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Background Conventional healthcare professionals have insufficient knowledge about complementary/alternative medicine (CAM) and often lack competencies to overcome attitudinal barriers to communicate effectively with patients about CAM. Interacting with a virtual simulation-based educational application program may help nurses learn current evidence and acquire communication skills when consulting with patients. Objectives The aim of this pilot study was to evaluate nurses' attitudes towards patients' CAM use and their competency in communicating with patients about CAM after interacting with a virtual simulation-based educational app. Design A quasi-experimental study with one-group, pretest-posttest design. Methods A total of 49 nurses volunteered to participate in the study. Participants interacted with a virtual simulation software app on a smartphone that included audiovisual presentations about CAM, 13 exercises, and a risk-benefit decision assessment. Data about nurses' attitudes and communication competency were collected at baseline and after completing the 13 exercises. Descriptive and comparative statistics were analyzed using the IBM® SPSS® version 22.0. Results Both the nurses' attitudes about patients' CAM use and communication competency improved significantly following the completion of the 13 exercises. The risk-benefit decision scores correlated significantly with the increase in nurses' attitudes and their communication competency. Conclusions Using a virtual simulation-based educational app may help nurses not only increase their attitudes towards CAM but also increase their communication competency in consulting with patients about CAM use.

There have been no reports on the association of hyperthyroidism with hyperlipidemia in patients undergoing treatment especially in Asia. To determine the association between hyperthyroidism and the risk of hyperlipidemia in patients, we conducted a retrospective cohort study using Longitudinal Health Insurance Database (LHID) from Taiwan, R.O.C. We also evaluate the influence of 6-n-propyl-2-thiouracil (PTU) and methimazole (MMI) on hepatic genes to explain changes in blood lipid levels in a hepatic cell line model. The cohort study involved 13,667 patients with hyperthyroidism, and the corresponding comparison cohort had four times as many patients. Using Kaplan-Meier analysis method, the results showed that, compared to patients without hyperthyroidism, the overall incidence of hyperlipidemia was significantly higher in the hyperthyroidism patients (18.7 vs. 11.8 cases/1,000 persons-years; adjusted HR 1.5; 95% CI, 1.41-1.59). With only PTU or MMI/carbimazole (CBM) treatment, patients with hyperthyroidism showed a 1.78-fold (95% CI, 1.50-2.11) and 1.43-fold (95% CI, 1.27-1.60) higher risk of hyperlipidemia than those without hyperthyroidism, respectively. Additionally, hyperthyroidism patients that received surgery only or surgery with I131 therapy tended to have a higher risk of hyperlipidemia. Although PTU and MMI treatment decreased the expression levels of genes responsible for circulating remnant lipoproteins, they increased the levels of lipogenic gene expression in hepatic cells. Thus, treatment of hyperthyroid patients with anti-thyroid drugs (ATDs), I131, or surgery is likely to induce hyperlipidemia. ATDs downregulate the expression of genes involved in lipoproteins clearance; increases lipogenic genes expression, which may partly contribute to abnormal blood lipid profiles.

Nonalcoholic fatty liver disease (NAFLD) is a very common liver disease, and its incidence has significantly increased worldwide. The liver X receptor α (LXRα) is a multifunctional nuclear receptor that controls lipid homeostasis. Inhibition of LXRα transactivation may be beneficial for NAFLD and hyperlipidemia treatment. Ursolic acid (UA) is a plant triterpenoid with many beneficial effects; however, the mechanism of its action on LXRα remains elusive. We evaluated the effects of UA on T0901317 (T090)-induced LXRα activation and steatosis. UA significantly decreased the LXR response element and sterol regulatory element-binding protein-1c ( SREBP-1c) gene promoter activities, mRNA, protein expression of LXRα target genes, and hepatic cellular lipid content in a T090-induced mouse model. A molecular docking study indicated that UA bound competitively with T090 at the LXRα ligand binding domain. UA stimulated AMP-activated protein kinase (AMPK) phosphorylation in hepatic cells and increased corepressor, small heterodimer partner-interacting leucine zipper protein (SMILE) but decreased coactivator, steroid receptor coactivator-1 (SRC-1) recruitment to the SREBP-1c promoter region. In contrast, UA induced SRC-1 binding but decreased SMILE binding to reverse cholesterol transport-related gene promoters in intestinal cells, increasing lipid excretion from intestinal cells. Additionally, UA reduced valproate-induced LXRα mediated and rifampin-induced pregnane X receptor mediated lipogenesis, offering potential treatments for drug-induced hepatic steatosis. Thus, UA displays liver specificity and can be selectively repressed while RCT stimulation by LXRα is preserved and enhanced. This is a novel therapeutic option to treat NAFLD and may be helpful in developing LXR agonists to prevent atherosclerosis.

Liver X receptor α (LXRα) controls important biological and pathophysiological processes such as lipid homeostasis. Inhibiting LXRα transactivation may beneficial in the treatment of nonalcoholic fatty liver disease (NAFLD), which is one of the main causes of liver diseases and hyperlipidemia. Oleanolic acid (OA) is a naturally occurring triterpenoid found in many plants. It has several beneficial effects on biological pathways; however, the mechanisms underlying its effects on LXRα are unclear. Therefore, we evaluated the effects of OA on T0901317-induced LXRα activation and explored whether OA can attenuate hepatic lipogenesis. The results showed that OA significantly decreased the promoter activities of LXR response element and sterol regulatory element binding protein-1c (SREBP-1c). It also decreased the mRNA and protein expression of LXRα target genes. These resulted in reduced hepatocellular lipid content. Our results also revealed that the overall binding pose of OA is similar to the X-ray pose of T0901317. Furthermore, OA stimulated AMP-activated protein kinase phosphorylation in hepatic cells. Additionally, it increased small heterodimer partner-interacting leucine zipper protein (SMILE) but decreased steroid receptor coactivator-1 (SRC-1) recruitment to the SREBP-1c promoter region. OA also enhanced LXRα-mediated induction of reverse cholesterol transport (RCT)-related gene, ATP-binding cassette transporter (ABC) A1, and ABCG1 expression in intestinal cells. It was found that OA increased the binding of SRC-1 but decreased SMILE recruitment to the ABCG1 gene promoter region. Furthermore, it reduced valproate- and rifampin-induced LXRα- and pregnane X receptor-mediated lipogenesis, respectively, which indicates its potential benefit in treating drug-induced hepatic steatosis. The results also show that OA is liver-specific and can be selectively repressed of lipogenesis. Moreover, it preserves and enhances LXRα-induced RCT stimulation. The results show that OA may be a promising treatment for NAFLD. Additionally, it can be used in the development of LXRα agonists to prevent atherosclerosis.

This study investigated the effects of rowing with different seat cushion and cadence conditions on oxyhemoglobin (O2Hb) and total hemoglobin (tHb) levels of the erector spinae (ES) as well as the effects on heart rate (HR) and ratings of perceived exertion (RPE). Thirty healthy adults completed tests under three unstable air seat cushion pressure levels (0, 80, and 140 mmHg) and three rowing cadences (slow: 18 bpm, medium: 30 bpm, and fast: 36 bpm) on a rowing machine, for a total of nine test conditions. During the exercise period, rowing on cushions set to 80 mmHg resulted in greater O2Hb and tHb changes than did rowing at 0 mmHg (p &lt, 0.05). When rowing cadence increased, the O2Hb and tHb decreased during the exercise period, whereas HR and RPE increased (p &lt, 0.05). During the recovery period, O2Hb and tHb on cushions set to 140 mmHg during slow rowing were higher than those at 0 mmHg during slow rowing and 140 mmHg during fast rowing (p &lt, 0.05). Rowing on an appropriate pressure of seat cushion and using a slow cadence contribute to increasing muscle oxygenation of low back during exercise.

Supplemental Digital Content is available in the text, Background: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. Methods: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. Results: The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ± 25.22 to 41.24 ± 21 48 (P = .015) in CAI group after medial wedge intervention. Conclusion: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.

To evaluate the effectiveness of a mobile health (mHealth) application, based on self-regulation theory, on patients' knowledge of wound care, skills in changing dressings and anxiety.A prospective randomized controlled trial.Seventy patients (or family members) at a 1,500-bed university hospital in Taiwan were randomized into an experimental (N = 35) or control group (N = 35) from March to December 2016. The experimental group used a mHealth application for wound care; the control group received verbal instructions and a booklet. Instruments to collect data were a wound care knowledge scale, wound care skills scale, State-Trait Anxiety Inventory, and a digital heart variability device. Data were collected at baseline, after three additional demonstrations and before discharge. The generalized estimating equation was used for statistical analysis.The experimental group showed significantly higher levels of wound care knowledge, improved wound care skills, lower levels of state anxiety, and lower heart rate variability than the control group after baseline data collection.Results support hat a mHealth application may be effective in health education. Clinicians can use the results to promote patients' wound care knowledge, enhance their wound care skills, and reduce anxiety related to dressing changes.Lack of wound care knowledge and skills can affect the willingness and ability to perform effective wound dressing changes, producing anxiety and having an impact on a patient's self-care after hospital discharge. mHealth applications (apps) have the potential to deliver health information in targeted and tailored ways that strengthen the self-management of diseases. mHealth app can increase wound care knowledge, improve care skills, and reduce anxiety related to wound care. mHealth app effectively supports self-monitoring of the wound healing process, self-judgement of the wound condition, and self-reaction of wound care accuracy. mHealth app provides step-by-step visual tutorials on wound care that allow patients and family caregivers to take pictures of the wounds and monitor the wound healing process. mHealth app for wound care knowledge is an effective and individualized method for learning.This study was registered by U.S. National Library of Medicine, ClinicalTrials.gov (ID: NCT03683303).目的: 基于自我调节理论,评估移动医疗(mHealth)应用程序对患者伤口护理知识、换药技能和焦虑程度的作用。 设计: 一项前瞻性随机对照试验 方法: 2016年3月至2016年12月,台湾一所拥有1,500张床位的大学附属医院的70名患者(或家属)被随机分为实验组(N = 35)或对照组(N = 35)。实验组使用移动医疗(mHealth)应用程序申请进行伤口护理;对照组收到口头指示和小册子。数据采集工具包括伤口护理知识量表、伤口护理技能量表、状态特质焦虑问卷和数字式心率变异装置。数据收集时间点是治疗前的基础值、三次额外演示后和出院前。采用广义估计方程进行统计分析。 结果: 在进行基础数据收集之后,实验组的伤口护理知识水平、伤口护理技能改善情况、状态特质焦虑水平和心率变异性均显著高于对照组。 结论: 研究结果支持移动医疗(mHealth)应用程序在健康教育中的有效性。临床医生可利用这些结果来加强患者的伤口护理知识,提高他们的伤口护理技能,降低与换药相关的焦虑。 影响: 缺乏伤口护理知识和技能会影响患者进行有效伤口换药的意愿和能力,使患者产生焦虑,并影响患者出院后的自我护理。移动医疗(mHealth)应用程序(apps)有可能提供具有针对性的定制化健康信息,从而加强患者对疾病的自我管理。移动医疗(mHealth)应用程序可以增加患者的伤口护理知识,提高护理技能,降低与伤口护理相关的焦虑。移动医疗(mHealth)应用程序可有效支持伤口愈合过程的自我监控、伤口状况的自我判断以及伤口护理准确性的自我反应。移动医疗(mHealth)应用程序可提供有关伤口护理的分步式可视化教程,允许患者和家庭护理提供者拍摄伤口照片并监控伤口愈合过程。移动医疗(mHealth)伤口护理知识应用程序是一种有效的个性化学习方法。 临床试验: 该研究在美国国立医学图书馆ClinicalTrials.gov注册(编号:NCT03683303)。.

Alteration of elbow range of motion (ROM) has been observed in baseball pitchers. This study aims to compare dominant elbow ROM between early-puberty, late-puberty, and young-adult pitchers.We recruited 62 pitchers, consisting of 17 early-puberty (mean age 13.1 years old), 22 late-puberty (mean age 17.7 years old), and 23 young-adult players (mean age 19.4 years old). Dominant elbow ROMs was measured. One-way ANOVA was used to compare the differences in elbow ROM variables between 3 groups.Late-puberty pitchers exhibited a significantly lower elbow hyperextension and flexion than early-puberty or young-adult pitchers (P .05). Valgus angle was significantly lower in young-adult (7.7°±5.5°) versus early-puberty (12.1°±2.3°) and late-puberty pitchers (13.0°±4.1°; P .05). Young-adult pitchers had the largest forearm supination range (101.2°±18.1°), followed by early-puberty (82.5°±6.5°; P .05) and late-puberty pitchers (70.6°±15.8°). Elbow flexion-hyperextension total range was smallest in late-puberty pitchers (130.3°±7.4°), followed by young-adult (142.6°±9.3°) and early-puberty pitchers (144.6°±8.3°; P .05). Forearm pronation-supination total range was also smallest in late-puberty pitchers (142.0°±20.3°), followed by early-puberty (159.8°±9.5°) and young-adult pitchers (177.2°±20.8°; P .05).These results indicate that careful monitoring of the elbow and forearm range of motion should be undertaken in adolescent baseball pitchers to prevent and or minimize injury risk.

BACKGROUND This study was to investigate the effects of prophylactic Kinesio taping and athletic taping on the functional performance of the lower extremities in healthy collegiate players with tapes applied to the dominant leg. METHODS The study design was a prospective, randomized, clinical trial with comparison of groups. The 32 healthy collegiate players who participated in this study were randomly assigned to 2 groups, an athletic taping group and a Kinesio taping group. Active range of motion of ankle joint, ankle plantar-flexor strength, endurance, vertical jump performance, and dynamic balance were used to measure the player's functional performance of the lower extremities. These tests were conducted 2 times at 4-hour intervals before and after different tapes were applied. The repeated measures analysis of variance was used to examine the interaction in functional performance between the groups before and after the tapes applied. RESULTS The results found less limitation of range of motion in active ankle dorsiflexion and significant improvement in dynamic balance in the Kinesio taping group (F=5.150, P=0.031, F=18.766, P

Aims and objectives This study reviewed existing literature to investigate how frequently nurses include complementary and alternative forms of medicine in their clinical practice. In so doing, we investigated nurses' knowledge of and attitudes towards complementary and alternative medicine as well as their ability to communicate the risks and benefits of these therapies with patients. Background Little information is available concerning nurses' knowledge and attitudes towards complementary and alternative medicine or how they incorporate these therapies into their practice. In addition, little is known about the ability of nurses to communicate the risks and benefits of complementary and alternative medicine to their patients. Study design This study used a scoping review method to map and synthesise existing literature. Data sources Both electronic and manual searches were used to identify relevant studies published between January 2007 and January 2014. Review methods The review was conducted in five stages: (1) identification of research question(s), (2) locate studies, (3) selection of studies, (4) charting of data, and (5) collating, summarising, and reporting of results. Results Fifteen papers met the inclusion criteria for this review, among which 53·7% referenced how frequently nurses include complementary and alternative medicine in their practice. We found that 66·4% of nurses had positive attitudes towards complementary and alternative medicine; however, 77·4% did not possess a comprehensive understanding of the associated risks and benefits. In addition, nearly half of the respondents (47·3–67·7%) reported feeling uncomfortable discussing complementary and alternative medicine therapies with their patients. Conclusion The lack of knowledge about complementary and alternative medicine among nurses is a cause for concern, particularly in light of its widespread application. Relevance to clinical practice Findings from this study suggest that health care professionals need to promote evidence informed decision-making in complementary and alternative medicine practice and be knowledgeable enough to discuss complementary and alternative medicine therapies. Without involvement of complementary and alternative medicine communication on the part of our profession, we may put our patients at risk of uninformed and without medical guidance.

Aims To investigate the effects of threshold inspiratory muscle training (IMT) in patients with stages II through IV chronic obstructive pulmonary disease (COPD) using maximum inspiratory pressure (PImax), baseline dyspnoea index (BDI), 6-minute walk test (6MWT), and quality of life (QoL). Background A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. Design Randomized experimental design Methods A total of 55 patients completed this study between September 2013 and April 2014. The experimental group (n=27) was provided medical treatment and routine care, along with five sessions of threshold IMT per week (21-30 minutes per session), accompanied by a progressive increase in the pressure threshold over a period of eight weeks. The control group (n=28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values

Objective: To illustrate the experiences and perceived benefits of healing yoga as described by patients with breast cancer participating in a healing yoga program. Methods: The qualitative research with naturalistic design was conducted after the completion of an 8 weeks healing yoga program. A total of 11 breast cancer women with adjuvant chemotherapy were interviewed using the semi-structured interview guidelines. Findings: Participants expressed their experiences of healing yoga, including transforming concern to confidence, regaining a sense of belonging, gaining experience and satisfaction, and leading the way for life, were critical in developing these benefits. The perceived benefits of participating in this program was described as positive mental support, promoted a mind-body interaction and provided benefits ascribed to social activities, leading to a reported increase in active participation in life. Conclusion: This study gives support for the positive experiences of healing yoga among patients with a breast cancer. The objective effect of the healing yoga must be examined further to guide nurses in implementing suitable health promotional strategies for breast cancer patients.

Compared with regulation-weight baseballs, lightweight baseballs generate lower torque on the shoulder and elbow joints without altering the pitching movement and timing. This study investigates the throwing accuracy, throwing velocity, arm swing velocity, and maximum shoulder external rotation (MSER) of adolescent players after 10 weeks of pitching training with appropriate lightweight baseballs. We assigned 24 adolescent players to a lightweight baseball group (group L) and a regulation-weight baseball group (group R) based on their pretraining throwing velocity. Both groups received pitching training 3 times per week for 10 weeks with 4.4- and 5-oz baseballs. The players' throwing accuracy, throwing velocity, arm swing velocity, and MSER were measured from 10 maximum efforts throws using a regulation-weight baseball before and after undergoing the pitching training. The results showed that the players in group L significantly increased their throwing velocity and arm swing velocity (p0.05) after 10 weeks of pitching training with the 4.4-oz baseball, whereas group R did not (p0.05). Furthermore, the percentage change in the throwing velocity and arm swing velocity of group L was significantly superior to that of group R (p0.05). Thus, we concluded that the 10 weeks of pitching training with an appropriate lightweight baseball substantially enhanced the arm swing velocity and throwing velocity of the adolescent baseball players. These findings suggest that using a lightweight baseball, which can reduce the risk of injury without altering pitching patterns, has positive training effects on players in the rapid physical growth and technique development stage.

Background Adolescent tennis players require sufficient hip and shoulder flexibility to achieve the kinetic chain of a tennis stroke or serve. Hence, the objective of this study is to measure the glenohumeral joint internal and external rotation (IR and ER, respectively) and hip ER range of motion (ROM) and to compare these parameters between experienced and beginner-level adolescent tennis players. Methods Twenty-three adolescent tennis players were divided into experienced (N.=12) and beginner groups (N.=11) on the basis of the adolescent national ranking of the Taiwan Tennis Association. For all participants, the shoulder IR and ER at 90° of abduction were measured, and hip ER which used Partick's Test was also evaluated on the dominant and nondominant sides. The total rotation ROM of the shoulder and the difference in shoulder ER, IR, and total rotation and hip ER between the dominant and nondominant sides were also calculated after measurements. An independent-samples t-test was applied to test the homogeneity of the participants' demographic data and the difference in shoulder IR, ER, and total rotation and hip ER values between the dominant and nondominant sides. Subsequently, a repeated-measured two-way analysis of variance (2 × 2) was used to compare the dominant and nondominant shoulder and hip ROM of the participants between the experienced and beginner groups. Results The experienced group exhibited a significantly less total rotation ROM than the beginner group. In addition, both groups showed less dominant shoulder IR ROM and more dominant shoulder ER ROM compared with the nondominant side. Compared with the experienced group, the beginner group showed an obvious difference in total shoulder rotation between dominant and nondominant sides. More tightness for the hip ER was observed in the experienced group than in the beginner group, but no difference was observed between the dominant and nondominant sides in both groups. Conclusions Beginner adolescent tennis players differ more in the degree of total shoulder ROM between the dominant and nondominant sides than experienced players. Beginner and experienced adolescent tennis players also have more shoulder ER and less IR on the dominant side. The results suggest that beginner-level adolescent tennis players should undergo a stretching and strengthening program to reduce the potential risk of injury and possibly enhance performance.

Rhythmic gymnasts specialise in dynamic balance under sensory conditions of numerous somatosensory, visual, and vestibular stimulations. This study investigated whether adolescent rhythmic gymnasts are superior to peers in Sensory Organisation test (SOT) performance, which quantifies the ability to maintain standing balance in six sensory conditions, and explored whether they plateaued faster during familiarisation with the SOT. Three and six sessions of SOTs were administered to 15 female rhythmic gymnasts (15.0 ± 1.8 years) and matched peers (15.1 ± 2.1 years), respectively. The gymnasts were superior to their peers in terms of fitness measures, and their performance was better in the SOT equilibrium score when visual information was unreliable. The SOT learning effects were shown in more challenging sensory conditions between Sessions 1 and 2 and were equivalent in both groups; however, over time, the gymnasts gained marginally significant better visual ability and relied less on visual sense when unreliable. In conclusion, adolescent rhythmic gymnasts have generally the same sensory organisation ability and learning rates as their peers. However, when visual information is unreliable, they have superior sensory organisation ability and learn faster to rely less on visual sense.

Objectives To determine the immediate effects of applied forearm Kinesio taping on maximal grip strength and force sense of healthy collegiate athletes. Design Single group, repeated measures study. Setting Clinical sports medicine laboratory at a university hospital. Participants Twenty-one healthy collegiate athletes voluntarily participated in this study. All subjects were male (average height: 181.24 ± 7.60 cm; average body weight: 72.86 ± 7.03 kg; average age: 20.86 ± 2.59 years). Main Outcome Measures First, maximal grip strength of the dominant hand was assessed by hand-held dynamometer. Then, 50% of maximal grip strength was established as the reference value of force sense. Absolute and related force sense errors and maximal grip strength were measured under three conditions: (1) without taping; (2) with placebo taping; and (3) with Kinesio taping. Results Results revealed no significant differences in maximal grip strength between the three conditions ( p = 0.936). Both related and absolute force sense errors in grip strength measurements significantly increased the accuracy of the results under the three conditions (related force sense errors: p p Conclusion Forearm Kinesio taping may enhance either related or absolute force sense in healthy collegiate athletes. However, Kinesio taping did not result in changes in maximal grip strength in healthy subjects.

Context:Fatigue of the shoulder rotator muscles may negatively affect joint position sense (JPS) and ultimately lead to injury.Objective:Recovery of shoulder JPS after muscle fatigue.Design:A repeated-measures study.Setting:Musculoskeletal research laboratory.Patients:Thirteen subjects participated in joint position error tests and isokinetic concentric strength assessment in shoulder rotation, before and after rotator muscle fatigue.Interventions:Local muscle fatigue was induced using isokinetic concentric contractions of the shoulder rotator muscles.Main Outcome Measurements:Shoulder rotator strength and JPS error signals were measured before fatigue, immediately after fatigue, and every ten minutes thereafter for one hour.Results:Before shoulder rotation muscle fatigue, the accuracy of shoulder JPS was 2.79 ± 1.67 degrees. After muscle fatigue, the accuracy decreased to 6.39 ± 2.90 degrees. Shoulder JPS was influenced up to 40 minutes after muscle fatigue, but shoulder strength was only affected for 10 minutes after muscle fatigue.Conclusions:Proprioceptive recovery was slower than strength following fatigue of the shoulder rotators.

OBJECTIVE To test the hypothesis that recreational tennis players transmit more shock impact from the racket to the elbow joint than experienced tennis players during the backhand stroke. Also, to test whether recreational tennis players used higher electromyographic (EMG) activities in common wrist extensor and flexor around epicondylar region at follow-through phase. DESIGN A repeated-measure, cross-sectional study. SETTING National College of Physical Education and Sports at Taipei, Taiwan. PARTICIPANTS Twenty-four male tennis players with no abnormal forearm musculoskeletal injury participated in the study. According to performance level, subjects were categorized into 2 groups: experienced and recreational. MAIN OUTCOME MEASUREMENTS Impact transmission and wrist extensor-flexor EMG for backhand acceleration, impact, and follow-through phases were recorded for each player. An independent t test with a significance level of 0.05 was used to examine mean differences of shock impact and EMG between the 2 test groups. One-way ANOVA associated with Tukey multiple comparisons was used to identify differences among different impact locations and EMG phases. RESULTS Experienced athletes reduced the racket impact to the elbow joint by 89.2%, but recreational players reduced it by only 61.8%. The largest EMG differences were found in the follow-through phase (P

This study compared the strength and endurance of shoulder internal rotators (IR) and external rotators (ER) among baseball pitchers of four age levels. Eighty baseball pitchers aged 10-23 years participated this study. Strength was assessed by the average peak torque of the middle 3 out of 5 repetitions. Endurance was assessed by thirty concentric internal and external contractions. Percentage of strength loss, initial and final torque ratio were used to assess endurance ability. The results showed that IR strength was greater than the ERs for all groups. The ER/IR ratio ranged 0.71-0.77. In endurance assessment, the players were found to have 70% strength loss in the IRs. Adolescent and pre-pubescent players had larger ( p< 0.05) strength loss in the ERs. Compared with adult pitchers, adolescent and pre-pubescent baseball pitchers had relatively weaker shoulder ERs especially after high repetition muscle contraction. In order to prevent shoulder injury in adolescent and pre-adolescent baseball throwers, muscle endurance in ER should be emphasized.

Sedentary work is a common work style in modern society. Many studies show that sitting for a long time may diminish physical activity level and cause muscle pain, low back pain or even cardiovascular disease and high blood pressure. To improve the muscle strength of sedentary people, the study developed a training exercise for core muscles and lower limb muscles. Infrared sensors and electromyography (EMG) extracting circuit were used to record the subjects' EMG. Meanwhile, Median Frequency (MDF) and muscle Electromyographic Activity (EA) were applied to analyze the fatigue status of muscles and prevent muscle damage caused by excessive exercise.

The study was to investigate relation between tennis serving techniques and shoulder joint muscles in various skilled players in Taiwan. The study used Micro FET3 (Digital Manual Muscle Dynamometer and Goniometer) which appraised the isometric capacity of the shoulder joint and perimeter muscle. The research consists of 13 collegiate male tennis players; 6 players were in elite groups and the other 7 players were in general groups. The tennis players performed 30 servers testing the range to appraise serve technique reflect. The application of t-test and Linear Regression analyzed the serve technique reflect interrelated with the shoulder joint muscle. The muscle strength and the serve accuracy predominate interrelated place where middle trapezius, shoulder internal rotator, and shoulder external rotator of favor hands were obvious. The muscle strength and the serve speed predominated interrelated place where shoulder internal rotator and shoulder external rotator of favor hands were obvious. This study also discovered triceps of favor hands, shoulder extensor, shoulder abductor, triceps, and middle trapezius of non- favor hands muscle strength didn't have any outstanding reference with tennis league table. The research confirmed that the shoulder joint muscle discipline increased shoulder internal rotator, shoulder external rotator, and middle trapezius that help the serve technique reflect.

Background There is little understanding of the reasons for the limited communication between patients and conventional healthcare professionals regarding patients’ use of complementary and alternative medicine (CAM). The purpose of this study is to explore the predictors of outpatients’ decision to disclose their use of natural products to conventional healthcare professionals. Methods A mixed method design was used. Quantitative data were obtained through a survey and qualitative data were obtained from semi-structured interviews. A total of 257 outpatients who fulfilled the criteria of having used natural products prior to the interview were recruited for this study. Subsequently, 39 patients of those who completed the survey were further selected to take part in an in-depth qualitative interview. Results Predictors of the decision to disclose the use of natural products to conventional healthcare professionals included age, frequency of clinic visits, knowledge of the natural products and the attitude towards the benefits of CAM use. The themes that emerged from the qualitative data included safeness of the natural products, consulting alternative sources of information, apprehension regarding the development of negative relationships with healthcare professionals and reactions from the healthcare professionals. Conclusions Understanding the factors and reasons affecting patients’ decision as to whether to disclose their use of natural products provides an opportunity for conventional healthcare professionals to communicate better with patients. It is important to encourage patients to disclose their use of natural products in order to provide responsible health care as well as increasing patient safety regarding medication usage.

Chun-Ming Chang,1,* Yen-Ching Chang,2,3 Hsiao-Yun Chang,4 Li-Wei Chou5,6,* 1Department of Applied Informatics and Multimedia, Asia University, Taichung, Taiwan; 2Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan; 3Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; 4Department of Biotechnology, Asia University, Taichung, Taiwan; 5Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 6School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workBackground: Increases in the aging population and in the number of accidents have resulted in more people suffering from physical impairments or disabilities. Rehabilitation therapy thus attracts greater attention as a means of helping patients recover and return to a normal life. With the extremely long and tedious nature of traditional rehabilitation, patients are reluctant to continue the entire process, thus the expected effects of the therapy cannot be obtained. Games are well known to help patients improve their concentration and shift their attention away from the discomfort of their injuries during rehabilitation. Thus, incorporating game technology into a rehabilitation program may be a promising approach.Methods: In this study, a gaming system used for shoulder rehabilitation was developed. The mechanical parts and electric circuits were integrated to mimic the functionalities of a shoulder wheel. Several games were also designed to suit the rehabilitation needs of the patients based on the age and gender differences among the individual users, enabling individuals to undergo the rehabilitation process by playing games. Two surveys were conducted to evaluate the satisfaction of the participants regarding the gaming system.Results: The results of the online survey among a larger population coincide with the responses of the hands-on participants through a paper-and-pencil survey. Statistical results suggest that the participants are willing to accept this novel approach.Conclusion: This gaming system can distract a patient from the sensation of pain or anxiety, and increase their motivation to participate in the therapeutic program. Advantages in terms of low-cost and easy setup increase the attractiveness of this new equipment for various potential users.Keywords: virtual reality, virtual rehabilitation, shoulder wheel, game design