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Background: Although the use of physical restraints (PR) is a very common strategy used in hospitals, this strategy poses significant psychological and emotional drawbacks. Moreover, nurses may feel guilt or overestimate the benefits of using PR. Previous studies have indicated that an education program may ameliorate patient safety and thus minimize the negative aspects of PR use. No hospital-based intervention study on this topic has previously been conducted in Taiwan. Purpose: This study evaluates the effects of education programs on nursing staff in terms of improving PR-use knowledge, attitudes, and behaviors. Methods: This quasi-experimental study used a pre-post testing research design and used purpose sampling to recruit nurses working at two teaching hospitals in northern Taiwan (N = 380). We used PR guideline handbooks for eight sessions and conducted an education program and a group lesson for 2 hours during one session. We adopted the scale of knowledge, attitude, and behavior of PR to collect data at baseline (T1), at four-week immediate post-program (T2), and at three months follow-up (T3). SPSS/PC 20.0 analyzed data using repeated measures ANCOVA. Results: The intervention significantly improved knowledge (M = -7.13, p < .01) and altered both the attitudes toward PR use (M = -0.08, p < .001) and the behaviors toward PR use (M = -0.11, p < .01) of the participants in the first pre-post measurement. Additionally, the second pre-post measurement realized similar and significant improvements. The results indicate that, despite differences in length of work, unit of work, and participant ages, the PR intervention program significantly improved scores in knowledge, attitudes, and behaviors toward PR use. Conclusions / Implications for Practice: A thorough education program may improve staff knowledge, attitudes and behaviors related to using PR. These findings may guide future hospital training by promoting knowledge on the use of PR in clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to explore the effectiveness of fish-assisted therapy (FAT) program in improving multidimensional observation index, depression, and behavioral goal attainment of residents in a nursing home. Methods: A experimental design was used in this study. Residents of a nursing home in the northern part of Taiwan were recruited randomly. The FAT program was provided to 16 residents as the experimental group for 5 weeks (two days per week, two sessions per day, and 30 min/ per session). Other 16 patients in the control group continued their regular daily care activities. Research instruments included Multi-dimensional Observation Scale of Elderly Subjects (MOSES), Geriatric Depression Scale (GDS), and scale of individualized goals. The effectiveness FAT intervention was analyzed (fifth week, and one month later) by using Generalized Estimating Equation (GEE) approach. Results: After being controlled the confounding variables (cognitive and physical function), the results showed that residents in the experimental group had statistical significant in "withdraw behavior" of MOSES (β=3.08 SE=1.02 Waldχ² = 9.04 > P<0.001), and their "social function" (β=-68.74 SE=8.89 P 0.001) had the growth effect (β=44.73 SE=15.96 > P=0.005), the efficiency (β=44.73 SE=15.96 > P=0.005 at 5th weeks), and the delayed effect (β=30.66 - SE=11.15 P=0.006). All these variables showed statistical significance. However, there were not significant differences in residents' "depression", "motion ability", and "spoken ability" between two groups. Conclusion: This study indicates the effectiveness of the Fish-Assisted Therapy (FAT) program in elder residents, and also recommends to implement this program for activity design and care strategy for residents in nursing home as an intervention reference. [ABSTRACT FROM AUTHOR]

Background: Previous studies of institutionalized chronic schizophrenia patients have developed intervention activities designed to improve social interaction, depressive mood, and quality of life. Few interventions have been designed to improve the cognitive functions and apathy in this patient population. Objectives: The purpose of this study was to explore the effectiveness of a physical and mental functional activation program (PMFAP) in improving the apathy, depressive mood, and cognitive functions of institutionalized chronic schizophrenia patients. Methods: This quasi-experimental study used purposive sampling to recruit chronic schizophrenia patients (N = 77) at two institutions in Taipei, northern Taiwan. The PMFAP was provided to 43 patients in the experimental group for 3 months (90 minutes per week). The 34 patients in the control group continued their regular daily activities. The completion rate for participants in this study was 62.3% (experimental group: 34; control group: 14). The SPSS 17.0 software package for Windows was used to conduct non-parametric statistical analyses. Residents with chronic schizophrenia in the experimental group earned statistically significant improvements in terms of the orientation (X2 = 8.78, p = .032) and the constructive ability (X2 = 10.13, p = .016) dimensions of cognitive function as well as depressive mood (X2 = 13.71, p < .001). A posttest comparison found significant differences between the two groups in terms of cognitive function (Z = 2.67, p = .010) and depressive mood (Z = -4.10, p = .010). Conclusion: The results of this study indicate that the PMFAP intervention program improves the cognitive functions and depressive mood of institutionalized chronic schizophrenia patients. Therefore, we suggest implementing this program with patients with chronic schizophrenia to both improve symptoms and delay degeneration. Future studies should extend the follow-up time to assess the efficacy of the intervention over longer time periods. [ABSTRACT FROM AUTHOR]

Objectives: One objective of this study was to assess the effects of laughter on the psychological, immunological and physiological systems of the body. Another objective was to introduce the Laughing Qigong Program (LQP), as a method of standardization for simulated laughter interventions. Design: A randomized, prospective, experimental study of the LQP was conducted in a group of adolescents (n = 67) in Taiwan. During study-hall sessions, experimental subjects (n = 34) attended the LQP for eight-weeks. Simultaneously, control subjects (n = 33) read or did their homework. All subjects were tested before and after the intervention on the following: Rosenberg Self-Esteem scale (RSE), Chinese Humor Scale (CHS) and Face Scale (FS) as psychological markers; saliva cortisol (CS) as an immunological marker; blood pressure (BP), heart rate (HR), and heart rate variability (HRV) as physiological markers of the body's response to stress. Mood states (FS) were measured before/after each LQP session. Results: Mood states (p = .00) and humor (p = .004; p = .003) improved in the experimental group; no significant changes were found in the controls (p = 69; p = 60). The immunological marker of stress, cortisol levels, decreased significantly for those who participated in the LQP (p = .001), suggesting lower levels of stress after completion of the program. Conclusions: The LQP is a non-pharmacological and cost-effective means to help adolescents mitigate stresses in their everyday life. [ABSTRACT FROM AUTHOR]

Osteopaenia commonly occurs in preterm infants; however, its diagnosis is often delayed when based on radiological findings. The aim of this study was to examine whether serial measurements of bone turnover markers are useful for early prediction of osteopaenia in preterm infants. Premature infants of ≤34 weeks gestation were enrolled. Serum alkaline phosphatase (ALP), bone form ALP (BALP), calcium and inorganic phosphate were concurrently measured biweekly from 3 weeks post-natal age until 40 weeks post-conceptional age. Radiographic examination of the forearm was performed at term age. Osteopaenia was defined as positive radiographic findings according to Koo's criteria. Of the 46 premature infants completing the follow-up study at term age, 18 showed osteopaenia in radiographic examination. Serum ALP was highly correlated with BALP ( R = 0.93, P < 0.001). Infants who had osteopaenia showed a higher level of ALP and BALP after 3 weeks post-natal age than those who had no osteopaenia. ALP concentration exceeding 700 IU/L at 3 weeks post-natal age was predictive of osteopaenia at term age (sensitivity 73% and specificity 73%) and so did for the predictive value of BALP concentration exceeding 95 ug/L (sensitivity 73% and specificity 80%). BALP measures provided no greater benefit of diagnostic performance than ALP in early detection of osteopaenia. Furthermore, premature infants with osteopaenia showed similar levels of calcium and inorganic phosphatase concentration compared with those without. Serum ALP concentration exceeding 700 IU/L at 3 weeks post-natal age can predict the risk of osteopaenia in preterm infants. [ABSTRACT FROM AUTHOR]

Introduction: Maternal environmental tobacco smoke (ETS) has been identified as a key risk factor for problem behavior in children, but the role of genetic susceptibility is not clear. The purpose of this study was to examine the metabolic genetic modification effect of exposure to ETS in nonsmoking mothers on child behavior at 2 years of age. Methods: A prospective cohort study was conducted among 191 mothers who gave births between 2004 and 2005 and their infants in Taiwan. The mothers completed a questionnaire before delivery in which they provided information on exposure to ETS during pregnancy. Four metabolic genes, CYP1A1 MspI, CYP1A1 Ile462Val, GSTT1, and GSTM1 were isolated from both maternal and infant DNA samples. Children’s behavior problems at 2 years of age were reported by their mothers using the Child Behavior Checklist/1.5–5. Multiple linear models were used to estimate the effects of ETS and genotype on child behavior. Results: Maternal ETS exposure was associated with the anxious score. The ETS-exposed group with both the CYP1A1 MspI and the CYP1A1 Ile462Val variants had higher scores, as reflected in total CBCL score as well as scores on the internalizing scale and its emotional subdomain, the anxious scale, and the externalizing scale and its aggressive subdomain. Conclusions: Child behavioral problems may be associated with prenatal ETS exposure, and this effect may be modified by infant CYP1A1 MspI and CYP1A1 Ile462Val genes. [ABSTRACT FROM PUBLISHER]

Background: The purpose of this study was to explore risk factors, including age at menarche, body mass index (BMI), psychiatric stress and physical exercise on the menstrual cycle of healthy Taiwanese college nursing students. Methods: We conducted a cross-sectional survey involving 1300 female college students in the nursing curriculum between December 2002 and March 2003. We provided a structured questionnaire for each student. Information on the women’s demographics, lifestyles and reproductive history related to menstrual cycle characteristics was requested. A total of 1095 healthy students were included in the analysis. A logistic regression was used to estimate the odds ratios for each of the menstrual cycle characteristics. Results: We found that age at menarche, BMI and psychiatric stress were associated with menstrual cycle characteristics in healthy college nursing students. In addition to menarche at the age of 14 years or later, obesity and psychological stress, menarche before 12 years of age was an important risk factor for menstrual dysfunction. Moreover, obese students had the highest risk of having a longer cycle and cycle irregularity. Conclusions: Early menarche might be related to menstrual dysfunction in addition to late menarche, obesity and psychological stress. Moreover, obese students are at the highest risks for longer cycles and cycle irregularity. [ABSTRACT FROM AUTHOR]

Aim: Reference ranges of haematological parameters in preterm infants are limited. The aim of this study is to determine the reference values of haematological parameters in preterm infants in Taiwan, and to assess the impact of gestational age and mode of delivery on these parameters. Method: Medical records were retrospectively reviewed in preterm infants admitted to National Taiwan University Hospital from January 2001 to December 2004. The inclusion criteria included infants with <37 weeks of gestation who had blood sampling within 24 h of birth. The exclusion criteria included those with maternal history of antepartum haemorrhage, chorioamnionitis, fever, sepsis, preeclampsia and hypertension; and perinatal history of twin-to-twin transfusion syndrome, feto-maternal transfusion, injury and infection. Results: Of 568 preterm infants with blood cell counts, 337 were available for analysis. There were trends of increase in red blood cell counts, haemoglobin levels and haematocrit values as gestation increased up to 34 weeks. In contrast, a trend of decrease was noted in mean corpuscular volume values. There was an initial trend of decrease in white blood cell counts and then increased after 31 weeks gestation. The platelet counts were essentially unchanged. Infants born by vaginal delivery generally had higher haematological parameters than those born by Caesarean section at different gestational ages except for mean corpuscular volume values. Conclusions: We established the reference ranges of haematological parameters in Taiwanese preterm infants. Health-care professionals must be cautious in clinical application of the haematological values because of varying antenatal and perinatal risk factors. [ABSTRACT FROM AUTHOR]

Human interleukin-15 (hIL15) has anti-tumor activities, but it is not convenient for tumor treatment because of its short half-life. A gene therapy for mouse lung cancer using an adenovirus vector expressing IL15 has been reported. However, adenovirus vector-mediated gene therapy can provoke cellular toxicity and inflammatory reactions. The recombinant adenovirus-associated vector 2 (rAAV2) is safer due to minimal cellular toxicity and immune response. In order to demonstrate that gene therapy can be used safely and successfully for human cancer treatment, the rAAV2 expressing hIL15 gene (rAAV2-hIL15) is applied for human cervical cancer, HeLa cell, in this study. This study successfully demonstrates that rAAV2-hIL15 can express IL15 with bioactivities in vitro and in vivo. In conclusion, our studies show that human cervical cancers are inhibited on animal model with rAAV2-hIL15 treatment and provide a safer and important reference for human cancer gene therapy. [ABSTRACT FROM AUTHOR]

Abstract  This study aimed to evaluate the efficacy of hydrodistention (HD) and bladder training for interstitial cystitis (IC). From 1997 to 2006, 361 consecutive IC patients were treated by HD, followed by bladder training. Each patient was followed up using a diary for 8 weeks after HD weekly and monthly thereafter. The efficacy of the treatment was evaluated using the average of the voided volumes and the voiding frequency. The mean ± standard deviation of the pre-HD daytime voided volumes and voiding frequency were 110.0 ± 47.0 ml and 14.7 ± 11.0, respectively. Furthermore, the nocturnal values were 173.1 ± 91.8 ml and 2.8 ± 1.7, respectively. After 72 weeks post-HD, the 185 patients who completed the follow-up had volumes/frequency of daytime, 306.5 ± 80 ml and 6.9 ± 2.1, respectively, and nocturnal, 325.8 ± 122.4 ml and 1.3 ± 0.6, respectively. The implementation of HD and bladder training is crucially important for long-term remission among IC patients. [ABSTRACT FROM AUTHOR]

Aim: The living style, health-care system and socio-economic environments have changed substantially in Taiwan over past 20 years. This study was aimed to estimate the current perinatal cytomegalovirus (CMV) seroprevalence in northern Taiwan. Methods: In a Taiwan Birth Panel Study, 483 pairs of mothers and neonates were prospectively recruited from one tertiary medical center, one local hospital, and two obstetric clinics located in northern Taiwan from April 2004 through January 2005. Sera of their paired maternal and cord blood were tested by an enzyme-linked immunosorbent assay method for CMV IgG and IgM antibodies. Additional data were collected for health measures and epidemiological characteristics through trained interviewers utilising structured questionnaires. Results: Among 483 mothers studied, 93% were Taiwanese, 6.4% were immigrants from the south-eastern Asia and Mainland China, and 0.6% was aborigines. The seropositive rate of CMV IgG and IgM among the mothers was 91.1% and 3.5%, respectively. The immigrant mothers and the mothers younger than 20 years of age had a higher IgM seroprevalence ( P < 0.05). Furthermore, 90.8% of the offspring had CMV IgG seropositivity and yet none of the neonates were CMV IgM positive. Conclusion: The seroprevalence of CMV among childbearing women is high in northern Taiwan. The immigrant mothers and the teenage mothers appear to have higher seropositivity of CMV IgM. [ABSTRACT FROM AUTHOR]

Background: Human mast cells are multifunctional cells capable of a wide variety of inflammatory responses. Baicalein (BAI), isolated from the traditional Chinese herbal medicine Huangqin (Scutellaria baicalensis Georgi), has been shown to have anti-inflammatory effects. We examined its effects and mechanisms on the expression of inflammatory cytokines in an IL-1β- and TNF-α-activated human mast cell line, HMC-1. Methods: HMC-1 cells were stimulated either with IL-1β (10 ng/ml) or TNF-α (100 U/ml) in the presence or absence of BAI. We assessed the expression of IL-6, IL-8, and MCP-1 by ELISA and RT-PCR, NF-κB activation by electrophoretic mobility shift assay (EMSA), and IκBα activation by Western blot. Results: BAI (1.8 to 30 &mico;M) significantly inhibited production of IL-6, IL-8, and MCP-1 in a dose-dependent manner in IL-1β-activated HMC-1. BAI (30 µM) also significantly inhibited production of IL-6, IL-8, and MCP-1 in TNF-α-activated HMC-1. Inhibitory effects appear to involve the NF-κB pathway. BAI inhibited NF-κB activation in IL-1β- and TNF-α-activated HMC-1. Furthermore, BAI increased cytoplasmic IκBα proteins in IL-1β- and TNF-α-activated HMC-1. Conclusion: Our results showed that BAI inhibited the production of inflammatory cytokines through inhibition of NF-κB activation and IκBα phosphorylation and degradation in human mast cells. This inhibitory effect of BAI on the expression of inflammatory cytokines suggests its usefulness in the development of novel anti-inflammatory therapies. [ABSTRACT FROM AUTHOR]

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant disease characterized by the development of multiple hamartomas in many internal organs. Mutations in either one of 2 genes, TSC1 and TSC2, have been attributed to the development of TSC. More than two-thirds of TSC patients are sporadic cases, and a wide variety of mutations in the coding region of the TSC1 and TSC2 genes have been reported. Methods: Mutational analysis of TSC1 and TSC2 genes was performed in 84 Taiwanese TSC families using denaturing high-performance liquid chromatography (DHPLC) and direct sequencing. Results: Mutations were identified in a total of 64 (76 %) cases, including 9 TSC1 mutations (7 sporadic and 2 familial cases) and 55 TSC2 mutations (47 sporadic and 8 familial cases). Thirty-one of the 64 mutations found have not been described previously. The phenotype association is consistent with findings from other large studies, showing that disease resulting from mutations to TSC1 is less severe than disease due to TSC2 mutation. Conclusion: This study provides a representative picture of the distribution of mutations of the TSC1 and TSC2 genes in clinically ascertained TSC cases in the Taiwanese population. Although nearly half of the mutations identified were novel, the kinds and distribution of mutation were not different in this population compared to that seen in larger European and American studies. [ABSTRACT FROM AUTHOR]

The nursing profession has generally accepted humor as beneficial to health care. As nursing has always emphasized holistic care and the importance of individual needs, the profession values the ability of humor to positively affect all aspects of a patient's well being. The purposes of this study were to develop a "Chinese Humor Scale (CHS)" for the nursing profession and then test its reliability and validity. The 405 individuals selected for participation in this study included nursing on-the-job students from a medical university and professional nurses practicing at four hospitals in north Taiwan. Researchers developed a list of 57 key humor measures which were filled out and returned by study participants. An evaluation of results using Cronbach's alpha coefficients demonstrated good consistency (α = .93) for the developed CHS. Intercorrelations amongst the four sub-scales were generally quite low, indicating each sub-scale measures dimensions relatively distinct from one another (r = .24∼.48, both p's < .001). The CHS was tested using item analysis. The scale was constructed in accordance with exploratory factor analysis (EFA) (K.M.O. = .92). Thirty CHS items, categorized under the four indices of "humorous creativity", "tendency to laugh", "perceptivity to humor", and "humorous attitude", were found to explain 55.42% of total variances. The CHS was found to provide good validity using a content validity index (CVI) developed by five experts. The results of this study provide encouraging evidence for the construct validity and reliability of the proposed humor scale and support its application by nursing educators and clinicians to further test and assess concepts related to humor. Further research is needed to explore more fully the implications of humor in nursing. [ABSTRACT FROM AUTHOR]

Artemisia capillaris (A. capillaris) is a common herbal drug used for thousands years in ancient China. A. capillaris has been empirically used to manage hand-foot-mouth disease (HFMD), which is commonly caused by enterovirus 71 (EV71). EV71 can cause meningoencephalitis with mortality and neurologic sequelae without effective management. It is presently unknown whether A. capillaris is effective against EV71 infection. To test the hypothesis that it could protect cells from EV71-induced injury, a hot water extract of A. capillaris was tested in human foreskin fibroblast cells (CCFS-1/KMC) and human rhabdomyosarcoma cells (RD cells) by plaque reduction assay and flow cytometry. Inhibition of viral replication was examined by reverse quantitative RT-PCR (qRT-PCR). Its effect on translations of viral proteins (VP0, VP1, VP2, protease 2B and 3AB), and apoptotic proteins were examined by western blot. A. capillaris was dose-dependently effective against EV71 infection in both CCFS-1/KMC cells and RD cells by inhibiting viral internalization. However, A. capillaris was minimally effective on viral attachment, VP2 translation, and inhibition of virus-induced apoptosis. Further isolation of effective molecules is needed. In conclusion, A. capillaris has anti-EV71 activity mainly by inhibiting viral internalization. A. capillaris would be better to manage EV71 infection in combination with other agents.