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Syllable-final nasals /n/ and /ŋ/ in Taiwan Mandarin have been reported to be undergoing merging. Perceptual studies have reported that the alleged merging is context-sensitive and the merging directions are vowel-dependent. These findings have been mostly attributed to dialectal and social factors. The current study uses ultrasonography to capture postures of the entire tongue during the production of syllable-final nasals. The results, though confirming previous findings that the merging directions of syllable-final nasals are vowel-dependent, are best accounted for by the biomechanics of the tongue, as supported by computational 3D model simulations. Furthermore, for some speakers, although nasals were merged in terms of tongue posture, the degrees of nasalization of the preceding vowel were contrastive, suggesting that the merging process may be incomplete. [ABSTRACT FROM AUTHOR]

As international students, they need to adapt and learn new experiences in a foreign country quickly; this ability is instrumental in increasing their global awareness. This research is a quantitative study using descriptive statistical analysis and hypothesis testing using ANOVA. The ANOVA test is used to determine the effect of gender and college on global awareness which consists of Critical Thinking, Global Awareness, Information Literacy Self-efficacy, Communication and Teamwork. A student's characteristics are not only influenced by the classroom environment and the university environment but the person who is formed over the years before entering the new ecosystem. [ABSTRACT FROM AUTHOR]

Aims: To study the future outcomes and health needs of chronic hepatitis C (CHC) patients after receiving direct-acting antiviral (DAA) therapy based on the health promotion perspectives and cardiometabolic risks in a rural setting. Design: This cross-sectional study was conducted from May to December 2019 in coastal western and southern Taiwan. Methods: We included CHC patients who were diagnosed and transferred by the gastroenterologist and hepatologist in outpatient clinics and completed DAA treatments. Data on demographic characteristics, health-related behaviours and physiological biomarkers were collected through one-on-one interview using a questionnaire and from medical records obtained from a teaching hospital. Results: In total, 124 participants were enrolled. Most participants (87.1%) had no side effects and 79.8% felt satisfied after treatment. However, 62.1% had metabolic syndrome, 48.4% had hypertension and 37.9% had diabetes. Furthermore, 71.8% patients were considered to have medium-to-high risk based on Framingham risk scores. In the multiple regression model, after adjusting for education level, other chronic diseases were negatively associated with health-promoting behaviours in participants. Conclusions: Although there were few side effects and most patients were satisfied after treatment, there was a high prevalence of cardiometabolic risk factors and cardiometabolic diseases and less adoption of healthy behaviours in CHC patients. Despite the small sample size, the study suggests that clinicians can reduce the burden of the aforementioned comorbidities by providing adequate treatment and individualized lifestyle modification. Impact: This study highlights that primary healthcare providers should consider the health needs of CHC patients after DAA treatment since many patients have high cardiometabolic risks, but only a few adopt a healthy lifestyle. Further studies are needed to initiate health-promoting programs for these patients to reduce further injury to vital organs. [ABSTRACT FROM AUTHOR]

Background: Urinary catheters (UCs) with a closed urinary drainage system have been widely used in patients for many years. However, the frequency of replacing and operating these devices may be associated with catheter-associated urinary tract infection (CAUTI). Purpose: This study was designed to compare the incidence of CAUTI by replacement time (every 14 or ≥ 15 days) of the urinary drainage system. Methods: This 1-year prospective, nonrandomized controlled study was conducted in a major teaching hospital. The Transparent Reporting of Evaluations with Nonrandomized Designs Statement checklist was used. All of the patients with UCs were divided into two groups based on each patient's preference with regard to replacement time of the urinary drainage system. Results: Five hundred sixty-two patients were evaluated, and 341 patients with UCs were enrolled as participants in the study. In the per-protocol analysis, 16 patients (22.2%; 9.3 episodes/ 1,000 catheter-days) in the 14-day group and 15 patients (17.9%; relative risk = 1.24, 95% confidence interval [0.66, 2.34]) in the ≥ 15-day group (7.7 episodes/1,000 catheter-days; incidence density ratio 1.20, 95%confidence interval [0.60, 2.43]) had CAUTIs. A comparison of cleanliness within urinary bags showed no significant intergroup difference (p > .05). In the intention-to-treat analysis, the incidence of CAUTI between the two groups was also not significantly different (p > .05). Conclusions: No statistically significant difference in the incidence of CAUTI was identified between patients who used the 14-day replacement interval and those who used the ≥ 15-day replacement interval for their urinary drainage system. [ABSTRACT FROM AUTHOR]

Purpose: Secondary prevention of coronary artery disease, self‐management behavior, and blood pressure control are important to cardiovascular event prevention and promotion of quality of life (QOL), but they are underutilized. The purpose of this study was to investigate the effects of a self‐efficacy theory–based health information technology intervention implemented through blood control and patient self‐management. Design: A clinical randomized waitlist‐controlled trial. Methods: The study was conducted at a medical center in Taipei, Taiwan. A total of 60 subjects were randomly assigned to either the immediate intervention (experimental) group or the waitlist control group. The primary endpoint was systolic blood pressure at 3 months; secondary end points included self‐management behavior and QOL. Treatment for the immediate intervention group lasted 3 months, while the waitlist control group received routine care for the first 3 months, at which point they crossed over to the intervention arm and received the same intervention as the experimental group for another 3 months. Both groups were evaluated by questionnaires and physiological measurements at both 3 and 6 months postadmission. The results were analyzed using generalized estimating equations. Results: Systolic blood pressure significantly improved for the intervention group participants at 3 months, when there was also significant improvement in self‐management behavior and QOL. There was no significant or appreciable effect of time spent in the waitlist condition, with treatments in the two conditions being similarly effective. Conclusion: The use of a theory‐based health information technology treatment compared with usual care resulted in a significant improvement in systolic blood pressure, self‐management behavior, and QOL in patients with coronary artery disease. Clinical Relevance: This treatment would be a useful strategy for clinical care of cardiovascular disease patients, improving their disease self‐management. It also may help guide further digital health care strategies during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Aim: This study was designed to investigate the longitudinal effect of participating in a self‐management program (SMP) on renal function control in patients receiving hemodialysis. Methods: This randomized controlled trial enrolled a total of 58 patients at the hemodialysis center of a teaching hospital in Taiwan. The control group (n = 30) received the usual care and the experimental group (n = 28) received a 4‐week SMP intervention. The results of the follow‐up on the longitudinal data at 3, 6, and 9 months showed that the renal function indices, potassium and phosphorus levels, and interdialytic weight gain were significantly better than at the pre‐test for the experimental group. Results: In terms of the interaction between group and time, the potassium level dropped significantly below the pre‐test value only after 3 months (B = −0.31, SE = 0.15, p =.044), suggesting that the post‐test potassium level had significantly decreased after 3 months. In terms of the interaction between group and time, the phosphorus level dropped significantly below the pre‐test value only after 6 months (B = −0.53, SE = 0.28, p =.050), suggesting that the post‐test phosphorus level significantly decreased after 6 months. Finally, the intervention could effectively control the weight change between dialysis sessions for up to 9 months (B = −1.34, SE = 0.30, p <.001). Conclusions: The SMP intervention decreased potassium and phosphorus levels and helped control interdialytic weight gain in patients undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

Aims: This study examines how career barriers and supports (i.e., perceived discrimination, lack of advancement, human capital, and social capital) impact affective, normative, and continuance aspects of professional commitment and thus nurses' professional turnover intention. Background: Professional commitment is known to influence professional turnover intention. However, little is known about how career barriers and supports contribute to professional commitment and reduce professional turnover intention. Methods: This study adopted a cross‐sectional design and a survey to collect representative data in a major hospital in northern Taiwan. We used proportionate random sampling to ensure sample representativeness and obtained 524 responses. Results: Perceived discrimination and lack of advancement were negatively related to affective professional commitment. Human capital was positively related to affective, normative, and continuance professional commitment. Social capital was positively related to normative professional commitment. All aspects of professional commitment were negatively related to professional turnover intention. Conclusion: Career barriers and supports have an important influence on professional commitment. Reduced barriers and enhanced support may therefore help reduce nurses' professional turnover intentions. Implications for Nursing Management.: Nursing managers could aim to lessen career barriers while increasing career support for nurses, helping strengthen nurses' professional commitment and retention. [ABSTRACT FROM AUTHOR]

The study purpose was to examine the validities and reliabilities of the Chinese-versions Frommelt Attitudes Toward Care of the Dying Scale (Attitudes Scale) and Caregiving Behaviors Scale for End-of-Life Patients and Families (Behaviors Scale). The scales were tested in a convenience sample of 318 nurses with ≥6 months work experience at three hospitals. Cronbach’s alphas of the Attitudes and Behaviors Scales were .90 and .96, respectively. Each scale had Kaiser–Meyer–Olkin index >.85 and Bartlett’s test of sphericity >4000 (p < .001). Attitudes Scale loaded on three factors: respecting and caring for dying patients and families, avoiding care of the dying, and involving patients and families in end-of-life care. The Behaviors Scale loaded on two factors: supporting dying patients and families, and helping families cope with grief. Factor loadings for both scales were ≥.49. Both Attitudes and Behaviors Scales are reliable and valid for evaluating nurses’ attitudes and caregiving behaviors for the dying. [ABSTRACT FROM AUTHOR]

Abstract: Aim: End‐stage renal disease (ESRD) not only threatens a patient's life expectancy but also burdens the family and society with medical expenses. The mortality and prevalence rates are extremely high in Taiwan. Thus, this articleinvestigated the effectiveness of an innovative self‐management program on the physiology, psychology, and management of patients with pre‐ESRD. Methods: This study was designed as a randomized, controlled trial and was set in the department of nephrology in a regional teaching hospital in Taiwan. In total, 112 patients with pre‐ESRD were assigned randomly to either an experimental (n = 67) or a control (n = 45) group. The baseline data collection included physiological indicators, psychological factors (depression, anxiety), and measures of self‐efficacy and self‐management. Routine hospital care was provided for the control group after the pretest and an innovative self‐management intervention was used in the experimental group for 4 weeks after the pretest. The effectiveness of the intervention was evaluated 3 months later. Results: Improvements in the physiological indicators, such as blood urea nitrogen and creatinine, and the psychological indicators, such as depression, self‐efficacy, and self‐management, reached statistical significance. Conclusion: The innovative self‐management program effectively decreased patients' functional indicators (blood urea nitrogen, creatinine) and level of depression and enhanced their self‐efficacy and self‐management. [ABSTRACT FROM AUTHOR]

Abstract: Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients’ symptoms and health; however, the effects of family interventions on family function and caregivers’ health‐related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family‐centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60‐min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90‐min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem‐solving (P = 0.04), but there were no significant interaction effects on the caregivers’ perceived health status and caregivers’ burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers. [ABSTRACT FROM AUTHOR]

Aims To examine the sleep characteristics of infants with parentally reported sleep problems, with parentally reported no sleep problems and with parentally reported uncertain sleep conditions. Background Infant sleep problems are recognized as a major health issue worldwide. However, in our daily clinical practices, it is not uncommon for parents not to know whether their infant sleep is problematic. Design and Methods A prospective study conducted between 2012 - 2015 where 219 parents completed questionnaires and infants wore an actigraph monitor for 7 days. Multinomial logistic regression models were used to evaluate the actigraphic and parentally reported infant sleep behaviours between the groups. Results Thirty-two (14.61%) parents did not know whether their infant sleep was problematic and 118 (53.88%) parents considered their infant sleep a problem. Compared with infants without sleep problems, infants with uncertain sleep conditions had significantly increased odds of having shortened longest sleep duration according to parental report. A significant association was found for infants without sleep problems compared with those with sleep problems who had significantly more wake after sleep onset as measured by actigraphy, as well as reduced longest sleep duration according to parental report. Conclusion Infants with uncertain sleep conditions have the same problematic sleep behaviours resembling those of children with reported sleep problems. Healthcare professionals should actively disseminate sleep knowledge to help parents interpret infant sleep behaviours and consider possible intervention strategies for improving parental sleep-related knowledge and infant sleep. [ABSTRACT FROM AUTHOR]

Background: The results of numerous studies indicate that people with disabilities seek more healthcare than those who are not disabled, particularly for conditions such as chronic kidney disease, cardiovascular disease, and obesity. However, little is known about the incidence of impaired kidney function and its associated factors among adults with disabilities in Taiwan. Purpose: The aim of this study was to explore the prevalence and factors associated with impaired kidney function among adults with disabilities. Methods: This descriptive study was nurse led and was conducted as part of a health promotion program for disadvantaged rural adults with disabilities in Chiayi County, Taiwan. Health screening and a health needs survey were conducted between July and December 2013. Kidney function, physiological biomarkers, health-related behaviors, and demographic characteristics were examined. Results: Eight hundred ten rural adults with disabilities were enrolled. The most common disabilities included physical-related disability (33.1%), intellectual-related disability (26.7%), and hearing and vision impairment (18.6%). The prevalence of impaired kidney function in this population was 85%. According to classification for chronic kidney disease, 68.6% were in Stages 1--2, and 16.8% were in Stages 3--4. Univariate analysis showed that impaired kidney function was significantly associated with lower educational level (p < .001), hearing or vision impairment (p < .001), being overweight or obese (p < .05), high systolic blood pressure (p < .01), fasting blood glucose (p < .001), total cholesterol (p < .001), total triglyceride (p < .05), older age (p < .001), smoking (p < .05), chewing betel nuts (p = .001), and low levels of participation in social activities (p < .05). The final logistic regression model showed that residents with disabilities who were older or had less education, high fasting blood glucose, and high total cholesterol tended to have impaired kidney function after adjustment for other potential confounding variables. Conclusions/Implications for Practice: Most participants showed impaired kidney function. The factors that were found to relate significantly to this impairment include being overweight, having hyperlipidemia, having hypertension, having high fasting blood glucose, and having an unhealthy lifestyle. Because of the lack of symptoms during the early stages of chronic kidney disease, a community-based health promotion program for these factors is an important element in health advocacy for this vulnerable population. [ABSTRACT FROM AUTHOR]

In Oriental countries, combinations of Chinese herbal products (CHPs) are often utilized as therapeutic agents for chronic obstructive pulmonary disease (COPD). The effects of CHPs on COPD have been previously reported. This study aimed to analyze the frequency of prescription and usage of CHPs in patients with COPD in Taiwan. In this nationwide population-based cross-sectional study, 19,142 patients from a random sample of one million individuals in the Longitudinal Health Insurance Database 2000 (LHID 2000) of the National Health Insurance Research Database (NHIRD) were enrolled from 2000 to 2011. The multiple logistic regression method was used to evaluate the adjusted odds ratios for the utilization of CHPs. For patients with COPD, there was an average of 6.31 CHPs in a single prescription. The most frequently prescribed CHP for COPD was Xiao-Qing-Long-Tang (XQLT) (2.6%), and the most commonly used combination of two formula CHPs was XQLT with Ma-Xing-Gan-Shi-Tang (MXGST) (1.28%). The most commonly used single CHP for COPD was Bulbus Fritillariae (3.65%), and the most commonly used combination of two single CHPs was Bulbus Fritillariae with Puerariae Lobatae (1.09%). These results provide information regarding personalized therapies and may promote further clinical experiments and pharmacologic research on the use of CHPs for the management of COPD. Furthermore, we found that TCM usage was more prevalent among men, younger, manual workers, residents of Northern Taiwan, and patients with chronic bronchitis and asthma. This information on the distribution of TCM usage around the country is valuable to public health policymakers and clinicians. [ABSTRACT FROM AUTHOR]

Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention (n = 41) or control group (n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures (p < .02) and pre–post differences (p < .03) except for diastolic blood pressure. Because of music intervention’s low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient’s mood should be monitored after the music intervention. [ABSTRACT FROM AUTHOR]

Objective. Gout is characterized by recurrent attacks of arthritis with hyperuricaemia and urate crystal-induced inflammation. Although urate transporters are known as risk factors, the immunogenetics of gouty inflammation remains unclear. This study aimed to investigate the genetic association between immune/metabolism regulators and gout. Methods. We enrolled 448 gout patients and 943 population controls from Taiwan; all were Han Chinese. We screened association between gout and 22 variants of candidate genes, including NLRP3, caspase 1, peroxisome proliferator-activated receptor-γ, proliferator-activated receptor-γ coactivator 1α (PPARGC1A) and 1β (PPARGC1B). The association was validated by replication and combined-sample analyses. Functional assays were performed by quantitative PCR, ELISA, siRNA knockdown and transfection using THP-1 cells, peripheral blood mononuclear cells and synovial cells from patients. Results. Gouty arthritis exhibited significant association with variants of peroxisome PPARGC1B, which included a missense single nucleotide polymorphism, rs45520937 [P = 6.66 x 10-9; odds ratio (95% CI): 1.85 (1.51, 2.28)]. Expression of PPARGC1B and NLRP3 was induced in urate crystal-activated THP-1, peripheral blood mononuclear cells and synovial cells from gout patients in acute stage. siRNA knockdown of PPARGC1B upregulated NLRP3 in urate crystal-activated macrophages. Compared with the wild-type carriers, patients with the risk A allele of rs45520937 showed statistically increased NLRP3 (P = 0.044) and plasma IL-1β (P = 0.006). Transfection of PPARGC1B cDNA with rs45520937 A allele to macrophages significantly augmented the expression of NLRP3 and IL-1β. Conclusion. Genetic variants of PPARGC1B are significantly associated with gout, and a missense single nucleotide polymorphism, rs45520937, augments NLRP3 and IL-1β expression. These data suggest that variants of PPARGC1B, a regulator of metabolism and inflammation, contribute to the pathogenesis of gouty arthritis. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore distinct trajectories of caregivers' depressive symptoms and the effects of a training programme on these trajectories over 18 months after the programme. Background Overall effects of caregiver-training programmes on family caregivers' depressive symptoms have been reported, but few studies explored distinct courses of changes in caregivers' depressive symptoms and followed up intervention effects on these distinct courses. Design Randomized clinical trial. Methods Family caregivers ( n = 116) were randomly assigned into experimental ( n = 57) and control ( n = 59) groups. The experimental group received the training programme with telephone consultation and the control group received written educational materials and social telephone follow-ups. Caregivers' depressive symptoms were assessed from June 2009 - March 2012 by self-completed questionnaires before, at 2 weeks and 3, 6, 12 and 18 months after the intervention. Groups of individual trajectories were distinguished using group-based trajectory modelling. Results Caregivers' depressive symptoms fell into three stable trajectories: non-depressed, mildly blue and depressed. After controlling for covariates, caregivers who received the caregiver-training programme were less likely than those who did not experience persistent depressive symptoms ( b = −1·92, odds ratio = 0·15, P < 0·05). Conclusion Depressive symptoms of family caregivers of persons with dementia were relatively stable and followed three distinct courses: non-depressed, mildly blue and depressed. Therefore, caregivers' depressive symptoms should be assessed as early as possible. Caregivers in the experimental group had a lower probability of persistent depressive symptoms than caregivers in the control group. Therefore, this training programme can be used by healthcare providers for persons with dementia and their caregivers. Trial registration number: NCT02667951. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Baseline thyroid function testing and regular follow-up of thyroid function under amiodarone usage was recommended by guidelines. Little is known about the status of amiodarone monitoring in real-world clinical care in Taiwan. The objective was to determine the rate of thyroid monitoring and to assess the clinical and physicians' characteristics associated with adequate monitoring in a tertiary referral centre for arrhythmia. Methods We reviewed the medical records of patients receiving amiodarone during the period 2008-2009 at Taipei Veterans General Hospital. The rate of baseline and follow-up thyroid function monitoring during amiodarone therapy were calculated. Factors associated with guideline adherence to monitoring were analysed. Results Among the 1319 enrolled cases, 36.4% ( n = 480) underwent baseline thyroid function testing and 1.1% ( n = 15) received measurement of anti-thyroid peroxidase antibody before amiodarone initiation. Regular follow up of thyroid function under amiodarone usage occurred in only 8.6% ( n = 114) of cases. Baseline thyroid function was more likely to be present in patients of younger age ( P < 0.001), female sex ( P = 0.01), and in those who received amiodarone therapy from cardiologists ( P < 0.001) or electrophysiologists ( P < 0.001) with fewer years of service ( P < 0.001). Upon multivariate analysis, only physicians' expertise (cardiologist versus non-cardiologist, OR = 5.67, 95% CI: 2.44-13.16) and years of service (OR = 0.97, 95% CI: 0.95-0.998) were significantly associated with adequate thyroid monitoring. Conclusions The rate of thyroid monitoring with amiodarone therapy had been suboptimal. Strategies to enhance guideline adherence are needed. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes is a huge burden both for individuals and society as a whole. Although depression has been negatively associated with ideal glycemic control, little is known about the prevalence of depression or its associated factors among rural Taiwanese adults with Type 2 diabetes mellitus (type2 DM). Purpose: The purposes of this study were to investigate the prevalence of depression in rural-dwelling sufferers of type2 DM and to highlight the relationships between their depression status and health promoting behaviors such as physical activity, keeping active in life, sleep sufficiency, and adopting a diabetic diet. Methods: A cross-sectional, correlational design was used to recruit 696 participants from local healthcare centers in rural areas of Chiayi County, Taiwan. Data were collected from March 30, 2010, to August 30, 2012. The Chinese version of the Geriatric Depression Scale and its associated physiological biomarkers were used as screening tools. Logistic regression was used to identify the factors that were associated with depression status. Results: The prevalence of depression in this study was 16.8%. Factors found to be associated with depression included being female, having a low level of education, receiving reduced family support, having little physical activity, failing to follow a diabetic diet, frequent inactivity, and having insufficient sleep. There were no significant differences in the physiological indicators between the depressive and nondepressive groups. After controlling for confounding factors, a logistic regression model showed that depression status was associated with a lack of sleep (OR = 2.85, p < .001), less frequent exercise (OR = 2.67, p < .001), and frequent inactivity (OR = 2.35, p = .001). Conclusions/Implications for Practice: This study showed that the prevalence of depression among adults with type2 DM living in rural areas is relatively high. From the perspective of health promotion, future research should focus on how to improve quality of sleep by enhancing daily physical activity and on investigating the effect of promoting a more active lifestyle among those at risk on depression. [ABSTRACT FROM AUTHOR]

The article focuses on a research related to influences of aerobic dance on cognitive performance in adults with schizophrenia. Topics discussed include experimental group who participated in a 60-minute aerobic dance group class and control group who participated in colouring and handwriting activities; measuring cognitive functions before and after the interventions for both groups; and role of aerobic dance as an adjunct activity-based intervention to improve cognitive functions.

Aims and objectives. To examine the predictors of coronary artery disease among middle-aged women at various menopausal statuses. Background. Few studies have explored coronary artery disease predictors among middle-aged women at various menopausal statuses, particularly with the inclusion of women who underwent a hysterectomy. Design. A cross-sectional design was adopted. Methods. Two hundred and twenty-five middle-aged women who were waiting for catheterisation examinations because of possible coronary artery disease were selected. These patients were divided into premenopausal (n = 41), post-menopausal (n = 143) and women who had undergone a hysterectomy groups (n = 41). The differences in the risk factors for coronary artery disease between patients with coronary artery disease (catheterisation results showing stenosis of >50% in at least one major coronary artery) and those without coronary artery disease in the three groups were compared. Results. The participants were aged 56-8 ± 5-9 years. In the premenopausal group, the odds of coronary artery disease among ever or current smokers was 8-46 times the odds of coronary artery disease for the never smokers. In the post-menopausal group, the odds of coronary artery disease among diabetes patients was 2-89 times the odds of coronary artery disease for those without diabetes. Each additional point on the Chinese Beck Depression Inventory-II increased the risk of coronary artery disease by 5%. In the hysterectomy group, each additional increase in 1 mmHg in systolic blood pressure increased the risk of coronary artery disease by 4%. Conclusions. Smoking, diabetes, depression and systolic blood pressure are predictors of coronary artery disease in middle-aged women at premenopause, post-menopause and after undergoing hysterectomy respectively. Relevance to clinical practice. These results are beneficial for middle-aged women at various menopausal stages to effectively implement prevention of coronary artery disease. These findings were among women being evaluated for possible coronary artery disease, we suggest the need for further study in lager, longitudinal studies. [ABSTRACT FROM AUTHOR]

Aims and objectives. To assess the efficacy of pelvic floor muscle exercise for enhancing fecal incontinence quality of life after coloanal anastomosis in colorectal cancer patients. Background. Methods of improving incontinence have been evaluated in many countries, but never in a Taiwan population. Design. A longitudinal experimental study. Methods. Fifty-two colorectal cancer patients who had received colostomy closure and coloanal anastomosis surgery were recruited from a general hospital in southern Taiwan and randomly assigned to an experimental group (n = 26) or a control group (n = 26). Both groups received routine postoperative care. However, the experimental group received private consultations, educational DVDs and pamphlets to instruct them in performing pelvic flow muscle exercise. In all participants, the Fecal Incontinence Quality of Life Scale was used to measure quality of life before discharge and at one, two, three, six and nine months after discharge. Generalised estimating equations were used to compare longitudinal effects between the two groups. Results. The generalised estimating equations revealed that all participants had significantly improved Fecal Incontinence Quality of Life Scale scores at two, three, six and nine months after discharge. Compared to the controls, however, the experimental group had significantly higher scores at two, three, and six months after discharge. Conclusions. Patient education in pelvic floor muscle exercise positively affects Fecal Incontinence Quality of Life Scale scores in patients who have received coloanal anastomosis. Relevance to clinical practice. Early education in pelvic floor muscle exercise can improve management of fecal incontinence symptoms after coloanal anastomosis and can improve quality of life. [ABSTRACT FROM AUTHOR]

Background: Community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging problem. Compared with urban infants, rural infants may encounter different distributions of community-acquired resistant strains and various barriers to efficient management. Methods: A retrospective survey and comparison was conducted for infants with UTI caused by ESBL-producing E. coli admitted to an urban hospital ( n = 111) and a rural hospital ( n = 48) in southern Taiwan from 2009 to 2012. Results: Compared with 2009 and 2010, the total number of cases at both hospitals significantly increased in 2011 and 2012 ( p < 0.001). Compared with the rural patients, the urban patients were significantly younger, and they had fewer days of fever before and after admission, fewer presentations of poor activity and poor appetite, and a lower serum creatinine level. Most of the patients had no prior history of illness, and we could not identify any significant different risk factors for acquiring ESBL-producing E. coli, such as past antimicrobial use, hospitalization, UTI, and underlying renal diseases, between the urban and rural populations. Conclusions: The increase in community-acquired UTI in infants caused by ESBL-producing E. coli was similar between the urban and rural populations. Our preliminary data suggest that the rural-urban disparities were probably related to easy access to health care by the urban population. ESBL complicates disease management, and the increase in the prevalence of ESBL producers is a major health concern and requires further healthy carrier and environmental surveillance. [ABSTRACT FROM AUTHOR]

Aim To develop and psychometrically test the Protective Reasons against Suicide Inventory among older Chinese-speaking outpatients. Background Tools currently exist to test reasons for living among individuals of all ages in western countries, but few are available to assess older adults' protective reasons against suicide in Asia. Design A cross-sectional survey to investigate protective reasons against suicide among older Chinese-speaking outpatients. Methods The Protective Reasons against Suicide Inventory was developed based on individual interviews with 83 older outpatients in Taiwan, the literature and the authors' clinical experiences. The resulting Inventory was examined in 2013 for content validity, face validity, construct validity, criterion-related validity, internal consistency reliability and test-retest reliability. Results The Inventory had excellent content validity and face validity. Factor analysis yielded a seven-factor solution, accounting for 87·7% of the variance. Scores on the global Inventory and its subscales tended to be higher in outpatients diagnosed without suicidal ideation than in outpatients diagnosed with suicidal ideation, indicating good criterion validity. Inventory reliability and the intraclass correlation coefficient were satisfactory. Conclusions The Protective Reasons against Suicide Inventory can be completed in 5 minutes and is perceived as easy to complete. Moreover, the Inventory yielded highly acceptable parameters for validity and reliability. The Protective Reasons against Suicide Inventory can be used to assess older Chinese-speaking outpatients for factors that protect them from attempting suicide. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a common symptom in patients with heart failure that is easy to ignore. In addition, fatigue may affect patients’ physical function and psychosocial conditions that can impair their quality of life. An effective nursing care programme is required to alleviate patients’ fatigue and improve their quality of life. Aim: To investigate the effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure. Methods: A randomised controlled trial design was used. Ninety-two patients with heart failure were randomly assigned to an intervention group (n=47) or a control group (n=45). The patients in the intervention group participated in 12 weeks of a supportive educational nursing care programme including fatigue assessment, education, coaching self-care and evaluation. The intervention was conducted by a cardiac nurse during four face-to-face interviews and three follow-up telephone interviews. Fatigue and quality of life were assessed at the baseline and 4 weeks, 8 weeks and 12 weeks after enrollment in both groups. Results: The participants in the intervention group exhibited a significant decrease in the level of fatigue after 12 weeks, whereas those in the control group exhibited no significant changes. Compared with the control group, the intervention group exhibited a significantly greater decrease in the level of fatigue and significantly greater improvement in quality of life after 12 weeks of intervention. Conclusions: The supportive educational nursing care programme was recommended to alleviate fatigue and improve quality of life in patients with heart failure. [ABSTRACT FROM AUTHOR]

Workplace health promotion (WHP) is important to prevent work-related diseases, reduce workplace hazards, and improve personal health of the workers. Health promotion projects were launched through the centers of WHP funded by the Taiwan Bureau of Health Promotion since 2003. Hence, the aim of this study is to evaluate the of WHP programs intervention from 2003 to 2007. The intervention group consisted of 838 business entities which had ever undergone counseling of the three centers in northern, central, and southern Taiwan from 2003 to 2007. The control group was composed of 1000 business entities randomly selected from the business directories of the Ministry of Economic Affairs, Taiwan. The questionnaire survey included general company profiles and the assessment of workplace health according to the five action areas of the Ottawa Charter for Health Promotion. We have received 447 (53.3%) questionnaires from the intervention group and 97 questionnaires from the control group. The intervention group was more effective in using the external resources and medical consultation, and they had better follow-up rates of the abnormal results of annual health examinations. Compared to the control group, the intervention group had a significantly decreased smoking rate in 246 companies (61.2%) and a reduced second-hand smoke exposure in 323 companies (78.6%) (p<0.001). By means of the intervention of WHP programs, we can enhance the awareness of the enterprises and the employees to improve worksite health and . [ABSTRACT FROM AUTHOR]

Background: The shortage of professional nurses is a global issue of critical importance. Improving the retention and recruitment of nurses is necessary to reduce this shortage. The ability to measure the quality of work life (QWL) of nurses is important to understand the current QWL status among nurses and to develop appropriate improvement strategies. The two instruments that are currently used in Taiwan both require excessive amounts of time to complete. Furthermore, the results that these two instruments generate are not easily interdisciplinary and international comparisons. Purpose: The aims of this study were to translate into Chinese the English version of the Work-Related Quality of Life Scale (WRQoL) that was developed by Van Laar, Edwards, and Easton (2007) and then to determine the reliability and validity of this Chinese-version scale in terms of measuring the QWL of nurses in Taiwan. Methods: The WRQoL was translated from English into Chinese using forward-translation with group discussions, back-translation, and verification of conceptual equivalence. Concurrent validity, test-retest reliability, and internal consistency reliability were determined in two samples of nurses (n = 30 and n = 213 for Phases 1 and 2, respectively) from a medical center in Taiwan during September 2009. Results: The 23-item Taiwanese version of the WRQoL showed satisfactory concurrent validity with a Taiwanese QWL scale (correlation = .75). The 3-week test-retest reliability was .89, and the Cronbach's alpha was .88, indicating high internal consistency reliability. Conclusions/Implications for Practice: The Taiwanese version of the WRQoL is acceptable for measuring the QWL of nurses in Taiwan. Larger scale studies are recommended for confirmatory factor analysis. This tool may be used for human resources management and policy-making applications, providing the potential to help retain and recruit nurses in Taiwan. Furthermore, the Taiwanese-version scale may be used to compare work-related quality of life between Taiwanese nurses and their counterparts overseas. [ABSTRACT FROM AUTHOR]

Background: People in both Taiwan and China originally descended from the Han Chinese, but the societies have been separated for approximately 38 years. Due to different political systems, variations exist in healthcare and nursing education systems in Taiwan and China. Objective: The purpose of this study was to examine the professional values of nursing students in Taiwan and China. Design: A cross-sectional design was applied in this study. The Nursing Professional Value Scale–Revised was used to measure the professional values of the students. The questionnaire was distributed to eligible undergraduate students in a classroom setting. Ethical considerations: This study was approved by the Institutional Review Board at the first investigator’s university. Participants were informed that completion and return of the questionnaire was voluntary, and confidentiality was ensured by keeping the responses anonymous. Participants: A convenience sample included 292 Taiwanese students and 654 Chinese students. Findings: A total of 11 individual Nursing Professional Value Scale–Revised items showed significant differences between the two groups. These results reflect the differences in the perceived importance of these items between the groups. There was no significant difference between the two groups in the mean overall scores for the Nursing Professional Value Scale–Revised (p = .766) and three subscales (all p > .05). Conclusion: There are some differences in professional values between nursing students in Taiwan and China. Given the increasingly frequent and close interactions between Taiwan and China and the globalization of nursing, understanding these differences may help nursing educators identify students’ perceptions of their professional values and support the development of strategies to improve weaknesses in professional values. [ABSTRACT FROM AUTHOR]

One major drawback of previous research on speech-to-text recognition (STR) is that most findings showing the effectiveness of STR for learning were based upon subjective evidence. Very few studies have used eye-tracking techniques to investigate visual attention of students on STR-generated text. Furthermore, not much attention was paid to learning differences, such as learning ability, learning style preferences and gender, to use STR texts. Therefore, this study carried out one experiment. Firstly, participants' visual attention on STR-generated text was investigated by employing eye-tracking technique. Secondly, how differently effective STR-generated texts can be to influence participants' learning achievement was tested. Thirdly, this study compared visual attention and learning behaviour with the different characteristics of participants, such as learning ability, learning style preferences and gender, to use STR-generated texts. Finally, this study explored students' perceptions regarding usefulness of STR-generated texts for learning. This paper discusses results, research findings and implications along with conclusions and several suggestions for future development and research. [ABSTRACT FROM AUTHOR]

Background: Certain factors originating from the perinatal and childhood periods are suspected of contributing to the recent increasing trend of childhood type 1 diabetes (T1D) incidence. This study sought to investigate the relationships between various perinatal and childhood risk factors and T1D incidence in young children (<10 years). Methods: We used a nested case-control design based on 1 478 573 live births born in 2000-05 in Taiwan. Cases were 632 incident cases of T1D between 2000 and 2008. Ten matched controls for each case were randomly selected. Information on various perinatal risk factors was also identified from claim data. Multiple conditional logistic regression was employed to estimate odds ratio (OR) and 95 confidence interval (CI) of T1D. Results: Childhood infection was significantly associated with an increased risk of T1D (OR = 1.46, 95% CI = 1.23-1.73). Increased risk of T1D was also noted in children born to younger mothers (<25 years) (OR = 1.94, 95% CI = 1.34-2.81), older fathers (>30 years) (OR = 1.56 (95% CI = 1.16-2.10) to 1.57 (95% CI = 1.19-2.05), mothers with Caesarean section (CS) (OR = 2.35, 95% CI = 1.52-3.64), and mothers with gestational diabetes mellitus (OR = 4.36, 95% CI =2.76-7.77). Fathers with T1D (OR = 7.36, 95% CI = 1.02-57.21) or type 2 diabetes (OR = 1.54, 95% CI = 1.04-2.26) were observed to substantially increase the risk of offspring T1D. Conclusions: Certain modifiable perinatal factors such as infection and CS may predispose incidence of T1D in young children. [ABSTRACT FROM AUTHOR]

Objectives To investigate the correlation between zopiclone use and risk of hip fracture in elderly adults. Design Case-control study. Setting Claim data from the Taiwan National Health Insurance Program. Participants Individuals aged 65 and older who experienced their first episode of hip fracture between 1998 and 2011 were enrolled as the case group (n = 10,996). Randomly selected subjects aged 65 and older without hip fracture were enrolled as controls (n = 9,081). Case and control groups were matched according to sex, comorbidities, and index year of hip fracture diagnosis. Measurements Current users of zopiclone were defined as those whose last remaining tablet of zopiclone was detected within 7 days or less before the date of hip fracture diagnosis. Late users of zopiclone were defined as those whose last remaining tablet of zopiclone was detected more than 7 days before the date of hip fracture diagnosis. Subjects who never received a prescription of zopiclone were defined as nonusers of zopiclone. A multivariable unconditional logistic regression model was used to estimate odds ratios ( ORs) and 95% confidence intervals ( CIs) to investigate the correlation between zopiclone use and risk of hip fracture. Results After adjusting for confounders, multivariable logistic regression analysis demonstrated that current users of zopiclone were three and a half times as likely as nonusers to experience a hip fracture (adjusted OR = 3.56, 95% CI = 2.33-4.84), whereas late users were essentially equally as likely as nonusers to experience a hip fracture ( OR = 1.05, 95% CI = 0.94-1.18). Conclusion Current use of zopiclone was associated with greater risk of hip fracture in the elderly adults studied. Clinicians should alert elderly people to the risk of hip fracture when prescribing zopiclone. [ABSTRACT FROM AUTHOR]

Objectives: Doing-the-month practice has been commonly observed by women during the first month after delivery for hundreds of years in several countries of Asia. This retrospective study examined the correlation between these restricted behaviors and mental status in postpartum women. Materials and Methods: The frequencies of seven restricted behaviors during the first month after delivery and levels of depression, anxiety, and sleep quality were measured in 341 women 4-6 weeks after delivery through self-reported questionnaires. The multivariate linear regression model was used to determine independent behavioral predictors for depression, anxiety, and sleep quality. Results: Bathing or showering was an independent predictor of low depression status, low anxiety status ( p<0.05), and good sleep quality ( p<0.001). Behaviors related to high depression status were touching cold water and squatting (both p<0.05). Squatting was also related to high anxiety status ( p<0.01), while exposing oneself to drafts was related to poor sleep quality ( p<0.05). Conclusion: The results indicate that the restrictions on squatting, touching cold water, and exposure to drafts are positively associated with good mental health in postpartum women and are worth preserving; however, the restriction on bathing or showering might negatively impact the mental health of postpartum women and needs further evaluation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the validity of the EuroQOL five dimensions questionnaire (EQ-5D) using a nationally representative data from the National Health Interview Survey (NHIS) through comparison with short-form 36 (SF-36). Methods: Data for this study came from the 2009 NHIS in Taiwan. The study sample was the 4007 participants aged 20-64 years who completed the survey. We used SUDAAN 10.0 (SAS-Callable) to carry out weighed estimation and statistical inference. The EQ index was estimated using norm values from a Taiwanese study as well as from Japan and the United Kingdom (UK). The SF-36 score was standardized using American norm values. Results: In terms of concurrent validity, the EQ-5D met the five hypotheses. The results did not fulfill hypothesis that women would have lower visual analogue scale (EQ-VAS) scores. In terms of discriminant validity, the EQ-5D fulfilled two hypotheses. Our results approached but did not fulfill hypothesis that there would be a weak association between the physical and psychological dimensions of the EQ-5D and the mental component summary score of the SF-36. Results were comparable regardless of whether the Japanese or UK norm value sets were used. Conclusions: We were able to fulfill many, not all of our validity hypotheses regardless of whether the established Japanese or UK norm value sets or the Taiwanese norm values were used. The EQ-5D is an effective and simple instrument for assessing health-related quality of life of general population in Taiwan. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop the newly designed thermal gown to test the effectiveness in relieving postoperative hypothermia as compared to traditional cotton cloth. Background Hypothermia is a common problem after spinal surgery. A patient's safety and comfort are significant. Currently, most research is focused on instruments that relieve a patient's hypothermia. Studies have rarely considered a patient's comfort while caring for their body temperature. Design This study employed an experimental design. The participants were assigned randomly to two groups: the experimental group ( N = 50) and the control group ( N = 50). Methods The experimental group received the newly designed thermal gown intervention. The control group received the standard postanaesthesia care unit re-warming intervention. The material used to collect data included demographic data, postoperative management and comfort level. Nurses measured patients' vital signs and asked for patients' subjective comfort level on admission to the postanaesthesia care unit every 10 minutes until their discharge from the postanaesthesia care unit. Result The accumulated percentage for thermal gown group patients in reaching 36 °C during the first 20 minutes of admission was significantly higher than that of the cotton cloth group. The thermal gown group individuals showed significantly higher comfort levels (score = 4) at 10 minutes, when compared to the cotton cloth group. Conclusion Results suggested that the newly designed thermal gown had effectively improved postoperative temperature and comfort level with an evidence-based intervention. Relevance to clinical practice Maintaining a patient's body temperature is a major task for nurses working in the post-anaesthesia care unit. With the newly designed thermal gown, the duration of a patient's stay in the postanaesthesia care unit was shortened and the patient's comfort was increased. [ABSTRACT FROM AUTHOR]

This study was conducted to examine the relationships between family caregivers' perception of caregiving and its influencing factors among Taiwanese with hospitalized relatives. The study used a cross-sectional and descriptive correlational design. A convenience sample of 200 primary caregivers of hospitalized patients diagnosed with cancer, stroke and chronic illness was recruited in a Taiwanese Medical Center; this focus was chosen because cancer, stroke and chronic illness generally require long term care. Data were collected by structured questionnaires. Pearson product-moment correlation and stepwise multiple regression analyses were used to analyse the results of this study. Family caregivers who lacked family support and whose patients' ADL (activities of daily living) dependency was increasing experienced a greater caregiving burden. Family caregivers who had better psychological well-being, better quality of relationship and more caregiving knowledge experienced a lower caregiving burden. Quality of relationship, lack of family support and patients' ADL dependency accounted for 43% of the Zarit Burden Interview variance. The results indicated that family caregivers' perception of caregiving included sacrifice, strain, embarrassment, anger and loss of control. It is vital for nurses to understand these caregiving perceptions and their related factors to provide a holistic care plan. [ABSTRACT FROM AUTHOR]

Purpose This study examined which aspects of professional commitment can effectively retain nurses in the nursing profession. Design, Settings, and Participants This study used a longitudinal design, simple random sampling, and two-wave data collection to survey and follow up a representative sample of 579 nurses for 1 year in a major medical center in northern Taiwan. Methods Items measuring each aspect of professional commitment came from Meyer et al.'s scale. In the second wave, administrative data were culled to determine whether these nurses remain employed as nurses. Structural equation modeling is used to analyze the data. Results Analytical results indicate that continuance commitment predicts nurse retention in the nursing profession (path coefficient = 0.34, p < .01). Conclusions Institutional efforts to improve continuance commitment (e.g., improved salary structures and enhanced professional development opportunities) likely retain nurses in the nursing profession. Clinical Relevance The findings of this study indicate the importance of continuance intention in retaining nurses. Nursing managers who face staff retention issues may consider making efforts to improve nurse salary and employer-sponsored benefits. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) carries significant morbidity and mortality. No previous studies have investigated the long-term outcomes of ARDS patients in Taiwan. Objective; This study aimed to investigate the survival of ARDS patients after discharge from the hospital in Taiwan. Methods: Medical records from 150 ARDS patients discharged alive from the intensive care unit from January 2004 to June 2009 were reviewed. Survival of these patients was followed for 5 years, and prognostic factors were identified. Results: Cumulative survival rates were 81.4% at 6 months, 79.0% at 1 year, 67.2% at 2 years, and 45.7% at 5 years. Independent prognostic factors influencing both 1- and 5-year survival rates were age, previous lung disease, and disposition after discharge. For 5-year survival, renal disease was also an independent risk factor. Discussion: The mortality rate of ARDS survivors after intensive care unit discharge is still high in Taiwan. Three independent risk factors were found to affect the overall survival of these patients. [ABSTRACT FROM AUTHOR]

Sponsorships play an increasingly important role in the viability of events, including those targeted at tourists, and sponsors typically seek to build a rapport between their brands and the event attendees. The extent to which the event-related imagery benefits the sponsor brand will depend on the alignment between the sponsor brand and the event. In addressing this issue this study examines the mediating role of event–sponsor fit between visitor event-liking, self-sponsor congruity, and sponsor brand favorability. Interviews were conducted with 1215 attendees at the 2010 Taipei International Flora Exhibition and formed a basis for hypothesis testing. An examination of three sponsor brands over nine surveys concluded that event–sponsor fit consistently mediates the effect of event-liking and self-sponsor congruity on brand favorability. Results confirmed that event organizers and sponsors can benefit from the use of perceived fit as a means of shaping brand attitudes when they sponsor art- and/or social-related events. [ABSTRACT FROM PUBLISHER]

This exploratory study examines the relationship between cardiometabolic risk factors (blood pressure, waist circumference, BMI, and total cholesterol) and cognitive/academic performance. In this study, 1297 Taiwanese tenth-grade volunteers are recruited. Scores from the Basic Competency Test, an annual national competitive entrance examination, are used to evaluate academic performance. Cognitive abilities are accessed via the Multiple Aptitude Test Battery. The results indicate that systolic blood pressure is significantly, negatively associated with academic performance, both in male and female subjects. BMI and waist circumference are associated with verbal reasoning performance with an inverse U-shaped pattern, suggesting that both low and high BMI/waist circumference may be associated with lower verbal reasoning performance. [ABSTRACT FROM AUTHOR]

This study reviews theories on striving for closure in adolescent networks related to trust issues of adolescents and further examines whether adolescents in mixed-gender and single-gender classes are different in striving for closure. Stochastic actor-based models for network dynamics are applied to test our hypotheses based on longitudinal friendship nominations of 406 Taiwanese adolescents in mixed-gender, all-boy, and all-girl classes. The results show that adolescents strive for closure through connections of friends' friends. Further, the results reveal that while the tendency toward closure is stronger for girls in mixed-gender classes, such tendency toward closure is stronger in all-boy classes than in all-girl classes. Testing effects between types of classes supports the indications of variances in striving closure. [ABSTRACT FROM AUTHOR]

Introduction: Numerous people with chronic conditions like to use traditional Chinese medicine (TCM) treatment, or integrated treatment of TCM and Western medicine (WM). Our study explored the associations between multiple chronic conditions (MCC) and TCM use and the use of specific types of TCM therapy among adults in Taiwan. In addition, we explored the TCM use of adults with seven common types of chronic conditions. Methods: In our study, a national representative sample in 2005 was used. The Chronic Condition Indicator and the Clinical Classifications System created by the U.S. Agency for Healthcare Research and Quality were used to define the number of chronic conditions of adults. Logistic regressions adjusted for demographic characteristics were used to analyze the associations. The frequency of TCM use among adults with different numbers of chronic conditions was quantified. Results: TCM use for adults with ≥5 chronic conditions (odds ratio [OR] 1.86) was higher than TCM use for adults with 2-4 chronic conditions (OR 1.51) and TCM use for adults with one chronic condition (OR 1.48). The increase in the OR of the use of Chinese herbs and traumatology manipulative therapy according to the number of chronic conditions was not as substantial as that of acupuncture-moxibustion. The frequency of TCM use exhibited an increasing trend with the increase in the number of chronic conditions ( p<.001). Among the seven common types of chronic conditions for adults, TCM use for adults with arthropathy (OR 2.01) was the highest. Conclusion: The probability and frequency of TCM use increased as the number of chronic conditions increased. The probability of Chinese herbs use, traumatology manipulative therapy use, and, particularly, acupuncture-moxibustion use increased as the number of chronic conditions increased. We suggest that government policy makers emphasize administering integrated TCM and WM care to people with chronic conditions or MCC. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate whether physical activity is a protective factor against metabolic syndrome in middle-aged and older women. Background Socio-demographic and lifestyle behaviour factors contribute to metabolic syndrome. To minimise the risk of metabolic syndrome, several global guidelines recommend increasing physical activity level. However, only limited research has investigated the relationship between physical activity levels and metabolic syndrome in middle-aged and older women after adjusting for socio-demographic and lifestyle behaviour factors. Design Cross-sectional design. Methods A convenience sample of 326 middle-aged and older women was recruited. Metabolic syndrome was confirmed according to the National Cholesterol Education Program, Adult Treatment Panel III guidelines, and physical activity levels were measured by the International Physical Activity Questionnaire. Results The sample had a mean age of 60·9 years, and the prevalence of metabolic syndrome was 43·3%. Postmenopausal women and women with low socioeconomic status (low-education background, without personal income and currently unemployed) had a significantly higher risk of developing metabolic syndrome. After adjusting for significant socio-demographic and lifestyle behaviour factors, the women with moderate or high physical activity levels had a significantly lower ( OR = 0·10; OR = 0·11, p < 0·001) risk of metabolic syndrome and a lower risk for each specific component of metabolic syndrome, including elevated fasting plasma glucose ( OR = 0·29; OR = 0·26, p = 0·009), elevated blood pressure ( OR = 0·18; OR = 0·32, p = 0·029), elevated triglycerides ( OR = 0·41; OR = 0·15, p = 0·001), reduced high-density lipoprotein ( OR = 0·28; OR = 0·27, p = 0·004) and central obesity ( OR = 0·31; OR = 0·22, p = 0·027). Conclusions After adjusting for socio-demographic and lifestyle behaviour factors, physical activity level was a significant protective factor against metabolic syndrome in middle-aged and older women. Higher physical activity levels (moderate or high physical activity level) reduced the risk of metabolic syndrome in middle-aged and older women. Relevance to clinical practice Appropriate strategies should be developed to encourage middle-aged and older women across different socio-demographic backgrounds to engage in moderate or high levels of physical activity to reduce the risk of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Postoperative shoulder stiffness complicates functional recovery after arthroscopic rotator cuff repair. Purpose: To compare early passive range of motion (ROM) exercise with a delayed rehabilitation protocol with regard to the effectiveness of stiffness reduction and functional improvements and rates of improper healing in patients undergoing arthroscopic repair for torn rotator cuffs. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials (RCTs) comparing both rehabilitation approaches were identified in PubMed and Scopus. Between-group differences in shoulder function were transformed to effect sizes for comparisons, whereas the effectiveness against stiffness and the risk of tendon failure were reported using standardized mean differences of ROM degrees and odds ratios (ORs) of recurrent tears, respectively. Results: Six RCTs were included, consisting of 482 patients. No significant difference in shoulder function existed across both protocols. The early ROM group demonstrated more improvement in shoulder forward flexion than the delayed rehabilitation group, with a standardized mean difference of 7.45 (95% CI, 3.20-11.70) at 6 months and 3.51 (95% CI, 0.31-6.71) at 12 months. Early ROM exercise tended to cause a higher rate of recurrent tendon tears (OR, 1.43; 95% CI, 0.90-2.28), and the effect became statistically significant (OR, 1.93; 95% CI, 1.04-3.60) after excluding 2 RCTs that recruited only those patients with small to medium-sized tears. Conclusion: Early ROM exercise accelerated recovery from postoperative stiffness for patients after arthroscopic rotator cuff repair but was likely to result in improper tendon healing in shoulders with large-sized tears. The choice of either protocol should be based on an accommodation of the risks of recurrent tears and postoperative shoulder stiffness. [ABSTRACT FROM AUTHOR]

Few studies have investigated maternal fatigue, particularly fatigue throughout the duration of pregnancy and the postpartum period. The purpose of this study was to explore changes related to maternal fatigue from pregnancy to postpartum and the factors influencing fatigue. This prospective longitudinal study surveyed 197 pregnant women beyond 24 gestational weeks monthly until one month postpartum. The Multidimensional Assessment of Fatigue scale and one question about fatigue were used. Women at late pregnancy experienced a significant increase in level of fatigue, which remained high after childbirth. Those who were not happy about the pregnancy or were multiparas experienced a higher level of prenatal fatigue than their counterparts. At postpartum, mothers who were unemployed, had no one to help with childcare, or felt that the baby's night-time sleep pattern was a serious problem had a higher level of fatigue. Interventions can be planned and implemented at early pregnancy to reduce the prevalence of fatigue. Encouraging pregnant women to share experiences and thoughts about pregnancy and being a mother is suggested. Further studies that evaluate culturally sensitive instruments for fatigue are needed. [ABSTRACT FROM AUTHOR]

This study investigated the health and well-being of Vietnamese foreign brides recently immigrated to southern Taiwan. Forty-four participants were recruited during pregnancy and 23 were followed-up at six weeks post-partum. Standardized measures completed during face-to-face interviews revealed high levels of life stress, poor general health, low social support, and difficulty caring for their infant amongst participants. Estimated prevalence of probable antenatal depression was 32%, and 26% for probable post-partum depression using Edinburgh Postnatal Depression Scale ( EPDS) scores of ≥ 13. Probable antenatal depression predicted postnatal depression. Pregnant immigrant women experienced a high level of difficult life circumstances and were significantly more likely to develop depressive symptoms after birth. Immigrant women with low social support during pregnancy were also more likely to report higher EPDS scores than well-supported women. Given these results, prevention and intervention activities are needed to promote maternal psychological well-being in disadvantaged women, especially immigrant brides. [ABSTRACT FROM AUTHOR]

Purposes: This study evaluated the effectiveness of cold-gel packing on episiotomy pain among postpartum women who had normal spontaneous deliveries. Methods: A quasi-randomised control trial was conducted in a maternity ward of a regional teaching hospital in northern Taiwan. Seventy postpartum women were recruited, choosing to be in either the experimental or control group (35 women per group). Subjects in the experimental group received at least six interventions of cold-gel packing applied to the perineal wound and were provided oral analgesics routinely. The subjects in the control group received oral analgesics routinely. Findings: Pain intensity, pain interference on daily activities and satisfaction levels with pain management were assessed using Brief Pain Inventory (BPI) and pain management questionnaire, respectively. The results showed that women in the experimental group reported significantly lower mean pain intensity score, pain interference on daily activities scores at 48 hours post-delivery, and higher level of satisfaction with pain management at 24 and 48 hours post-delivery than the control group after adjusting for demographic and obstetric data. Conclusions: Cold-gel packing on the perineum is a cost-effective, convenient, easy-to-deploy and non-pharmacologic approach to pain reduction, with an overall positive impact on postpartum recovery for parturients. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a frequent cause of sexually transmitted infection worldwide, and has a key role in the etiology of cervical cancer. Young people are the most vulnerable age group for acquiring HPV infection, but this particular age group in Taiwan knows little about it. This study investigated Taiwanese adolescent women’s knowledge of HPV and factors associated with intention to use condoms for reducing HPV-related diseases among adolescent women. A descriptive cross-sectional design was used, and a convenience sample of 384 adolescent women aged 15 to 16 years in Southern Taiwan was recruited. Data were collected using a self-administered questionnaire and analyzed with descriptive statistics,t-test or ANOVA, and multiple regression analysis. Only 26.6% of the participants were aware of HPV. The percentage of correct answers for knowledge about HPV was 35.4%. Factors associated with intention to use condoms for HPV prevention were discussion of sexual issues, attitude, subjective norm, perceived behavioral control, and HPV knowledge. These variables accounted for 55.8% of the variance in scores for intention to use condoms for HPV prevention. These findings could be used in future HPV prevention education and campaigns. Future intervention programs might be particularly focused on insufficient HPV knowledge among adolescent females. [ABSTRACT FROM AUTHOR]

Objectives: Lack of sleep is a common problem amongst nurses. Short sleep duration has been related to stress and burnout. However, in nurses, the effects of short sleep duration on job strain and burnout are controversial and a clear relationship has been lacking. This study aims to assess whether short sleep duration is related to job strain and burnout statue, and whether such relationship is in a dose-dependent manner. Methods: A cross-sectional survey among female nurses in secondary referral health centers in Taiwan, using a self-administered structured questionnaire. Stratified sampling by region and patient bed number category was done to select representative centers for this survey. Approximately 10% of all secondary referral centers were randomly selected from each stratum. Non-linear dose--response relationship between sleep duration and job strain and burnout scores was assessed by general additive models (GAM), adjusting for personal characteristics, work condition, and family situation. Results: Among the 2268 full-time nurses in 39 hospitals invited to participate in this study, 1384 (61%) satisfactorily completed the questionnaire. There were 169 nurses (12.2%) who slept less than 6 h per working day. Among the participants, 37% (n = 512) were classified into high strain group. The mean scores of personal, work-related, and client-related burnout were 59.4 (SD = 22.0), 54.6 (SD = 21.7), and 42.3 (SD = 18.6). Compared to those slept longer than 7 h, nurse who slept less than 6 h per working day had higher risk for job strain (adjusted odds ratio, AOR = 1.8, 95% confidence interval, CI = 1.2-2.7), personal burnout (AOR = 3.0, CI = 1.7-5.2), work-related burnout (AOR = 3.4, CI = 2.0-6.0), and client-related burnout (AOR = 2.0, CI = 1.2-3.6). GAM analysis found a linear relationship between sleep duration and job strain, and client-related burnout. For personal and work-related burnout, a linear increase in burnout score between 7 h and 5 h of sleep was observed, followed by a leveling off for durations of less than 5 h. Conclusion: Our study found sleep duration at working days was inversely associated with female nurses' job strain and burnout in a dose-dependent manner. Further studies on work factors which affecting sleep duration are warranted. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the effects of an early postoperative walking exercise programme on postlobectomy lung cancer patients. Background Few interventional studies on the postoperative health status of lung cancer patients have considered the efficacy of programmes designed to improve critical health variables. Design A two-group quasi-experimental, longitudinal approach repeated four times examined participant data collected 12-18 hours prior to surgery and again at one, three and six months after surgery. Methods We assigned the first 33 enrolled participants to the intervention group and the second 33 to the control group. The intervention was a daily supervised walking exercise programme consisting of 12 weeks of brisk walking exercise that began on the day following transfer to the regular ward along with weekly telephone calls until 12 weeks after discharge. Health status was measured using a structured questionnaire ( World Health Organization Quality of Life, brief version) and clinical tests (pulmonary function test and 6-minute walk test). We analysed data using general estimating equations, with p < 0·05 considered significant. Results Intervention group pulmonary and physical functions were increasingly better over time than those of the control group, with no significant difference in quality of life between the two groups. Compared to the control group, the intervention group earned significantly better values for FVC% at postoperative month 3 and for FEV1% at postoperative months 3 and 6. Intervention group 6 MWT scores were significantly better than those of the control group at postoperative months 1, 3 and 6. Conclusion This study demonstrated the benefits of an early postoperative walking exercise intervention for pulmonary and physical function in postlobectomy lung cancer patients. Relevance to clinical practice The results may guide the design of appropriate interventions in the future. Clinical trials in other populations are needed to confirm the results of this study. [ABSTRACT FROM AUTHOR]

Cooperative learning has many pedagogical benefits. However, if the cooperative learning teams become ineffective, these benefits are lost. Accordingly, this study developed a computer-aided assessment method for identifying ineffective teams at their early stage of dysfunction by using the Mahalanobis distance metric to examine the difference between the sequential test scores of the unknown team and the test scores of a reference group of functioning teams. The effectiveness of the proposed method was verified by conducting field experiments over an 18-week engineering course in Taiwan. Forty-eight students were randomly assigned to cooperative learning teams. The students' learning performance was evaluated by means of unit tests and homework tests. The functioning of the cooperative teams was examined at seven different points during the course of the study. The ineffective teams were identified with quantified type I errors. It was found that some teams failed persistently. Such teams require some form of external intervention to remedy the group dynamics. The results also showed that teams can become ineffective at any stage of the cooperative learning process. Thus, continuous monitoring is required to ensure that appropriate remedial actions are taken in a timely manner. [ABSTRACT FROM AUTHOR]

The article presents a study of the association of personality features with teaching self-efficacy in clinical nursing preceptors. Clinical nursing preceptors at a county hospital in Taiwan were asked to complete three questionnaires and used a generalized linear model to determine the associations between the six dimensions of teaching self-efficacy. Results showed significant association between personality features and teaching self-efficacy in nursing preceptors.