore any discrepancies between such role traits perceived by nurses as ideally and actually important. Research design: For this mixed-method study, we used good nurse trait card play to trigger nurses’ reflections based on clinical practice. Nurse participants appraised the ideal and actual importance of each trait using a Q-sort grid. The gap between the perceived ideal and actual importance of each trait was examined quantitatively, while trait-related clinical experiences were analyzed qualitatively. Participants and research context: Participants were 35 in-service nurses (mean age = 31.6 years (range = 23–49 years); 10.1 years of nursing experience (range = 1.5–20 years)) recruited from a teaching hospital in Taiwan. Ethical considerations: The study was approved by the Institutional Review Board of the study site. Findings: Good nurse trait card play with a Q-sort grid served as an icebreaker to help nurse participants talk about their experiences as embodied in good quality nursing care. Nurses’ perceived role–trait discrepancies were divided into three categories: over-performed, least discrepant, and under-performed. The top over-performed trait was “obedience.” Discussion: Patients’ most valued traits (“patient,” “responsible,” “cautious,” and “considerate”) were perceived by participants as ideally important but were under-performed, perhaps due to experienced nurses’ loss of idealism. Conclusion: Good nurse trait card play with Q-sort grid elicited nurses’ self-dialogue and revealed evidence of the incongruity between nurses’ perceived ideal and actual importance of traits. The top over-performed trait, “obedience,” deserves more study. [ABSTRACT FROM AUTHOR]

This study determined the in-use effects of dry-fast and traditional hand-washing surgical scrubs among operating room staff members. This is a static group comparison study with purposive sampling. A total of 156 staff members were recruited in an operating room in a medical center located in southern Taiwan. The participants were divided into traditional and dry-fast hand-washing groups. Microbial counts were measured right after the two groups finished surgical scrubbing and at the completion of surgery. The results showed that the use of dry-fast antisepsis has a better persistent effect ( P = 0.001), more nurses chose dry-fast antisepsis than surgeons ( P = 0.012), and the post-operation number of colonies for nurses was significantly higher than that for surgeons ( P = 0.003). Operating room nurses are long-term and frequent users of antibacterial agents, and their requirement of skin protection is higher. The dry-fast technique has the advantage of being less irritating to the skin and less time consuming; therefore, brush-free and dry-fast antisepsis is recommended. [ABSTRACT FROM AUTHOR]

We assessed obesity, sex, menopause, and gender differences on hypertension in a Hakka-majority Taiwanese sample. Methods. 9621 subjects aged 20 and over participated in this community-based study. Trained nurses collected blood pressure (BP) measurements and anthropometric indices, including weight, height, hip circumference (HC), waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), and waist to hip ratio (WHR). Results. Levels of systolic and diastolic BP significantly increased at a dose-dependent relationship based on four anthropometric indices (BMI, WC, WHR, and WHtR); the slopes for SBP and DBP differed. After controlling for other covariates using multivariate logistic regression, we found the adjusted odds ratios (OR) of hypertension to be significantly related to the four anthropometric indices. Notably, the effect of obesity on the ORs for hypertension was considerably higher in premenopausal women, but we found no such phenomenon among men. BMI, WC, WHR, and WHtR had significant linear associations with BP. Conclusion. Obesity indices are significantly correlated with the risk of hypertension across gender and age, with BMI having the highest relative potency. The effect of obesity on the risk of hypertension is especially high in premenopausal women, implying a relationship between hormones and hypertension. [ABSTRACT FROM AUTHOR]

Objectives To determine the extent to which the co-occurrence of chronic obstructive pulmonary disease ( COPD) and cognitive impairment affect adverse health outcomes in older adults. Design Multicenter longitudinal cohort study. Setting California, Pennsylvania, Maryland, and North Carolina. Participants Three thousand ninety-three community-dwelling adults aged 65 and older from the Cardiovascular Health Study. Four hundred thirty-one had chronic obstructive pulmonary disease ( COPD) at study baseline. Measurements Follow-up began at the second CHS visit and continued for 3 years. Spirometric criteria for airflow limitation served to establish COPD using the Lambda- Mu- Sigma method, which accounts for age-related changes in lung function. Cognitive impairment was evaluated using the modified Mini- Mental State Examination and claims data. Outcomes were respiratory-related and all-cause hospitalizations and death. Results Participants with coexisting COPD and cognitive impairment had the highest rates of respiratory-related (adjusted hazard ratio (a HR) = 4.10, 95% confidence interval ( CI) = 1.86-9.05) and all-cause hospitalizations (a HR = 1.34, 95% CI = 1.00-1.80) and death (a HR = 2.29, 95% CI = 1.18-4.45). In particular, individuals with both conditions had a 48% higher rate of all-cause hospitalizations (adjusted synergy index (a SI) = 1.48, 95% CI = 0.19-11.31) and a rate of death nearly three times as high ( aSI = 2.74, 95% CI = 0.43-17.32) as the sum of risks for each respective outcome associated with having COPD or cognitive impairment alone. Nevertheless, tests for interaction were not statistically significant for the presence of synergism between the two conditions contributing to each of the outcomes. Therefore, it cannot be concluded that the combined effect of COPD and cognitive impairment is greater than additive. Conclusion Coexisting COPD and cognitive impairment have an additive effect on respiratory-related and all-cause hospitalizations and death. Optimizing outcomes in older adults with COPD and cognitive impairment will require that how to improve concurrent management of both conditions be determined. [ABSTRACT FROM AUTHOR]

The author discusses a pilot randomized controlled trial to compare the short-term and medium-term effect of Functional Fascial Taping to placebo taping on pain and function in people with non-specific low back pain. The study assessed the worst and average pain and function, after a 2-week intervention. The results revealed that Functional Fascial Taping reduced worst pain in patients during the treatment phase, but there was no medium-term difference in pain or function.

Abstract: Objective: Conjugated linoleic acid (CLA) has several benefits, including body fat reduction, as proved in animals. However, the results of CLA-induced body composition alterations in humans are inconsistent, and no related data are available for Chinese populations. This study aimed to determine whether CLA affects body weight (BW) loss and body composition of overweight and obese Chinese subjects. Methods: In this randomized, double-blind, placebo-controlled trial, subjects with a body mass index (BMI) of 24 to 35 kg/m2 randomly received 1.7 g of cis-9,trans-11 and trans-10,cis-12 CLA (n = 30) or placebo (salad oil; n = 33) in 200 mL of sterilized milk twice daily for 12 wk. Changes in body composition were determined by bioimpedance measurements. Results: Sixty-three subjects completed the study (CLA, n = 30). After 12 wk, compared with the baseline, the BW, BMI, total fat mass, fat percentage, subcutaneous fat mass, and waist-to-hip ratio decreased in the CLA group (P < 0.05). The CLA group was stratified by BMI and gender. The BW, BMI, subcutaneous fat mass, and waist-to-hip ratio decreased in 27 subjects with a BMI ≥ 27, and these indices, except subcutaneous fat mass, were lower in female subjects. The levels of total cholesterol, triacylglycerol, low-density lipoprotein, and plasma fasting glucose increased, whereas those of high-density lipoprotein decreased after 3 mo of CLA treatment. The changes were not significantly different from the baseline values. Conclusion: The supplementation of CLA for 12 wk in overweight and grade I obese Chinese subjects yielded lower obesity indices, with no obvious adverse effects. [Copyright &y& Elsevier]

Liao C-H, Chang C-S, Chang S-N, Lane H-Y, Lyu S-Y, Morisky DE, Sung F-C. The risk of temporomandibular disorder in patients with depression: a population-based cohort study. Community Dent Oral Epidemiol 2011; 39: 525-531. © 2011 John Wiley & Sons A/S Abstract - Objectives: This study used a population-based retrospective cohort design to examine whether depression is a risk factor of temporomandibular disorder (TMD) Methods: From a universal insurance database, we identified 7587 patients who are newly diagnosed individuals with depression in 2000 and 2001. A total of 30 197 comparison subjects were randomly selected from a nondepression cohort. Both groups were followed until the end of 2008 to measure the incidence of TMD. Results: The incidence of TMD was 2.65 times higher in the depression cohort than in the nondepression cohort (6.16 versus 2.32 per 1000 person-years). The hazard ratio (HR) measured by multivariate Cox's proportional hazard regression analysis of TMD for the depression cohort was 2.21 (95% confidence interval (CI) 1.83-2.66), after controlling for socio-demographic factors and other psychiatric comorbidities. Women had higher risk to develop TMD than men (HR 1.61, 95% CI 1.36-1.92 for women without depression; HR 3.54, 95% CI 2.81-4.45 for women with depression). Conclusions: This study demonstrates that patients with depression are at an elevated risk of developing TMD. [ABSTRACT FROM AUTHOR]

The authors report on the nature of assessing functional caregiving (FC) via three studies, conducted by a university-public preschool collaboration that was designed to measure mothers' confidence to care for children with intellectual disabilities in their homes. Caregiving of children with intellectual disabilities was conceptualized in terms of a task hierarchy that occurs in a complex, multi-level sociocultural ecology. Rating scale items were developed to survey mothers' caregiving confidence in this ecology, which were analyzed with a Rasch model. Raw ratings were transformed to an axiomatically strong, objective, unidimensional scale, and the obtained task difficulties conformed to a three-tier caregiving hierarchy of advocacy, personal caregiving, and community relations domains. Hierarchical regression of task difficulties on item components defined by FC domains was consistent with an ecological model (R2 > 0.60). The task hierarchy was also found to be consistent with humanistic psychology principles. When FC measurement properties were compared between suburban and urban mothers, as well as mothers of educationally at risk and special needs children, psychometric reliability was high (>0.90). Validity studies confirmed FC functional relations with mothers' health, age, and economic status. In general, these studies found that mothers' self-confidence measures were valid and reliable, but noted future studies are needed to link FC measures directly to competency and home caregiving quality. Future research should also explore replication of core items across other disabilities and chronic diseases, as well as applicability to objective caregiving standard setting. [ABSTRACT FROM AUTHOR]

Triple-negative breast cancer (TNBC) is an aggressive subtype with poor prognosis of breast cancer. Thiostrepton exerts anti-tumor activities against several cancers including TNBC. Herein we discussed the new molecular mechanisms of thiostrepton in TNBC. Thiostrepton inhibited MDA-MB-231 cell viability, accompanied by a decrease of c-FLIP and p-SMAD2/3. c-FLIP overexpression reduced the sensitivity of MDA-MB-231 cells to thiostrepton, while SMAD2/3 knockdown increased the sensitivity of MDA-MB-231 cells to thiostrepton. Moreover, c-FLIP overexpression significantly increased the expression and phosphorylation of SMAD2/3 proteins and vice versa. In conclusion, our study reveals c-FLIP/SMAD2/3 signaling pathway as a novel mechanism of antitumor activity of thiostrepton. [ABSTRACT FROM AUTHOR]

Background: Cognitive degeneration and agitated behavior symptoms of dementia in older adults are the main causes of disability and inability and increase the cost of medical care. Agitated behavior symptoms of dementia are the main causes of early institutionalization and make caregivers exhausted. Purpose: The aim of this study was to examine the effects of art therapy and reminiscence therapy on the alleviation of agitated behaviors in older adults with dementia. Methods: An experimental research design with two experimental groups and one comparison group was conducted to examine the effects for each group on agitated behaviors. Participants were recruited from two dementia care centers in central and northern Taiwan. The study included 54 older individuals who met the sampling criteria and completed the data collection process. The participants were randomly allocated into the art therapy group (n = 24), the reminiscence therapy group (n = 22), and the comparison group (n = 8). The intervention consisted of 50-minute sessions conducted weekly for 12 weeks. Regular activities were continued in the comparison group. The structured questionnaires were completed, and observations of agitated behaviors were collected before the intervention and at 1 and 6 weeks after the intervention. Results: Significant differences were found in agitated behavior symptoms at the three time points in the art therapy group, whereas reminiscence therapy was found to have had a clear and immediate effect on decreasing agitated behavior. The generalized estimating equation exchange model test revealed a significant and sustained, postintervention effect of art therapy on agitated behavior. In contrast, no significant and sustained effect on agitated behavior was observed in the reminiscence therapy group. Conclusions: The findings of this study support that art therapy may have a positive effect on dementia-associated agitated behaviors in institutionalized older adults. Reminiscence therapy activities conducted weekly for 50 minutes each session did not reach statistically significant implications. It is suggested that future studies consider conducting art and reminiscence therapies for a 16-week duration with two weekly sessions to evaluate the effectiveness of the therapy. The duration of follow-up should be extended as well in future studies. [ABSTRACT FROM AUTHOR]

Aims: Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy. Methods: We adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale. Results: A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age. Conclusion: Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management. Summary statement: What is already known about this topic? Psychological insulin resistance is a common psychological barrier to initiation and persistence with insulin therapy.Psychological insulin resistance causes poor glycaemic control and diabetes‐related complications.Psychological insulin resistance may negatively impact self‐management in patients with type II diabetes mellitus. What is the contribution of this paper? Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy.Patients with poor self‐management had statistically significantly higher levels of overall psychological insulin resistance, fear of injections and self‐testing, expectations regarding positive insulin‐related outcomes, and stigmatization by insulin injections, compared to those with appropriate self‐management. What are the implications of this paper? Knowing in advance the factors associated with diabetes self‐management will allow healthcare professionals prevent psychological insulin resistance in patients with type II diabetes mellitus treated with insulin therapy.Healthcare professionals can design and provide patient‐centred diabetes education based on education level to enhance self‐management. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to examine the factors associated with the intention to use adult preventive health services in Taiwan. Design and Sample: Using Andersen's behavioral model, we employed a cross‐sectional descriptive design to investigate 500 samples from four communities in southern Taiwan. Measures: We used a self‐reported survey to assess participants' intention to use adult preventive health services, and the predisposing, enabling, and need factors influencing their intention. Results: Intention to use adult preventive health services was more significantly explained by predisposing and enabling factors than by need factors. In addition, a lack of fixed medical facilities (enabling factor) and Taiwanese origin (predisposing factor) were associated with decreased odds of intention to use adult preventive health services. An educational level of high school or below (predisposing factor), higher amounts of exercise (predisposing factor), and lower barriers to use preventive health services (predisposing factor) were associated with increased odds of intention to use adult preventive health services. Conclusion: The findings can assist public health nurses in identifying high‐risk groups with lower intentions of using adult preventive health services. Additionally, community‐based health education program can be developed to increase people's intention to use adult preventive health services. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) patients who are unable to return to work after completing treatment might face financial loss and reduced self-esteem. The aim of this study was to identify factors influencing a return to work in HNC cancer patients in the first 6 months after treatment. This cross-sectional study examined HNC patients who completed treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Patients were assessed according to psychological distress, patient-perceived health status, barriers to returning to work, and facilitators of returning to work. Of the 106 HNC patients surveyed, 54.7% successfully returned to work. Barriers to returning to work included poor self-perception of health, greater psychological distress, and age ≥50 years. Patients who had higher psychological distress, returned to work after start of the pandemic, or received reconstruction surgery were less likely to experience a positive environment facilitating a return to work. [ABSTRACT FROM AUTHOR]

The synthesis of L-ascorbyl flurbiprofenate was achieved by esterification and transesterification in nonaqueous organic medium with Novozym 435 lipase as biocatalyst. The conversion was greatly influenced by the kinds of organic solvents, speed of agitation, catalyst loading amount, reaction time, and molar ratio of acyl donor to L-ascorbic acid. A series of solvents were investigated, and tert-butanol was found to be the most suitable from the standpoint of the substrate solubility and the conversion for both the esterification and transesterification. When flurbiprofen was used as acyl donor, 61.0% of L-ascorbic acid was converted against 46.4% in the presence of flurbiprofen methyl ester. The optimal conversion of L-ascorbic acid was obtained when the initial molar ratio of acyl donor to ascorbic acid was 5 : 1. kinetics parameters were solved by Lineweaver-Burk equation under nonsubstrate inhibition condition. Since transesterification has lower conversion, from the standpoint of productivity and the amount of steps required, esterification is a better method compared to transesterification. [ABSTRACT FROM AUTHOR]

Objectives Highly active antiretroviral therapy (HAART) provision to eligible HIV-infected pregnant and post-partum women is critical for optimizing maternal health. We assessed the impact of maternal HAART on HIV-free survival of breastfed infants in Malawi. Methods The post-exposure prophylaxis of infants-Malawi trial (2004-2009) enrolled mothers/infants during labor or immediately post-partum to evaluate 14-week extended infant antiretroviral prophylaxis for preventing HIV transmission through breastfeeding. Mothers meeting national HAART guidelines were referred for therapy. Child HIV-free survival-survival without HIV infection-was compared by maternal HAART status. Results Overall, 3022 mother-infant pairs contributed 4214 infant/person-years (PY) at-risk for HIV infection or death, with 532 events (incidence 12.6/100 PY, 95 % confidence interval [CI] 11.6-13.7). During follow-up, 349 mothers were HAART initiated; 581 remained HAART naïve with CD4 cell counts <250 cells/mm, and 2092 were never HAART-eligible. By 3 months, 11 % of infants with HAART naïve mothers (CD4 < 250) were infected with HIV or died versus 7 % of infants of HAART-initiated mothers and 4 % of infants of HAART-ineligible mothers. Maternal HAART was associated with a 46 % reduction in infant HIV infection or death as compared to infants with HAART naïve mothers (CD4 < 250) (adjusted hazards ratio 0.54, 95 % CI 0.36-0.81). Among HIV-exposed, uninfected infants, breastfeeding, but not HAART, was significantly associated with decreased child mortality. Conclusions HIV infection and mortality are high during the first 3 months post-partum in infants of mothers with advanced HIV, and rapid maternal HAART initiation can significantly improve HIV-related infant outcomes. Clinical Trials Registration This study is registered at under trial number NCT00115648. [ABSTRACT FROM AUTHOR]

Background Anxiety and fatigue adversely affect women's postpartum recovery, but few effective non-pharmacological interventions are known to relieve these two common and unpleasant symptoms. Objectives To examine the efficacy of an auricular acupressure intervention provided during early postpartum in reducing anxiety, fatigue levels, cortisol levels, blood pressure, and heart rate. Design A single-blind, randomised controlled trial. Setting A 40-bed postpartum unit. Participants Women who underwent caesarean section were randomly allocated to two groups: intervention (auricular pressure, n = 40), and control (usual care, n = 40). Methods The intervention group received auricular acupressure on the shenmen acupoint twice a day (9 AM and 5 PM), and the control group received usual postpartum care. Serum cortisol levels were assessed by immunochemiluminescence, with blood pressure and heart rate assessed by electric sphygmomanometer. Anxiety and fatigue symptoms were assessed using the State Anxiety subscale of the State-Trait Anxiety Inventory and the Fatigue Continuum Form, respectively. Results Of the 76 women who completed the study, those who received auricular acupressure had significantly lower mean cortisol levels (mean difference = 4 μg/dl, p < 0.05), heart rate (mean difference = 9.2 beats/min, p < 0.001), anxiety symptoms (mean difference = 3.8, p < 0.01), and fatigue symptoms (mean difference = 7.1, p < 0.01) than women in the control group at 5 days postpartum. Conclusions Auricular acupressure is an effective non-pharmacological method for reducing cortisol levels, heart rate, anxiety, and fatigue in early postpartum after caesarean section. [ABSTRACT FROM AUTHOR]

Purpose: Primary caregivers (PC) of patients with advanced head and neck cancer (HNC) report stress during caregiving time post‐treatment. We sought to identify the trajectories of resilience from initial completion of treatment to 1‐year post‐treatment in PC of patients with advanced HNC and to determine the factors associated with trajectories of resilience. Design: In this prospective cohort study with convenience sampling, patient–PC dyads were recruited from a medical center in northern Taiwan between August 2015 and July 2020. Methods: We recruited 120 patient–PC dyads and followed up at treatment completion and 1, 6, and 12 months post‐treatment. Generalized estimating equation analysis was performed to identified factors related to resilience. Findings: PCs' overall resilience increased from initial completion of treatment to peak at 1‐year post‐treatment. Patient factors associated with greater overall resilience included older age, higher performance status, and shorter time since cancer diagnosis; PC factors included reporting more social support, better physical health, and better mental health. Conclusions: PC mental health was the most important factor in the resilience trajectory of patients with advanced HNC cancer. Clinical relevance: Quantifying the relevant factors of trajectories of resilience will help to identify vulnerable PCs and guide survivorship care in the early stages of the post‐treatment period. [ABSTRACT FROM AUTHOR]

Purpose: After suddenly stopping smoking after an initial oral cancer (OC) diagnosis, patients may restart smoking and nicotine dependence. This study sought to identify factors associated with high nicotine dependence in OC patients who restarted smoking post‐treatment. Design: A cross‐sectional study. Methods: A group of 220 OC patients who restarted smoking post‐treatment were recruited from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed for nicotine and smoking dependence, physical activity and function, socio‐emotional function, social support, and depression. Results: Among patients who restarted smoking after treatment for OC, 75.9% reported low‐to‐moderate dependence on smoking, while 24.1% reported high nicotine dependence. Factors associated with high nicotine dependence included higher incidence of smoking per day, greater dependence on smoking, less physical activity per week, and poorer social–emotional function. Those highly dependent on nicotine were younger, unmarried, had less education, and had begun smoking earlier than those with low‐to‐moderate nicotine dependence. Conclusions: The amount of smoking per day, greater smoking behavioral dependence, less physical activity per week, and worse social–emotional function affected high nicotine dependence. Clinical relevance: Smoking cessation training and counseling for OC patients may help them better control their use of tobacco after treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the relationship between multidisciplinary team care (MDTC) and patient completion of their treatment regimen for oral squamous cell carcinoma (OSCC). Methods: We conducted a retrospective cohort study in patients diagnosed with OSCC in Taiwan from 1 January 2016 to 30 June 2018 using a linked cancer registry database. Results: Of the 969 OSCC MDTC patients in the study cohort, 6.3% reported incomplete treatment, with 1.3% interrupting ongoing treatment and 5.0% terminating definitive treatment. Patients who had advanced‐stage disease, experienced primary cancer recurrence or a secondary cancer, or were treated with surgery combined with chemotherapy, radiotherapy or chemoradiotherapy were more likely to terminate treatment before completion. The major reasons for interruption of ongoing treatment included 'patient or their family considered the patient to be in poor physical condition' and 'difficulty enduring physical discomfort caused by treatment'. The major reason for termination of definitive treatment was 'patient or their families or friends experienced negative treatment effects and worried about the side‐effects of treatment'. Conclusion: Advanced‐stage cancer, recurrence or secondary cancer, and surgery combined with chemotherapy, radiotherapy or chemoradiotherapy negatively affected treatment completion. MDTC allows for shared decision‐making to determine the optimal treatment. [ABSTRACT FROM AUTHOR]

This study aimed to assess patients' levels of belief, benefits and barriers toward physical activity, and to identify factors associated with physical activity performance in patients with type II diabetes mellitus (T2DM). The study was carried out using cross-sectional correlation design. Subjects from the endocrinology and metabolism outpatient departments of a teaching hospital in northern Taiwan were recruited by consecutive sampling. A total of 149 patients with type II DM were recruited. More physical activity was associated with stronger physical activity beliefs, including recovery self-efficacy, action and coping planning, and maintenance self-efficacy, which explained 40.9% of variance in physical activity performance. Patient-centered physical activity programs (resistance exercise, daily walking, or Tai Chi exercise) can reduce patients' barriers toward performing physical activity. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The purposes of this study were to identify the impact of a case management programme on the related factors of refusing treatment or discontinuing treatment in Taiwanese colorectal cancer patients. Background: Side effects of anti‐cancer treatments are associated with refusing treatment and discontinuing treatment. Design: This case–control study, longitudinal database and secondary analysis of population‐based data was conducted from 2009–2012. Methods: Logistic regression was used to reveal the factors related to refusing or discontinuing treatment. Results: Of the 68 patients who refused treatment, the top reasons for refusing treatment were patients or their family considered the patients poor physical condition, difficulty in enduring any condition likely to cause physical discomfort from the disease treatment, selected complementary and alternative medicine, patients or their families or friends experienced negative treatment effects and worried about the side effects of treatment, older age, poor family support and lost contact. Of the 278 patients who discontinued treatment, the most common reasons for discontinuing treatment were patients or their families or friends experienced negative treatment effects and worried about the side effects of treatment, inconvenient transportation, patients or their family considered the patients poor physical condition, difficulty in enduring any condition likely to cause physical discomfort from the disease treatment, poor treatment effect and selected complementary and alternative medicine. Conclusion: Case managers can provide positive communication and available resources in relation to cancer treatment. A case management programme can help patients cope with the difficulties encountered during the treatment period. [ABSTRACT FROM AUTHOR]

Aims and objectives To (i) investigate the characteristics of health-related quality of life and satisfaction with case management and (ii) to identify factors associated with health-related quality of life in cancer survivors. Background The level of health-related quality of life can reflect treatment efficacy and satisfaction with cancer care. Design A cross-sectional study design was adopted. Methods Subjects from the outpatient setting of a cancer centre in northern Taiwan were recruited by consecutive sampling. A set of questionnaires were employed, including a background information form, case management service satisfaction survey ( CMSS) and The European Quality of Life Scale ( EQ-5D). Descriptive statistics were used to examine levels of health-related quality of life and satisfaction with case management. Pearson's correlation was used to identify relationships between treatment characteristics, satisfaction with case management and health-related quality of life. Multiple stepwise regression was used to identify factors associated with health-related quality of life. Results A total of 252 cancer patients were recruited. The three lowest scores for items of health-related quality of life were mobility, self-care and usual activities. Cancer survivors with higher mobility, less pain and discomfort, and lower anxiety and depression were more likely to have better health-related quality of life. Conclusion Mobility, pain and discomfort, and anxiety and depression are important predictive factors of high health-related quality of life in cancer survivors. Relevance to clinical practice In clinical care, patients' physical mobility, pain and discomfort, and anxiety and depression are important indicators of health-related quality of life. Case managers should include self-care and symptom management into survivorship care plans to improve health-related quality of life during survival after treatment concludes. [ABSTRACT FROM AUTHOR]

Objectives To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization of community-dwelling older adults. Design Prospective observational cohort study. Setting Memphis, Tennessee, and Pittsburgh, Pennsylvania. Participants Of 3,075 well-functioning community-dwelling adults aged 70 to 79 enrolled in the Health, Aging, and Body Composition Study from 1997 to 1998, 1,441 had complete data in the data set of all variables used, a dental examination within 6 months of baseline, and were eligible for this study. Measurements The primary outcome was pneumonia requiring hospitalization through 2008. Results Of 1,441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male sex (hazard ratio ( HR) = 2.07, 95% confidence interval ( CI) = 1.51-2.83), white race ( HR = 1.44, 95% CI = 1.03-2.01), history of pneumonia ( HR = 3.09, 95% CI = 1.86-5.14), pack-years of smoking ( HR = 1.006, 95% CI = 1.001-1.011), and percentage of predicted forced expiratory volume in 1 minute (moderate vs mild lung disease or normal lung function, HR = 1.78, 95% CI = 1.28-2.48; severe lung disease vs mild lung disease or normal lung function, HR = 2.90, 95% CI = 1.51-5.57) were nonmodifiable risk factors for pneumonia. Incident mobility limitation ( HR = 1.77, 95% CI = 1.32-2.38) and higher mean oral plaque score ( HR = 1.29, 95% CI = 1.02-1.64) were modifiable risk factors for pneumonia. Average attributable fractions revealed that 11.5% of cases of pneumonia were attributed to incident mobility limitation and 10.3% to a mean oral plaque score of 1 or greater. Conclusion Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors that 22% of pneumonia requiring hospitalization could be attributed to. These data suggest innovative opportunities for pneumonia prevention among community-dwelling older adults. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to study the effectiveness of an emotional self-management training program to antenatal women in the prevention of postnatal depression. DESIGN AND METHODS: The sample comprised 240 women who were at 32 weeks antenatal. They were randomly assigned into the intervention group and the control group. FINDINGS: On completion of the program, the intervention group reported significantly lower mean Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale scores than the control group. Fewer participants from the intervention group were diagnosed as having postnatal depression using the Structured Clinical Interview for DSM-IV. PRACTICE IMPLICATIONS: An antenatal emotional self-management training that may lower the risk of developing postnatal depression among Chinese women is recommended. [ABSTRACT FROM AUTHOR]