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This study tested whether communication neglect (CN) mediated the relationship between caregivers' reports of care receivers' cognitive status and/or problem behavior and thoughts about potential harmful behaviors (PHB) toward their care receiver. It also examined if caregivers' expressed anger and a positive pre-morbid relational history moderated the prediction of CN on PHB. Family caregivers (N = 339) in the U.S. completed the survey via Qualtrics. Results suggested that CN is a meaningful mediator explaining how PHB might occur. Caregiver expressed anger moderated the prediction of CN on PHB/physical abuse. Lastly, caregivers' perceptions of a positive pre-morbid relational history were a potential protective factor against PHB. When caregiver expressed anger was moderate or high, the prediction of CN on PHB/physical abuse was positive, but its strength was reduced as pre-morbid relational history became stronger. [ABSTRACT FROM AUTHOR]

Puzzles are mental exercises that enhance cognitive function. Functional cognition is critical for older adults to be able to engage in activities of daily living (ADL) and is linked to positive aging. This paper reports participation by Hispanic older adults in puzzle working and explores the relationship between the reported need for assistance with ADL and puzzles participation. Survey findings from 156 older adults reveal that puzzle working not only provides an opportunity to exercise their mind to solve cognitive challenges, but also elicits emotional and social benefits. The reported need for assistance with ADL is not a statistically significant predictor of participation in puzzle working, indicating that regardless of the level of assistance senior adults need for ADL, they can participate in puzzle working. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of health coaching on self‐management and quality of life (QOL) in patients with chronic kidney disease (CKD) and to evaluate whether self‐efficacy and patient activation mediate the effect of health coaching on self‐management and QOL. Design and Methods: A single‐center, parallel‐group, randomized controlled trial. A total of 108 patients with stages 1 to 3a CKD participated in the study. Participants were randomly assigned to a health‐coaching intervention group or a usual care control group. Participants' QOL (World Health Organization Quality of Life Scale), self‐management (CKD Self‐Management instrument), patient activation (Patient Activation Measure), and self‐efficacy (CKD Self‐Efficacy instrument) were measured at baseline, immediately after, and 6 weeks after the intervention. Findings: Health coaching improved QOL, self‐management, patient activation, and self‐efficacy at postintervention and at 12 weeks' follow‐up. Health coaching had a significant indirect effect on QOL through improvements in patient activation. Health coaching exerted a significant indirect effect on self‐management through improvements in self‐efficacy and patient activation. Conclusions: The findings demonstrated that health coaching can effectively improve QOL and self‐management. A health‐coaching intervention can raise self‐efficacy and activation levels through which self‐management and QOL further improve. Clinical Relevance: Health‐coaching strategies can be used to assist patients with early‐stage CKD in reaching their health goals and becoming activated in self‐management of their diseases. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate progressive muscle relaxation (PMR) as an intervention for anxiety, psychotic symptoms, and quality of life (QOL) in patients with chronic schizophrenia. Design and methods: Eighty patients were recruited from a Taiwanese psychiatry ward. The intervention group received group PMR; control group received treatment‐as‐usual. Results: The results indicated that PMR might have a short‐term effect on reducing anxiety, improving psychotic syndromes, and QOL among patients with chronic schizophrenia; however, the effectiveness at the 3‐month follow‐up was not evident. Practice Implications: Both the psychiatric patients and the health institutions may be able to list PMR as a clinical routine care, and then become a mental health practice strategy for mental patients to improve the quality of mental care. Implications for Nursing Practice: Our studies suggest that prevention of severe mental illness among patients with schizophrenia requires PMR interventions. PMR had an immediate effect, and it is possible that a shorter intervention period using this approach would also be successful. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the psychometric properties of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Background. Sleep disturbances are an extensive and common problem among menopausal women. However, no unique and specific scale has yet been developed to detect the inductive symptoms distresses that cause poor sleep quality for menopausal women. Design. A cross-sectional design. Methods. The Menopausal Symptoms Distress Affecting Sleep Quality Scale was based on in-depth interviews with menopausal women and literature review. Convenience sampling was employed. One hundred and fifty three women participated in this study. Exploratory factor analysis, concurrent validity and contrasting group validity were used to examine the validity of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Cronbach's a was conducted to test the reliability. The accuracy of the scale was analysed with the receiver operating characteristic from MED CALC version 10.4.8.0 software. The scale's sensitivity, specificity, positive and negative predictive value were analysed to locate the best cut-off point. Results. One factor was generated by Exploratory factor analysis, and this factor explained 49-07% of total variance. In addition, the Menopausal Symptoms Distress Affecting Sleep Quality Scale had significant positive correlations with the Greene Climacteric Scale and the self-evaluation of menopausal symptoms scale. Cronbach's a of the Menopausal Symptoms Distress Affecting Sleep Quality Scale was 0-89. Moreover, the diagnostic accuracy probability of the scale's receiver operating characteristic curve was 0-85. The best cut-off point was three with a sensitivity of 76% and a specificity of 87%. Conclusions. The Menopausal Symptoms Distress Affecting Sleep Quality Scale had good reliability and validity, as well as refined indicators for assessing the tool's accuracy. Relevance to clinical Practice. The Menopausal Symptoms Distress Affecting Sleep Quality Scale is easy to use, can quickly detect the sleep conditions of menopausal women who suffer from menopausal symptom distress, and provide efficient nursing interventions to relieve menopausal symptom distresses, and then improve sleep quality. [ABSTRACT FROM AUTHOR]

The main purpose of this study is to investigate whether applicants' impression management ( IM) tactics indirectly influence hiring recommendations through cognitive mechanisms (i.e. recruiters' perceptions of person-organisation [ P- O] fit, person-job [ P- J] fit, and person-recruiter [ P- R] fit) or affective mechanisms (i.e. recruiters' positive mood) during authentic employment interviews for actual job openings. Participants consisted of 221 applicant-recruiter dyads from 50 companies in Taiwan. The results demonstrated that applicants' self-focused IM tactics are positively related to recruiter perceptions of P- J fit, which in turn influence hiring recommendations. In addition, applicant other-focused IM tactics affect hiring recommendations through recruiters' perceptions of P- O fit. Moreover, applicants' non-verbal IM tactics were positively related to recruiters' positive mood, which in turn affected recruiters' perceptions of P- J fit and P- O fit, thereby affecting hiring recommendations. [ABSTRACT FROM AUTHOR]

Aims and objectives The specific aims of this study were as follows: (1) to describe psychosocial adjustment in adults with end-stage renal disease who underwent maintenance peritoneal dialysis; (2) to explore the influence of demographics, clinical variables, symptom distress and social support on psychosocial adjustment and (3) to determine predictive factors of psychosocial adjustment. Background Proper psychosocial adjustment is important for patients with end-stage renal disease to cope with multiple stressors of their disease and to balance their lives within the restrictions imposed by peritoneal dialysis treatment. Knowledge on psychosocial adjustment in patients receiving long-term peritoneal dialysis has been limited. Design The study was based on a predictive correlational design. Method One hundred peritoneal dialysis patients were recruited from outpatient peritoneal dialysis clinics of a general hospital in Taipei, Taiwan. Data were collected with the study questionnaires, including the Physical Symptom Distress Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale - self-report. Results The mean score on the Psychosocial Adjustment to Illness Scale was 359·7 ( SD = 40·0), indicating that these participants were moderately struggling in adjusting to their illness. Symptom distress, family social support and financial status explained 38·3% of the variance in psychosocial adjustment ( F3,96 = 21·5, p < 0·001). Conclusions The level of psychosocial adjustment in peritoneal dialysis patients is suboptimal. Overall, the patients with high physical symptom distress, weak family social support and poor financial status reported deficient psychosocial adjustment to their illness. Implications for practice The findings of this study are relevant to the understanding of preconditions that enable peritoneal dialysis patients to successfully adjust to the disease and its diverse consequences. Patients with insufficient income, higher symptom distress and less family social support have a greater risk of psychosocial maladjustment. Medical professionals may use these variables to identify higher risk groups for early intensive intervention. [ABSTRACT FROM AUTHOR]

Xiao-chai-hu-tang (XCHT) is a traditional Chinese herbal medicine which has been demonstrated to exhibit antioxidant and hepatoprotective functions. To reduce the unpleasant dark brown color and precipitates during storage, the performances of membrane process on the clarification and antioxidant capability of XCHT was evaluated. A membrane system equipped with either a microfiltration membrane (0.45 urn) or one of four ultrafiltration membranes (UK 200, UK 50, UP 20 and UK 10) was used. Our results indicated that less total solid was filtered through the membranes and thus a higher degree of clarification degree was achieved in permeates. Higher concentrations of active compounds, such as total phenolic compounds, saikosaponins, glycyrrhizin and baicalin, were detected in permeate using membranes of smaller pore-size of membranes. Antioxidant capabilities, including scavenging of free radicals, reducing power and total antioxidant activity of permeates, increased as compared to those of feed, particularly of permeates obtained with a UK. 10 ultrafiltration membrane. Taken together, membrane process clarified aqueous herbal extract and selectively partitioned bioactive components in permeates, thus enhancing the feasibility of XCHT to be a commercial health drink product. [ABSTRACT FROM AUTHOR]

Background: Hypertension is prevalent in older women and is associated with increased cognitive impairment. Exercise has demonstrated beneficial effects on cognitive function, but the impact of exercise on older hypertensive women remains unclear. We investigated the effects of an aerobic walking program on memory, subjective cognitive complaints, and brain-derived neurotrophic factor in older hypertensive women. Methods: A quasi-experimental study with a pretest–posttest design was conducted. Older hypertensive women were randomly assigned to the aerobic walking group or a control group with routine care. The intervention group received a 24-week aerobic walking program. Data were collected at baseline and 24 weeks after enrollment. Participants' characteristics, memory, subjective cognitive complaints, and plasma brain-derived neurotrophic factor were analyzed. Results: The aerobic walking group (n = 30) reported improvements in total recall, delayed recall, and subjective cognitive impairment after 24 weeks of aerobic walking. Compared to the control group (n = 28), the aerobic walking group showed significantly greater improvement in delayed recall at 24 weeks. However, aerobic walking had no significant effect on subjective cognitive complaints or brain-derived neurotrophic factor. Conclusion: The aerobic walking training significantly improved memory performance among older women with hypertension. A longer randomized controlled trial with a larger sample is necessary to confirm and further explore the effects of this intervention. [ABSTRACT FROM AUTHOR]

Introduction: Mental health is a major concern among migrant workers worldwide. More than 200,846 female migrant workers in Taiwan are from Indonesia. The study's purpose was to investigate mediating effects of coping strategies on the relationship between mental health problems and the quality of life (QoL). Method: This cross-sectional study was conducted in Taiwan. In total, 500 Indonesian female migrant workers completed four questionnaires. A mediation test was conducted to estimate direct and indirect effects. Results: Coping strategies, namely substance use, behavioral disengagement, denial, and religious dedication, partially mediated the relationship between mental health problems (depression, anxiety, and stress) and QoL among Indonesian female migrant workers in Taiwan. Discussion: Health promotion programs should be developed for Indonesian female migrant workers in Taiwan to help them detect and overcome their mental health problems. Interventions that facilitate effective coping strategies should be administered to improve their QoL. [ABSTRACT FROM AUTHOR]

Background: Patient activation has been described as a potential strategy to improve chronic disease self-management. However, the effects of patient activation interventions on psychological and behavioral outcomes have not been systematically evaluated. Purpose: This study was designed to evaluate the effects of patient activation interventions on physiological, psychological, behavioral, and health-related quality of life outcomes in patients with chronic diseases. Methods: We systematically searched four databases (PubMed, Cochrane, CINAHL, and Embase) from inception to September 1, 2017. We identified English- and Chinese-language published reports of randomized controlled trials that evaluated the effects of patient activation interventions for adults with chronic diseases. Study selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized the intervention effects with Hedges's g values and 95% confidence intervals using a random-effects model. We used the Cochrane Handbook to assess the methodological quality of the randomized controlled trials. Results: Twenty-six randomized controlled trials were included in the qualitative synthesis and meta-analysis. In terms of overall study quality, most of the included studies were affected by performance and detection bias. Patient activation interventions produced significant effects on outcomes related to physiological, psychological, behavioral, and health-related quality of life in the context of chronic diseases. The following effect sizes were obtained: (a) physiological, namely, glycated hemoglobin = −0.31 (p <.01), systolic blood pressure = −0.20 (p <.01), diastolic blood pressure = −0.80 (p =.02), body weight = −0.12 (p =.03), and low-density lipoprotein = −0.21 (p =.01); (b) psychological, namely, depression = −0.16 (p <.01) and anxiety = −0.25 (p =.01); (c) behavioral, namely, patient activation = 0.33 (p <.01) and self-efficacy = 0.57 (p <.01); and (d) health-related quality of life = 0.25 (p =.01). Conclusions: Patient activation interventions significantly improve patients' physiological, psychosocial, and behavioral health statuses. Healthcare providers should implement patient activation interventions that tailor support to the individual patients' level of patient activation and strengthen the patients' role in managing their healthcare to improve chronic-disease-related health outcomes. [ABSTRACT FROM AUTHOR]

Aim: To assess the effects of self‐management interventions on systolic blood pressure, diastolic blood pressure, self‐efficacy, medication adherence and body mass index in older adults with hypertension. Background: Effective treatment of hypertension may require the practice of self‐management behaviours. However, evidence on effects of self‐management interventions on blood pressure, self‐efficacy, medication adherence and body mass index in older adults with hypertension is lacking. Design A systematic review and meta‐analysis. Data sources: CINAHL, Cochrane Library, Embase, Ovid‐Medline, PubMed, Scopus, Web of Science and other sources were searched to October 2020. Review methods: Data were analysed using Comprehensive Meta‐Analysis 2.0 and quality assessment was done using ROB 2.0. The pooled effect sizes were reported as Hedges' g values with corresponding 95% confidence intervals using a random‐effects model. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self‐management interventions significantly decreased blood pressure and increased self‐efficacy and medication adherence in older adult patients with hypertension, with no significant effect on body mass index. Conclusions: Self‐management interventions have considerable beneficial effects in older adults with hypertension. Health care providers should implement self‐management interventions to strengthen the patient's role in managing their health. SUMMARY STATEMENT: What is already known about this topic? Current evidence suggests self‐management interventions as a potential strategy for decreasing blood pressure in patients with hypertension.There is limited evidence of the effectiveness of self‐management interventions on blood pressure, self‐efficacy, medication adherence and body mass index in older adults with hypertension. What this paper adds? Self‐management interventions can decrease systolic blood pressure, diastolic blood pressure and improve self‐efficacy and medication adherence in older adults with hypertension. The implication of this paper: Findings highlight the importance of implementing self‐management programs in older adult patients with hypertension.Health care providers should implement self‐management interventions that are tailored to the individual's level of self‐efficacy to strengthen the patient's role in managing their health care. [ABSTRACT FROM AUTHOR]

Background: In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal. Methods: This study compared the risks of mortality and cardiovascular events in insulin-treated patients adding or not adding alpha-glucosidase inhibitors (AGIs). Results: This cohort study included data from the Taiwan National Health Insurance Research Database. In total, 17,417 patients newly diagnosed as having T2DM and undergoing insulin therapy during 2000–2012 were enrolled. Overall incidence rates of all-cause mortality, hospitalized coronary artery disease (CAD), stroke, and heart failure were compared between 4165 AGI users and 4165 matched nonusers. The incidence rates of all-cause mortality were 17.10 and 19.61 per 1000 person-years in AGI nonusers and users, respectively. Compared with nonusers, AGI users had a higher mortality risk [adjusted hazard ratio (aHR) = 1.21, 95% confidence interval (CI) = 1.05–1.40; p = 0.01]. Regarding AGI use, aHRs (95% CI) for cardiovascular death, non-cardiovascular death, hospitalized CAD, stroke, and heart failure were 1.20 (0.83–1.74), 1.27 (1.07–1.50), 1.12 (0.95–1.31), 0.98 (0.85–1.14), and 1.03 (0.87–1.22) respectively. Conclusion: AGI use was associated with higher risks of all-cause mortality and non-cardiovascular death in insulin-treated patients with T2DM. Therefore, adding AGIs in insulin-treated patients may not be appropriate. [ABSTRACT FROM AUTHOR]

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self‐reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount. [ABSTRACT FROM AUTHOR]

Purpose: To explore the efficacy of community rehabilitation for facilitating daily function among patients with mental illness. Design and Methods: A quasi‐experimental design was used. Two hundred and sixty‐four participants completed a daily living function scale questionnaire and provided disease‐related information. Findings: Community rehabilitation was shown to be efficient in helping to stabilize mental illness and enhance daily function. Daily function had a significant and positive correlation with disease stability. Practice Implications: Community rehabilitation for patients with mental illness can effectively stabilize and prevent disability among those with mental illness. [ABSTRACT FROM AUTHOR]

The differences of basic attributes, health promotion behaviors, and quality of life between elderly males and females in Taiwan were compared. Several scales were used to examine the gender differences and the factors associated with quality of life. Regression analysis revealed that gender, education level, depression level, and healthy diet were key factors influencing the overall quality of life. The education level of females was lower, and their depression level was higher; however, females had healthier diets. With regards to their satisfaction in the quality of life, elderly males scored higher than females in both the physical and psychological domains. [ABSTRACT FROM AUTHOR]

The objectives of this study were to develop a cross-cultural Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ-C) and test its validity and reliability among Chinese-speaking stroke patients. Various methods were used to develop the ESDQ-C. A cross-sectional study was used to examine the validity and reliability of the developed questionnaire, which consists of 28 items belonging to six factors, anger, helplessness, emotional dyscontrol, indifference, inertia and fatigue, and euphoria. Satisfactory convergence and known-group validities were confirmed by significant correlations of the ESDQ-C with the Profile of Mood States–Short Form (p < .05) and with the Hospital Anxiety and Depression Scale (p < .05). The internal consistency was represented by Cronbach’s alpha, which was .96 and .79 to .92 for the entire scale and subscales, respectively. Appropriate application of the ESDQ-C will be helpful to identify critical adjustment-related types of distress and patients who experience difficulty coping with such distress. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, the aim of conducting the network meta-analysis (NMA) was to explore the efficacy of different exercises and their respective ranks in the context of reducing cancer-related fatigue (CRF) in women with breast cancer (BC) during the inter-treatment and post-treatment periods. We found that yoga, resistance exercise, and aerobic resistance were the top three recommended exercise modes for the purposes of reducing CRF during the inter-treatment period among women with BC; moreover, Qigong ranked last in terms of efficacy. Yoga, aerobic yoga, and aerobic resistance were the top three exercise options that should be performed in order to relieve CRF during the post-treatment period; conversely, relaxation ranked last in this respect. Aerobic plus resistance, resistance exercise, and yoga were conducted via using a supervisor, as well as short-time sessions. Objective measures are recommended in order to examine the causal relationship of vigorous exercise or yoga on physical functions. This was performed in order to obtain clarity in respect to the optimal therapeutic management strategies that will best aid with the reduction in CRF among women with BC. Context: Cancer-related fatigue (CRF) is the most common cause of physical powerlessness in women with breast cancer (BC). The practice of continuous effective exercise is beneficial with respect to reducing CRF. Objective: To explore exercise efficacy and respective ranks with respect to reducing CRF in women with BC within the inter-treatment and post-treatment periods. Methods: Throughout this systematic review and network meta-analysis, articles published from 2000 to March 2022 were included. Article searches were conducted on the MEDLINE, Embase, CINAHL, and CENTRAL databases. Adult women with BC and different exercise programs were compared with those involved in regular care as a control during or after treatment. In addition, randomized controlled trials (RCT) were also included. A risk-of-bias assessment, with the revised Cochrane risk-of-bias tool regarding RCT and probability-based ranking, was established based on the surface under the cumulative rank (SUCRA) method via network meta-analysis. Results: a total of 5747 women with BC followed seven exercise interventions. Yoga (SMD = −0.54, 95% CI [−0.86, −0.22]) was ranked first (94.5%), with significant effects in respect of mitigating CRF, followed by resistance exercise (66.2%), and aerobic resistance (63.3%), while Qigong ranked last (22.2%) among the 36 RCT in inter-treatment. Aerobic resistance exercise (SMD = −0.52, 95% CI [−0.98, −0.07]) induced significant effects in respect of mitigating CRF in the 38 RCTs in the post-treatment period. Yoga, aerobic yoga, and aerobic resistance exercise ranked as the top three (75.5%, 75.0%, and 72.4%, respectively), whereas relaxation ranked last (38.8%) in the post-treatment period. Conclusion: Yoga, aerobic resistance, and aerobic yoga are recommended for the purposes of inter- and post-treatment exercise to reduce CRF in women with BC by enhancing their physical resilience and long-term quality of life. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002–2011 using nationally representative data in China Methods: This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002–2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China's annual consumer price index. Results: The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage. Conclusion: The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs. [ABSTRACT FROM AUTHOR]

The role of allopurinol usage in colorectal cancer (CRC) has no definite conclusion. The aim of this study was to explore the correlation between allopurinol usage and CRC risk in Taiwan. Using the National Health Insurance Database, we conducted a case‐control study of cases who were ≥20 years old and had newly diagnosed CRC for the period from 2000 to 2013. The controls were matched to cases by age, sex, index year, comorbidities, and socioeconomic status using propensity scores. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were measured by the conditional logistic regression model. We examined 4372 cases and 4372 matched controls. A statistically significant correlation was noted between allopurinol usage and CRC risk (OR, 0.79; 95%CI, 0.69‐0.90). We used the cumulative‐defined daily doses (cDDDs) in a further subgroup analysis, the ORs decreased from tertile 1 (T1; low dose, <12 cDDDs), T2 (medium dose, 12 to 88.5 cDDDs), to T3 (high dose, >88.5 cDDDs). These values were 0.85 (95%CI, 0.69‐1.06), 0.77 (95%CI, 0.62‐0.95), to 0.76 (95%CI, 0.61‐0.94). The results indicated a dose‐response relationship between allopurinol usage and CRC risk (P for trend <.001). We thus inferred that patients with medium and high doses of allopurinol (≥12 cDDDs) had a statistically significantly decreased CRC risk. [ABSTRACT FROM AUTHOR]

Objective This study discusses the intervening conditions of hospital-based home care ( HBHC) for people with severe mental illness in Taiwan. Design and Sample Grounded theory of the Strauss and Corbin approach was used. Participants were selected from six hospitals in Central Taiwan, including 21 clients, 19 caregivers, and 25 professionals. Measures Semi-structured one-on-one interviews were used to collect data. Data analysis consisted of three stages: open, axial, and selective coding. Data analysis, data collection, and sampling were conducted through the constant comparative analysis process. Results Two categories were generated as positive and negative intervening conditions of HBHC services. Eight positive effects and nine negative effects were generated from the data. Conclusions Several positive and negative intervening conditions were found in this study to affect the delivery of HBHC. Government support and several limitations regarding HBHC services quality should be noticed and improved. [ABSTRACT FROM AUTHOR]

Initial 3-year results from our clinical trial in locoregionally advanced nasopharyngeal carcinoma (NPC) patients showed that induction chemotherapy (IC) with cisplatin and fluorouracil resulted in improved disease-free survival (DFS) with a marginally significant effect on distant metastasis-free survival (DMFS), but the effect of IC on locoregional relapse-free survival and overall survival (OS) did not differ significantly. Here, we present 5-year follow-up results. Our trial was a randomised, open-label phase III trial comparing IC followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone in patients with stage III-IVB (except T3N0-1) NPC. The IC followed by CCRT group received cisplatin (80 mg/m2 d1) and fluorouracil (800 mg/m2 d1-5) every 3 weeks for two cycles before CCRT. Both groups were treated with 80 mg/m2 cisplatin every 3 weeks concurrently with radiotherapy. The primary end-points were DFS and DMFS. We did efficacy analyses in the 476 randomised patients (intention-to-treat population). After a median follow-up of 82.6 months, the 5-year DFS rate was 73.4% (95% confidence interval [CI] 67.7–79.1) in the IC followed by CCRT group and 63.1% (95% CI 56.8–69.4) in the CCRT alone group (p = 0.007). The 5-year DMFS rate was also significantly higher in the IC followed by CCRT group (82.8%, 95% CI 77.9–87.7) than in the CCRT alone group (73.1%, 95% CI 67.2–79.0, p = 0.014). Our updated analysis revealed an OS benefit of IC: the 5-year OS rate was 80.8% in the IC followed by CCRT group versus 76.8% in the CCRT alone group (p = 0.040). The proportion of patients with eye damage was significantly higher in the CCRT alone group than the IC followed by CCRT group (16.4% [39/238] versus 9.7% [23/238], p = 0.029). IC followed by CCRT provides long-term DFS, DMFS and OS benefits compared with CCRT alone in locoregionally advanced NPC and, therefore, can be recommended for these patients. • IC followed by CCRT improved not only DMFS and DFS, but also OS at 5 years in patients with locoregionally advanced NPC. • The addition of cisplatin and fluorouracil induction chemotherapy did not significantly increase late toxicities. • IC followed by CCRT can be recommended for patients with locoregionally advanced NPC. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the distribution and risk factors associated with undiagnosed obstructive sleep apnoea among hypertensive patients. Background: Obstructive sleep Apnoea has been deemed a cardinal risk factor affecting cardiovascular event, and the condition is still frequently overlooked clinically. The lack of advanced diagnosis often causes hypertensive patients with obstructive sleep apnoea to miss opportunities for preventing chronic diseases. Design: A cross‐sectional design. Methods: A total of 215 hypertensive participants were recruited from the cardiovascular outpatients of medical centre in northern and middle Taiwan. The Chinese version of Pittsburgh Sleep Quality Index, the Chinese version of the Epworth Sleep Scale and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting hypertensive patients with obstructive sleep apnoea, and a multinomial logistic regression analysis was used to examine the major influence factors for each obstructive sleep apnoea severity level. Results: 81.9% of the hypertensive participants were found having obstructive sleep apnoea. Concerning to the obstructive sleep apnoea severity, 50.0% of participants had mild obstructive sleep apnoea. After controlling the confounding variables, the supine position (odds ratio, 1.04; 95% CI, 1.01–1.07), SO2 (odds ratio, 0.58; 95% CI, 0.38–0.89) and oxygen desaturation index (odds ratio, 2.70; 95% CI, 1.18–6.18) were significantly associated with obstructive sleep apnoea. Furthermore, severe obstructive sleep apnoea was significantly correlated with gender (odds ratio, 0.04; 95% CI, 0.00–0.66), excessive daytime sleepiness (odds ratio, 20.27; 95% CI, 1.58–26.97) and oxygen desaturation index (odds ratio, 4.05; 95% CI, 1.86–8.81). Conclusions: Nearly 82% of the hypertensive participants were found having undiagnosed obstructive sleep apnoea, and 80% of them were mild or moderate severity. Oxygen desaturation index, SO2 and the supine position were found to be major predictors for obstructive sleep apnoea. Remarkably, oxygen desaturation index was the most significant predictor for mild, moderate and severe obstructive sleep apnoea. Relevance to clinical practice: Healthcare providers should enhance their sensitivities to hypertensive patients at a high risk for obstructive sleep apnoea by actively assessing common obstructive sleep apnoea symptoms and providing strategies to alleviate obstructive sleep apnoea symptoms. [ABSTRACT FROM AUTHOR]

Background: Chronic asthma is characterized by airway inflammation and remodeling. Objective: This study aimed to evaluate the effects of zileuton on bronchial hyperresponsiveness, airway inflammation and airway smooth muscle (ASM) remodeling. Methods: Two experimental groups of brown Norway rats sensitized and repeatedly challenged with aerosolized ovalbumin (OA) were given oral zileuton (OA-zileuton group) and oral saline only (OA-saline group). A third, control group was sensitized and challenged by saline. The rats were anesthetized and paralyzed. Pulmonary function tests were performed at baseline and after varying doses of acetylcholine. Bronchoalveolar lavage fluid and lung tissues were examined. Results: Zileuton had beneficial effects on pulmonary function, airway inflammation and ASM remodeling in the OA-zileuton group compared to the OA-saline group. Zileuton inhibited an OA-stimulated increase in ASM by inhibiting hypertrophy, hyperplasia and increased extracellular matrix via the phosphatidylinositol 3-kinase (PI3K)/Akt pathway, thereby reducing cyclin D1 expression and attenuating bronchial hyperresponsiveness. Conclusion: OA increases airway inflammation and ASM mass. Zileuton effectively prevents bronchial hyperresponsiveness, airway inflammation and ASM remodeling in sensitized rats through the PI3K/Akt pathway, which reduces cyclin D1 expression. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Culture serves as an adhesive to bind the lives of people. There are no objective, useful tools to assess cultural competence and practice. In this study, we evaluated whether the cultural competence of nurses was strengthened through the Cultural Competence Cultivation Programme. Methods: A quasi-experimental research design was used to evaluate nurses working at a medical centre in Taiwan. They were randomly allocated into an experimental group (n = 47), which received the Cultural Competence Cultivation Programme, or a control group (n = 50), which did not receive the educational programme. After the intervention, learning efficacy of the participants was assessed using an Objective Structured Clinical Examination (OSCE). The research data were statistically analysed on SPSS. Results: The average score of the experimental group was significantly higher in the 'communication ability and skill' category. Furthermore, OSCE scores and Standardised Patient Survey assessment and total scores were significantly and positively correlated. Conclusion: The findings of this study can serve as a reference for designing future clinical education programmes. [ABSTRACT FROM AUTHOR]