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Background/purpose: Low viral load (LVL) of hepatitis B virus (HBV) is a predictor of chronic HBV infection. However, the usefulness of quantitative hepatitis B surface antigen (qHBsAg) in predicting LVL in community-based screening has not been well studied. We aimed to measure the prevalence of LVL in HBV carriers and validate the efficacy of qHBsAg in predicting LVL., Methods: This community-based screening study was conducted in Taiwan. HBV DNA was assayed in HBsAg carriers. Participants were randomized to training and validation sets to determine the ability of qHBsAg to predict LVL. Receiver operating characteristic curves were used to identify the best cutoff values in the training set., Results: Among the 2919 participants, 359 (12.2%) were HBsAg carriers. There were 132 and 137 carriers in the training and validation sets, respectively. Significant correlations were found between qHBsAg and HBV DNA in both training and validation sets. Thirty and 29 participants with qHBsAg <8 IU/mL in the training and validation sets, respectively, had LVL. Using 8 IU/mL as the cutoff, negative predictive value (NPV) of qHBsAg for HBV DNA levels >2000 IU/mL was 100%. The best cutoff level of qHBsAg to predict HBV LVL was 200 IU/mL, with a sensitivity, specificity, and accuracy of 75.0%, 76.1%, and 75.8%, respectively, in the training set. The positive predictive value and NPV were 70.0% and 77.9%, respectively, in the validation set., Conclusion: Approximately 60% of HBsAg carriers had HBV LVL, and qHBsAg <8 IU/mL accurately predicts LVL. This quantitative test provides additional information for community-based screening., Competing Interests: Declaration of Competing Interest All authors declare no conflicts of interest., (Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Diabetes mellitus is a known risk factor for infection. Pay for Performance (P4P) program is designed to enhance the comprehensive patient care. The aim of this study is to evaluate the effect of the P4P program on infection incidence in type 2 diabetic patients., Methods: This is a retrospective longitudinal cohort study using data from the National Health Insurance Research Database in Taiwan. Diabetic patients between 1 January 2002 and 31 December 2013 were included. Primary outcomes analyzed were patient emergency room (ER) infection events and deaths., Results: After propensity score matching, there were 337,184 patients in both the P4P and non-P4P cohort. The results showed that patients' completing one-year P4P program was associated with a decreased risk of any ER infection event (27.2% vs. 29%; subdistribution hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.86-0.88). While the number needed to treat was 58 for the non-P4P group, it dropped to 28 in the P4P group. The risk of infection-related death was significantly lower in the P4P group than in the non-P4P group (4.1% vs. 7.6%; HR 0.46, 95% CI 0.45-0.47). The effect of P4P on ER infection incidence and infection-related death was more apparent in the subgroups of patients who were female, had diabetes duration ≥5 years, chronic kidney disease, higher Charlson's Comorbidity Index scores and infection-related hospitalization in the previous 3 years., Conclusions: The P4P program might reduce risk of ER infection events and infection-related deaths in type 2 diabetic patients.

The COVID-19 pandemic has greatly impacted first-line medical staff as well as nursing-student clinical practicum programs. How to cooperate with the government's pandemic-prevention policies and reduce the gap between education and clinical practice represent significant challenges. In this paper, Chang Gung University of Science and Technology (CCUST) is used as an example to show how schools in Taiwan have effectively adapted the fundamentals of nursing practicum programs to the current pandemic using e-learning, group discussions, case analysis, clinical skill practice, and clinical case simulation scenario exercises. The program at CCUST both takes into account the safety of students and has achieved all critical nursing practice goals. After implementation of these adjustments, satisfaction among nursing students with the practicum environment and the clinical instructors was found to be significantly higher for the on-campus clinical practicum than for the off-campus clinical practicum. Furthermore, the results of qualitative data analyses show that nursing students in the on-campus practicum gained significant knowledge and experience and commented positively on their experience. For example, the students indicated that they were satisfied with the simulated clinical environment of the CCC, the teaching strategies and adaptability of the instructor, and the application of virtual reality scenario cases to enhance skill proficiency and learning outcomes. The adjusted nursing clinical practicum described in this paper may be used as a reference to ensure the quality of nursing clinical practicum programs is maintained during epidemics.

Background: Studies have shown that oral health is closely related to systemic diseases. Poor oral hygiene may lead to dental caries and periodontal disease and also increase the risk of cardiovascular disease. Patients with stroke have a possibility of recurrence, and good oral health is expected to benefit their general health. Nevertheless, nursing research exploring the oral health and oral hygiene behaviors of stroke patients has been rare., Purpose: To explore the factors significantly associated with oral health status and oral hygiene behaviors in patients with stroke., Methods: A cross-sectional research design with convenient sampling was used. Information on health promoting behaviors and oral health status was collected in a teaching hospital in southern Taiwan. A multivariate linear regression model was applied to explore the factors associated with oral health status in patients with stroke., Results: One hundred and eight-five patients with stroke were enrolled in this study. The average number of real teeth was 11.3 and the average score for oral health status was 4. The univariate analysis showed that being 65 years of age or older, having an education level below primary school, having a lower Barthel index score, having a higher modified Rankin scale score, not brushing and flossing, not having a regular tooth cleaning, having a lower of health promotion score, and having insufficient water intake levels were all associated with a worse oral health status. The stepwise regression analysis showed that factors affecting oral health status include health promotion behaviors, age, tooth brushing, and water intake, which, together, accounted for 28.5% of the total variance., Conclusions / Implications for Practice: The findings indicate that oral health status, oral hygiene behaviors, and health promoting behaviors are inadequate among patients with stroke. Clinicians should promote health-related behaviors early to their patients with stroke, specifically in terms of implementing proper oral hygiene behaviors in daily routine care.

In rapidly aging societies, it is commonly found that the limited number of remaining teeth in elders results in chewing difficulties that cause health problems and malnutrition. Surprisingly, even the latest high-tech oral medical care achieves health maintenance results that are inferior to those regularly achieved by healthy natural teeth. Oral health issues are particularly serious in rural areas. The literature supports a close association between oral hygiene and general health. Because oral microorganisms are known to cause infections and inflammation reactions, people with poor oral hygiene often have high incidences of periodontal disease and tooth loss and an even higher prevalence of cardiometabolic-related chronic diseases, poorer life quality, and higher mortality than their peers with better oral hygiene (Ma et al., 2017; Tsai et al., 2015; World Health Organization, 2018). Although promoting oral hygiene may be done on a minimal budget and with high efficacy, many people retain improper oral-hygiene concepts and behaviors. For instance, many do not recognize the relationship between real teeth and general health, brush their teeth for inadequate durations, and/or apply improper methods. Furthermore, many do not make use of the regular dental cleaning resources available through the National Health Insurance program, leading to poor oral hygiene care outcomes such as tooth decay in school-age children, periodontal disease and tooth loss in adulthood, and the current average of fewer than 20 real teeth in adults 65~80 years of age. All of these poor oral-hygiene realities lead to Taiwan falling far short of WHO oral-health-related goals. Based on the perspective of prevention and health promotion, this column presents the important role of the nursing profession in improving the quality of oral hygiene care through the three critical phases of life: school age, active adulthood, and elderly adulthood. We look to advance national oral hygiene in Taiwan to a standard exceeding that of the World Health Organization in order to demonstrate the practical benefit of Taiwan's two-decade-long National Health Insurance system.

Background: High-dose steroids and intravenous immunoglobulin (IVIG) are controversial treatments for pediatric patients with acute myocarditis. This study aimed to investigate their efficacies in the Taiwanese pediatric population., Methods: This study evaluated 5563 acute myocarditis patients from the Taiwan's National Health Insurance Research Database and identified 1542 pediatric patients hospitalized for acute myocarditis between January 1, 2001 and December 31, 2011. The exclusion criteria were age of > 11 years, associated cardiovascular comorbidities, autoimmune disease, malignancy before the index hospitalization, extracorporeal membrane oxygenation, intra-aortic balloon pumping, and dual therapy using IVIG and high-dose steroids., Results: After 2:1 propensity score matching, we identified 208 subjects without steroid therapy and 104 subjects who received high-dose steroids. The mean age in that cohort was 2.6 ± 2.9 years, and high-dose steroid therapy had no significant effects on major in-hospital complications and post-discharge outcomes. After 2:1 propensity score matching, we identified 178 subjects without IVIG therapy and 89 subjects who received IVIG. The mean age in that cohort was 2.0 ± 2.1 years, and IVIG had no significant effects on the major outcomes., Conclusions: The present study revealed that high-dose steroid or IVIG therapy had no significant effects on major in-hospital complications, late heart failure hospitalization, and long-term mortality.

Background: The promotion of healthy behaviors is a relevant issue worldwide, especially among adolescent populations, as this is the developmental stage where most unhealthy behaviors become ingrained., Purpose: The aim of this study was to analyze the psychometric properties of the Spanish version of the Adolescent Health Promotion Scale (AHPS) in a Chilean sample of early adolescents., Methods: The sample was composed of 1,156 adolescents aged 10-14 years from schools in San Felipe, Chile. Item structure was assessed using exploratory and confirmatory factor analyses; reliability was measured using Cronbach's alpha; and differences in terms of gender, age, and socioeconomic status (SES) were established using analysis of variance., Results: The analyses of item structure identified all of the six original factors (nutrition behaviors, health responsibility, social support, life appreciation, stress management and exercise behavior) as significant. However, eight items did not fit the Chilean population well. Therefore, the AHPS in Chile has been reduced to 32 items. The Cronbach's alpha of the 32-item Chilean AHPS was .95, with the subscale coefficients ranging from .76 to .94. In addition, female subjects performed better than male subjects, and individuals of higher SES scored higher than the middle and lower socioeconomic groups. No differences on AHPS scores were found in different age groups., Conclusions: The AHPS appears to have good psychometric properties in terms of item structure and reliability. Consistent with studies carried out in other countries, health promotion behavioral differences were observed in association with gender and SES. The results support the Chilean version of the AHPS as an appropriate instrument for measuring the health promotion behaviors of early adolescents in Chile and for comparing results with those from other countries.

Background and Objectives: The majority of patients with diabetes foot ulcer have peripheral arterial disease. The technique of near infrared spectroscopy (NIRS) used to monitor the dorsal foot blood circulation condition is by measuring the absorption differences between oxy-hemoglobin and deoxy-hemoglobin., Study Designs/materials and Methods: Patients with diabetic foot ulcer (DFU) treated in our wound care center were divided into two sub-groups based on the Duplex ultrasound or angiography. Patients with peripheral arterial disease (PAD) and non-peripheral arterial disease were divided into group A1 and A2, respectively. We applied wireless NIRS on patients' dorsal foot to assess the peripheral circulation by continuously detect the signal penetrating the tissue while patients were asked to do Buerger's exercise. The same procedure was also repeated on 15 healthy participants as control group B., Results: From January to August 2015, 30 patients with DFU (Group A) were enrolled in the study, 9 patients in Group A1 and 21 patients in Group A2. Tissue concentration of oxygenated hemoglobin (HbO2) in each group varied in a similar trend among five stages of Buerger's exercise. HbO2 concentration increases at post-exercise stages in all groups (P = 0.006 in Group A1, P = 0.223 in Group A2, P = 0.03 in Group B), however, there were significant difference in both pre- and post-exercise stages (P = 0.001 and P = 0.01, respectively) between Group A and B. Moreover, significant differences (P = 0.0009) of HbO2 were also found between Group A1 and A2 in pre-exercise status, but no significant difference (P = 0.294) was found in post-exercise status. Similar results were also found in total hemoglobin (Hb) concentration analyses., Conclusions: Buerger's exercise could increase peripheral HbO2 and total Hb circulation in patients with diabetes foot ulcer. The NIRS could continuously and quantitatively monitor real-time peripheral circulation in postural changes and is novel to rehabilitation program. A larger scale study to prove the accuracy of NIRS system in detecting peripheral circulation could be worthwhile. Lasers Surg. Med. 49:652-657, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

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.

Background: Family behavior models may influence health promoting conducts among adolescents., Aim: To determine the association between health promoting behaviors among parents and healthy behaviors of early adolescents., Material and Methods: Analysis of the baseline assessment of a longitudinal study of early adolescents in the city of San Felipe, Region of Valparaiso, Chile. Parents and their teenage children, attending 5th to 7th grade, from ten municipal schools, participated in this study. Self-reported questionnaires were used to assess healthy lifestyles, answered separately by parents and their children. Univariable and multivariable ordinal logistic regression analyses with complete data were carried out, using the students’ health promoting behaviors as dependent variables and the same behaviors among parents as the main predictors, controlling for other personal and family variables., Results: We contacted 1,035 parents and 682 consented to participate along with 560 students. The mean age of adolescents was 11.5 ± 1.2 years (49% females) The mean age of parents was 39.8 ± 8.8 years and 90% were women. The parental behaviors associated with teenage health promoting behaviors were eating vegetables (odds ratio (OR) = 1.22, p < 0.05), having breakfast (OR = 1.27, p < 0.05), do stretching exercises every day (OR = 1.19, p < 0.05) and take some time for relaxation (OR = 1.24, p < 0.05)., Conclusions: These results show an association between healthy behaviors among parents and these behaviors among their adolescent offspring.

Background: Smoking and alcohol use are risky behaviors that can start early in life., Aim: To determine the lifetime prevalence of tobacco and alcohol use in adolescents aged 10 to 14 years and related factors., Subjects and Methods: A survey about smoking and alcohol use was answered by 1,392 teenagers aged 10 to 14 years (46% women) from seven schools in a small city near Santiago. Personal, family, and school factors were evaluated through self-report scales. Smoking and alcohol use, as dichotomous dependent variables, were defined as having consumed any of these substances throughout life. Prevalence was calculated as percentages with 95% confidence intervals. Association analyses were conducted using multivariable logistic regression models., Results: Six and eleven percent of participants reported having smoked and used alcohol in their life, respectively. Smoking was associated with age, having behavioral problems, mothers’ smoking, perceiving that parents had drug problems, and not living with both parents. Alcohol use was mainly associated with age, having behavioral problems, perceiving that other students consumed drugs, alcohol use by both parents, and perceiving a lack of family support., Conclusions: Tobacco and alcohol use is highly prevalent in adolescents aged 10-14 years. There were common risk factors for smoking and alcohol use such as age and having behavioral problems, while other factors were more specific such as mothers’ smoking, or parental alcohol use.

Objectives: A community-based health promotion program (CBHP) might be beneficial for the elderly, but evidence is limited. We therefore examined the effect of a CBHP on change of lifestyle, physiological indicators and depression score among seniors in 2 rural areas., Methods: A prospective quasi-experimental design involved a total of 520 senior participants living in 6 rural villages, who were clustered and conveniently assigned to 2 intervention groups. Senior nursing students were the interveners for group 1 and community peer supporters for group 2. The primary outcome measure was the change in health-related behavior measured on the geriatric health promotion scale (GHPS). The secondary outcome comprised changes in the short form of the Chinese geriatric depression scale (CGDS-15), fasting blood sugar, total cholesterol, waist circumference and blood pressure. Paired-t test and analysis of covariance were used for statistical inspection., Results: Most of the participants were retired farmers or fishermen >75years of age who had little education. The total scores and all subscales of GHPS, along with some physiological indicators, improved significantly between pretest and post-test in both groups. After adjustment for confounders, intervention in group 1 was more effective than that in group 2 regarding self-protection behaviors. Systolic and diastolic blood pressure was significantly lower in group 2., Conclusions: CBHP programs are valuable for improving healthy lifestyle, fasting blood sugar, blood pressure and depression score among seniors. The low cost and effectiveness of incorporating multidisciplinary resources to help rural elders to maintain a healthy status and a healthier lifestyle., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Hepatitis C virus (HCV) infection is a serious disease worldwide and it leads to several serious hepatic sequels. Some studies find possible correlation between HCV and ischemic heart disease in retrospective observations. Based on lacked community-based evidence, the study aims to assess correlation between ischemic heart disease and chronic HCV infection via electrocardiogram (ECG) because its abnormalities is strongly associating with cardiovascular disease mortality., Methods: The population was from one community health examination in December 2010 in a southern village of Taiwan. A total of 9856 participants were evaluated and finally 5015 eligible residents with age older than 40 years were included. The baseline characteristics and laboratory data in nonischemic ECG and ischemic ECG groups were compared, and multivariate-adjusted analysis was used to evaluate the risks to ischemic ECG., Results: The higher prevalence of hypertension, metabolic syndrome and even HCV infection (25.3% versus 11.6%; P < 0.001) in ischemic ECG group than those in nonischemic ECG group. In the multivariate adjusted analysis, HCV infection would lead to a 1.759-fold risk to ischemic ECG when compared with non-HCV subjects., Conclusions: HCV was strongly associated with ischemic ECG findings in this community study, and it could be a nonconventional risk factor for coronary artery disease.

Background: Health-promoting behaviors are important to prevent diseases and prolong life in the population. People develop these behaviors throughout life. However, better benefits for health are obtained with an early development., Aim: To determine the prevalence of health-promoting behaviors among early adolescents and its associated factors., Material and Methods: Cross-sectional survey performed in 1,465 students of high, medium and low socio-economic status, attending fifth to eighth grades of schools located in a small Chilean city. Participants answered a questionnaire that gathered information about frequency of health-promoting behaviors such as health responsibility and nutrition, physical exercise and stress management, life appreciation, social support and different personal, school and familial factors., Results: A higher frequency of health-promoting behaviors was associated with better academic achievement, better school commitment, and higher perception of school membership. It also was associated with a better perception of health status and a higher conformity with physical appearance., Conclusions: Health promoting behaviors in these children are related to a better academic achievement and a higher integration with school environment.

Background: Peripheral arterial disease (PAD) is one of the major manifestations of systemic atherosclerosis and plays an important role in low-extremity amputation in type 2 diabetic patients. The aim of this study was to explore the prevalence and risk factors for asymptomatic PAD in type 2 diabetic community residents., Methods: This cross-sectional study enrolled 552 type 2 diabetic adults (232 men and 320 women) without subjective symptoms of intermittent claudication. We defined the PAD group as an ankle-brachial index (ABI) ≤ 0.90, and the normal group as an ABI 0.91-1.30. Their clinical characteristics, Michigan Neuropathy Screening Instrument (MNSI) scores and blood pressure were compared., Results: We discovered that 51 patients have asymptomatic PAD. Univariate logistic regression analysis revealed that age, history of stroke, longer duration of diabetes (> 10 years), unemployment or retirement, pulse pressure, systolic blood pressure, and high MNSI score (> 2) were risk factors for PAD. By multivariate logistic regression analysis, pulse pressure, high MNSI score, age, and history of stroke were independent risk factors with odds ratios (95% confidence intervals, CI) of 1.032 (1.012-1.053), 2.359 (1.274-4.370), 1.050 (1.010-1.091), and 5.152 (1.985-13.368), respectively. Furthermore, the prevalence of PAD increased significantly with increment in the pulse pressure and MNSI., Conclusions: In summary, the overall prevalence of asymptomatic PAD in the type 2 diabetic adults was 9.2%. Age, history of stroke, pulse pressure and MNSI score may provide important clinical information. Primary care physicians should be aware of asymptomatic patients with high pulse pressure and MNSI scores.

Background: Tainan City has the third highest prevalence of junior high school student obesity of all administrative districts in Taiwan. School nurses play an important role in promoting student health. Understanding the factors that significantly impact student weight is critical to designing effective student health promotion programs., Purpose: This study explored the relationships between health promotion behavior and serum biomarker variables and body size., Methods: Researchers used a cross-sectional descriptive study design and stratified cluster random sampling. Subjects were 7th graders who received an in-school health checkup with blood test at 41 public junior high schools in Tainan City between July 2010 and May 2011. Research instruments included the adolescent health promotion (AHP) scale, serum biochemical profile and BMI (body mass index). Obtained data were analyzed using descriptive and inferential statistics., Results: Of the 726 students who participated in this study, 22.2% were underweight and 23.8% were overweight or obese. Higher AHP scores correlated with better biomarkers and body size. Multivariate analysis found factors that increased the risk of being overweight included: being male, having a father with a relatively low level of education, playing video games frequently, and doing little or no exercise (odds ratio = 1.93, 1.75, 1.07, 1.04, respectively)., Implications for Practice: Participants with relatively healthy behaviors had better biomarkers and a lower risk of being overweight. Findings can support the development of evidence-based school programs to promote student health.

Health policies in many advanced countries have been revised and reformed to address increasing public healthcare demands and increasingly limited resources. Upgrading the quality and quantity of community healthcare is the most effective solution. Implementation of the National Health Insurance system in Taiwan has introduced instability into the medical system, as insurance premiums no longer correspond to healthcare demand, Taiwanese live inadequately healthy lifestyles, and expectations of the healthcare system continue to grow. Community nursing now faces many challenges at this historic crossroads. This paper tries to analyze factors in the domestic and international environment that affect Taiwan's national community healthcare. These include changes in population structure, adjustment of governmental policies, the implementation of nursing and medical regulations, and consensus among nursing professional groups. The authors hope to anticipate the trends and prospects and advantages and opportunities in community healthcare in the coming decade in order to help our community healthcare partners prepare a good foundation and establish a model for the national healthcare system and nursing profession.

Over the past three decades, chronic disease has replaced communicable disease as the leading collective cause of death in Taiwan. As a result, medical and public healthcare manpower and budgets dedicated to communicable diseases have been reduced. The 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) changed government epidemic prevention policies and marked a renewed focus on preventing and controlling communicable diseases. This study introduces Taiwan's communicable disease control system and reforms, the domestic status of communicable diseases, the infection control policies of Japanese colonial authorities in the early 20th century, and national / community-level communicable disease control mechanisms in place before and after 2003. This paper further examines the actual health management conditions in a county in southern Taiwan to show how the public health system is rooted in communities, how infection control strategies are promoted, and how social organizations influence community life and mores.

Objectives: The incidence and mortality rate of cervical cancer in Taiwan are higher than in other developed countries. This study aimed to explore women's responses and actions after receiving their test reports and their practice of health-promoting behaviors., Design: This study employed a cross-sectional descriptive design., Sample: A convenient sample of 101 women living in a rural area., Measurements: Demographic characteristics, semistructured questions and Chinese Adult Health Promotion scale were used in this study., Results: The mode of the duration of their marriages was 20 years. Nearly 14% were diagnosed as precancerous and underwent further treatment. 24 percent of the women took no action during the 3 months after receiving the results. As many as 96% of the participants were not aware of the 90% 5-year survival rate for localized cervical cancer. From semistructured interviews, 4 behavioral responses and 5 actions were identified. Notably, many women in this study practiced health-promoting behaviors for health responsibility, regular exercise and stress management with low frequency., Conclusions: These analytical results may prove useful in developing intervention strategies to assist women with positive Papanicolaou test results to choose treatment modalities and adopt healthy behaviors.

Nurses understand that protecting the health of the general public represents one of their core responsibilities. In recent years, health promotion policies and strategies have been treated as critical components in overall efforts to enhance the holistic health of the nation. This study investigated the roles and influences of nurses in health promotion. Our paper introduces the history of health promotion, studies on improvements in healthy behavior attributable to evidence-based health promotion activities, and the roles and influences of nurses in health promotion. The authors hope this study can help confirm the critical role played by nurses in making health promotion activities effective in improving the overall health of the nation. Also, study results can help nurses self-check themselves to confirm whether they are maximizing their own potential as role models for healthy behavior. Does a healthy image exist for nursing professionals in Taiwan? Let us remind each other of this important objective and work together to "do what we say and say what we do" in health promotion.

The purpose of this study was to examine the health promoting behaviors and associated factors among patients who visited a health promotion center to receive nursing counseling. A cross-sectional survey and convenience sampling were applied in this study. Four hundred visitors to a medical center in northern Taiwan participated in the investigation. The results showed that: (1) The majority of participants were female, working, married, had a mean age of 41.5 years old, and were educated to college level. More than half of them had a religious belief, and most of them did not smoke, chew betel nut or drink alcohol; nearly one-third were overweight or obese. (2) Among the 40 items, there were nine behaviors categorized as high frequency, e.g. eating breakfast, maintaining good relationships etc. Four behaviors were categorized as low frequency, e.g. discuss with health personnel, check pulse rate when I do exercise, etc. (3) The demographic characteristics showed that those who worked, were married, more than 40 years old, and did not smoke had significantly higher scores on health promoting behaviors than their counterpart group. (4) The regression analysis showed that the higher the frequency of eating breakfast, the higher the age group, and the higher the educational level, and that unemployment explained the total variance of 14.6% in health promoting behavior. These findings will be an important reference for the implementation of health promoting programs for hospital visitors.

Taiwan has good support systems for obesity prevention and management. The percentage of elementary school students with normal body weight, however, has undergone a sustained decrease to 55%. Many factors are associated with this trend, such as lack of physical activity, dissatisfaction with body image, unbalanced dietary pattern, and unsupportive environment. Even though the rate of overweight and obesity is under control, the rate of underweight among girls has undergone a sustained increase, to 28%. Nurses therefore organized the "Aid students to fit" project, which emphasizes the bipolar issue of overweight and underweight. This national project is sponsored by the Ministry of Education and is expected to establish a beneficial environment, in which students can easily adopt healthy lifestyles and increase self-esteem. The program incorporates the AID triangle concept (Active, Image, Diet) and five strategies for achieving the goals. These strategies are: 1. Develop a persuasive statement to fit in with the philosophies of parents, students and teachers. 2. Set up measurable behavior indices and slogans. (Active life: 210 minutes per week. Image: confident and elegant. Diet: balanced and wise choice of low fat and high fiber foods.) 3. Establish a nation-wide interactive surveillance system for body weight control. 4. Develop an internet system that emphasizes tailored case management for overweight students. 5. Develop a supportive teaching plan, material, and aids to promote a healthy school environment. Five modeling schools, moreover, can be used to demonstrate the program. Educators can also download a free teaching plan, material, and aids at the website for healthy weight management (www.ym.edu.tw/active/aid). The authors brought together scholars from eight universities to accomplish the program. In support of the program, the Taiwan Ministry of Education addressed the new recommendation for physical activity which is to engage in moderate intensity physical activity every day for 30 minutes. We also shared this unique Asian experience at the round table discussion addressing the practical and policy issues of implementing public health strategies to reduce physical inactivity and prevent obesity in children. This was hosted by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) Collaborating Center for Physical Activity in order to establish declarations and recommendations for the prevention of obesity in children.

Objective: To explore health-related behaviors among adolescent mothers living in the rural area of Taoyuan, Taiwan., Design: A cross-sectional descriptive design and nonrandom survey method were used., Sample: The sample consisted of 37 adolescent mothers, identified by public health nurses., Measurements: Standardized interview and Adolescent Health Promotion (AHP) questionnaire., Results: Findings revealed a pattern of economic disadvantage. Nearly half of the participants still lived with their biological parents. Two-thirds needed economic support from their parents (generally coming from their biological mother). Thirty-five percent of participants reported never using contraceptives, two-thirds had never had a Pap smear, and 44% did not breast-feed their infants. Nearly 60% of the children were cared for by the biological mothers of the participants. Adolescent mothers with high school education, and who were employed, married, and received parental economic support had better health-related behaviors than adolescent mothers without these characteristics., Conclusions: Although the study sample has geographic limitations, future international studies with similar populations of adolescent mothers in rural settings will help public health nurses understand adolescent mothers' stressors and needs which in turn affect their health-related behaviors. Intervention strategies are needed to encourage behaviors to keep this population healthy.

The purposes of this study were to (a) develop a teaching course on health promotion for nursing students in Taiwan, (b) evaluate the effects of this teaching course, and (c) understand students' appraisals of its effectiveness in helping them to change unhealthy behavior. A sample of 65 randomly selected female nursing students took an 18-week course developed by the investigators, which included 30 h of classroom lectures and 4 weeks of written reports by students chronicling the changes in their behavior. Health promotion questionnaires administered before and after the course and content analysis of the students' reports were used to evaluate the effects of the course. Students' questionnaire scores after course completion indicated significantly increased intent to adopt healthy lifestyles. Content analysis of students' reports on their personal behavior-changing experiences showed that they accepted the potential value of curriculum aspects such as experiencing the struggle, suffering, and even abandonment of the process, experiencing the benefits of change, increasing self-confidence, and empathizing with how difficult it is for clients to change behavior. These results support the value of teaching courses on health promotion to nursing students. The authors recommend including such a course as part of a regular nursing education.

Background: The mortality rate and prevalence for some chronic diseases are higher for aborigines compared with the rest of the Taiwanese population. Health professionals in many countries have been concerned with the health of aborigines, but specific health policies for native adolescents have been neglected., Aims: This paper reports a study comparing the general health status of aborigines and non-aborigine female adolescents, based on school enrollment health examinations., Methods: A cross-sectional prevalence study with between group comparison was conducted. School enrollment health files were accessed between September 2000 and June 2001. A total of 320 selected female aboriginal students were compared with 237 non-aborigines., Results: With the exception of eye problems, general health status was inferior for the aboriginal female adolescent students. They had lower mean red blood cell volumes, lower haemoglobin concentrations, more oral decay, a greater prevalence of hepatitis B virus carriers and were more likely to be overweight., Conclusions: It seems reasonable to suggest that health intervention strategies specific for indigenous adolescents should be provided. The design of these strategies should target lifestyle modification and provision of more accessible health information. Health professionals, and particularly nurses, are in a prime position to offer advice and support to this group.