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Population aging has caused a rise in the institutionalization, disability, and mortality rates of older adults worldwide. Older adults are able to engage in muscle training. Elastic band exercises can safely and effectively improve the upper and lower muscle strength and balance of older adults.This study was developed to examine the effects of a 3-month elastic band exercise program on the activities of daily living (ADLs), hand muscle strength, balance, and lower limb muscle strength of older adults living in institutional settings.This was a randomized controlled trial. Sixty-one participants were randomly sampled from two long-term care facilities (LTCFs) in northern Taiwan (31 participants in the experimental group and 30 participants in the control group). Both groups underwent pretesting concurrently. The experimental group participated in 3 months of elastic band exercises, whereas the control group participated in the routine exercise program in their LTCFs. All of the participants were tested 1 and 3 months after the intervention.The average ADL, hand muscle strength, balance, and lower limb muscle strength scores of participants in the experimental group had improved significantly more than those of the control group at posttest (all p s.05).Elastic band exercises positively affect ADLs, hand muscle strength, balance, and lower limb muscle strength in older adults living in LTCFs. Moreover, the high benefit-to-cost ratio of these exercises helps lower the threshold of health promotion. We recommend including elastic band exercises in routine activities and designing different elastic band exercises for older adults at different proficiency levels. Furthermore, an elastic band exercise network should be established to improve the policy and implementation aspects of elastic band activities, raise awareness among community-dwelling and institutionalized older adults, and promote elastic band exercises to LTCFs nationwide.

Background Aromatherapy is effective in treating pain; however, aromatherapy is not offered in formal nursing education in Taiwan. Methods This study designed aromatherapy training courses for nurses using the flipped teaching approach and explored the effectiveness of the method, which can serve as a reference for future aromatherapy courses. A quasi-experimental design and convenience sampling were adopted. Results The participants were nurses who had been employed for over one year in two hospitals in Taiwan. In the experimental group, 40 participants received 2.5 hours of flipped teaching. In the control group, 40 participants received a one-hour traditional teaching course. Pre- and post-test knowledge and self-efficacy in aromatherapy were assessed. There were no significant differences in the pre-test knowledge and self-efficacy scores between the two groups. The test was analyzed using a generalized estimating equation. Post-test knowledge and self-efficacy results showed that the change in scores in the experimental group was significantly better than that in the control group, indicating that flipped teaching improved the participants’ knowledge and self-efficacy in aromatherapy. Conclusions This study confirmed that flipped teaching was effective for helping nursing personnel learn aromatherapy. Implementation of aromatherapy by nurses in clinical practice and its impact on patient care should be further assessed.

Background The purpose of this study was to apply the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model to analyze the factors influencing preschool educators’ ability to teach health education through life skills. Methods This cross-sectional study utilized stratified random sampling and administered survey questionnaires to 503 preschool educators in public and private kindergartens in Taipei City and New Taipei City in 2019. Descriptive and hierarchical regression analyses were conducted. The PRECEDE model demonstrated a significant correlation between the enabling, reinforcing, and predisposing factors explored in this study and the preschool educators’ ability to teach health education through life skills. Results The variables explained 25% of the total variance in the ability to teach health education through life skills. When controlled in individual layers, the background variables and the enabling, reinforcing, and predisposing factors demonstrated explanatory powers of 6, 5, 7, and 7%, respectively, with respect to the ability to teach health education by utilizing life skills. Conclusions Enhancement of the enabling, reinforcing, and predisposing factors can improve preschool educators’ ability to teach health education through life skills. The support provided by the governmental policies for related training can facilitate the effective implementation of health promotion programs in kindergartens. Preschool educators must also receive on-the-job training to facilitate the effective transaction of the health education curriculum. Health classes centered on life skills in kindergartens are vital and must be incorporated into the curricula.

Background Down syndrome is a common chromosomal abnormality and prenatal screening can inform parents of the risk of their baby having Down syndrome. Little research has examined how decisions regarding both Down syndrome screening as well as diagnosis are made among women who are currently pregnant and how their decisions are influenced by their social contexts, specifically family and social media, using mixed methods. The study was to test the validity and reliability of a scale that measures pregnant women’s attitudes and decision-making concerning prenatal Down syndrome screening and diagnosis in urban areas of Taiwan. Methods We developed an item pool based on a literature review and in-depth interviews with 30 pregnant women recruited at two district hospitals in urban areas. The item pool was reviewed by a panel of experts and then administered to 300 women who had been pregnant for less than 24 weeks and had not received the Down syndrome screening tests. We used item analysis and exploratory factor analysis to validate the scale and test its reliability. Results The initial item pool had 54 items. After the expert review, three items were deleted. After the item analysis, 16 additional items were deleted. Exploratory factor analysis of the remaining items revealed four factors labeled – “Attitudes towards Down syndrome and Screening Tests,” “Important others’ Attitudes towards Down Syndrome,” “Influence of Important Others on Decision-Making,” and “Influence of Social Media on Decision-Making” – and 16 of the remaining items had satisfactory loadings on those factors, explaining 72.0% of the total variance. The Cronbach’s α values of the dimensions ranged between 0.75 and 0.90, demonstrating satisfactory internal reliability. Conclusions The scale has satisfactory validity and reliability, and can be used to understand pregnant women’s attitudes and decision-making regarding Down syndrome screening and diagnosis, and to help design tailored consultations for pregnant women in clinical settings.

Objective:The objective of this study was to examine the relationships between students’ perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity.Design:Cross-sectional study.Setting:Primary, middle and high schools in Taiwan.Participants:A nationally representative sample of 2433 primary school (5th–6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018.Results:Multivariate analysis results showed that after controlling for school level, gender and age, the students’ perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools’ campaigns promoting the eating of vegetables and fruit were positively associated with students’ consumption of vegetables. In addition, schools’ initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students’ engagement in outdoor physical activities and daily moderate-to-vigorous physical activity.Conclusions:Students’ perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

健康素養對健康狀態、健康不平等、醫療支出、醫療照護可近性、健康資訊的理解及醫療場域中的決定行為皆有重要影響。然而，目前健康素養的相關研究卻仍存在以醫療場域為背景及以成人為對象的問題，因此，本研究旨在以健康促進觀點建構青少年健康素養之定義與能力指標。本研究以國中三年級學生及高中職三年級學生為指標發展之目標對象，為能建立青少年健康生活情境之基礎資料，故訪談青少年及與其生活情境相關之重要他人，共 85 名青少年、23 名家長與 34 名教師，並同步參酌國中與高中職健康教育教學相關能力指標，發展青少年健康素養之定義與能力指標，由八位健康教育相關背景之專家學者及八位資深的健康教育教師，進行兩回合的德懷術後定稿。本研究發展出青少年功能性、互動性及批判性健康素養之定義，並依其定義發展出青少年健康素養能力指標共 56 項；在個別指標部分，適用國中階段之指標 13 項，適用高中職階段之指標 18 項，共用指標部分共 25 項，指標內容共涵蓋10 個健康議題。由於本研究之健康素養定義與能力指標之發展乃依據青少年之真實生活情境，也同步考量國家健康教育課程綱要，故可作為健康素養測量工具發展及教學介入策略之重要參考依據。 Research has demonstrated that health literacy significantly affects health status, health inequality, medical expenses, accessibility of medical care, understanding of health information, and decision-making behavior. However, most studies on the topic of health literacy have focused on adults and are based on a medical perspective. This study proposed a definition of health literacy and an ability indicator for adolescents. The target study population were students in their third year of junior and senior high school. Thirty-four teachers, 23 parents, and 85 adolescents were interviewed to collect data concerning the real-life context of adolescents. The collected data and national health education curriculum guildines were used as a reference to develop health literacy definitions and abilities. Eight health education experts and eight senior teachers were invited to conduct a two-round Delphi survey. Based on the 3 types of adolescent health literacy (functional, interactive, and critical health literacy), this study developed health literacy definitions and 56 abilities (10 for the junior high indicator, 18 for the senior high indicator, and 28 for the junior and senior high indicator) covering 10 issues. The definitions and ability indicators in this study were developed on the basis of real-life adolescent contexts and considered Taiwan’s health education guildines. Therefore, the results can serve as a valuable reference for developing health literacy measurement instruments or intervention programs.

Background: Preschool educators who facilitate life skills health education have an important role. Limited research has explored the comprehensive content and strategies of courses related to health education in kindergarten. The aim of this study is to create a questionnaire scale suitable for assessing preschool educators' capacity for life skills health education in Taipei, Taiwan. Methods: A cross-sectional study design was used to explore and assess life skills health education as a teaching approach for preschool educators. The scale was developed in three steps. The first step was to create a draft questionnaire that passed a validation review by 9 experts. The second step was a pretest (N=128) with category analysis and exploratory factor analysis (EFA) to create the formal version of the scale. The dimension analysis of the scale to assess the life skills health education capacity of preschool educators in kindergartens included cognition, attitude and self-efficacy. The third step was official testing (N=503), in which the efficacy criterion correlation validity test showed good simultaneous validity and discrimination. Results: The first draft of the pretest analysis contained 45 initial questions; 38 questions remained after 7 questions were deleted based on the EFA. According to the theoretical framework and after deleting 8 items that did not conform to the standard, a total of 30 questions were included in the formal scale. The two factors in the cognitive subscale were "health-promoting kindergarten" and "life skills teaching" for a total of 9 questions, and the two factors in the attitude subscale were "perceived benefits" and "perceived barriers" for a total of 11 questions. The three factors of the self-efficacy subscale were "adaptability and self-management ability", "decision-making and critical thinking ability" and "communication and interpersonal communication ability" for a total of 10 questions. Cronbach's α coefficient for each subscale fell in the range of .813 to .936. Conclusions: This scale has satisfactory reliability and validity and can be administered to assess the outcomes of pedagogical training for life skills health education for preschool educators in health-promoting kindergartens.

Objective: This study assessed school principals’ understanding, attitudes and willingness to influence the implementation of the health-promoting schools (HPS) programme in Taiwan and teachers’ willingness to sustain it. Method: In 2014, a total of 1,140 school principals and 1,110 teachers (HPS coordinators) completed questionnaires concerning their perspectives on implementation and sustainability. Results: Compared with teachers, school principals reported higher levels of willingness to sustain HPS implementation. School principals’ levels of understanding of HPS and willingness to sustain it were significantly associated with higher levels of HPS implementation and an increase in teachers’ willingness to sustain HPS implementation. Conclusion: School principals’ understanding and willingness to support are central to the effective implementation and sustainability of initiatives such as HPS.

Background: Poor glycemic control in patients with diabetes mellitus can increase associated complications and mortality. We use the telehomecare system in patients with diabetes and investigate the associated impact in clinical practice. Materials and Methods: The purpose of the study is to examine the effectiveness of the telehomecare system on diabetic self-care. The telehomecare system incorporated into the daily care program in the experimental group. A cloud health-care platform designed for information storage and exchange be constructed and monitored by case managers. Comprehensive care instructions and in-time consultation in case of abnormalities were provided. The patients in the control group adopted conventional care program. Self-care questionnaires were completed by both groups before and after the study. All participants measured before the experiment and at 4 months after. Results: The participants were 117 patients (including 56 at the experimental and 61 at the control group), which recruited from a community hospital in New Taipei city, Taiwan. In two-way mixed design ANCOVA, in self-care behaviors, there are significant differences between two groups. The outcome of experimental group is superior to the control group both in posttest. However, there is no significant difference between two groups in subscales of foot care and athletics care. Moreover, there is no delayed effect in self-care behaviors of drug adjustment and blood sugar surveillance. Conclusions: This observational study revealed early intervention model to the health education strategy, the telehomecare might strengthen self-care behaviors of the participants. To the future study, we can put emphasis on the diabetes mellitus patient's foot care and exercise behaviors. The telehomecare model could also become the important health-care policy for the government in the future.

Summary Background World Stroke Day (WSD) is an international campaign for raising stroke awareness according to the WSD proclamation. We investigated whether the 2012 WSD campaign organized in Taiwan fulfilled the requirements of the target population and improved stroke literacy among the attendees. Method A questionnaire survey regarding the 2012 WSD Taiwan campaign was administered by our trained interviewers to the attendees. Results In total, 350 attendees participated in the survey, and only 57.89% of the attendees identified the brain as the main damaged organ in stroke. Most attendees recognized ischemic stroke (85.94%) as a stroke type and hypertension (47%) as a common risk factor. The three most commonly recognized stroke symptoms were limb weakness, slurred speech, and facial weakness. Most attendees could seek medical help and call emergency services if a stroke occurred. Regarding the main themes, only 56.16% and 19.76% of the attendees knew about golden hours 123 and the FAST (Facial drooping, Arm weakness, Speech difficulties, Time) mnemonic, respectively, prior to the campaign. Furthermore, 50.44% of the attendees knew that thrombolytic therapy is the treatment of choice for stroke, and 58.06% and 40.32% of the attendees were partially and completely satisfied with the campaign, respectively. Only 20 attendees showed good stroke literacy. Conclusion When preparing for future WSD campaigns, the organizing committee must perform a detailed assessment to understand target population requirements and design more appropriate events. For promoting the WSD campaigns, proficient advertising is necessary for attracting attendees and increasing their willingness to participate.

Background: Currently, health literacy (HL) worldwide is measured primarily among adults from a medical perspective. A children’s HL test from a health promotion perspective is needed. This study develops the Taiwan Children’s Health Literacy Test (TCHL) targeted at Taiwanese sixth-graders. Methods: HL indicators were identified through interviews of sixth-grade teachers, primary caregivers, and sixth-graders. They were used to develop a 25-item online test, which was finalized after pretesting and administered to a stratified random sample of 671 students across 29 sixth-grade classes. Results: The response rate was 87.2% (585 participants). Cronbach’s α was 0.60–0.78 for the HL subtests and 0.79 for the overall HL test. Correlation coefficients among subtests ranged from 0.49 to 0.87. The average proportion correct was 0.80 for overall HL. In item response theory analysis, the difficulty level ranged from −2.77 to −0.40, while the degree of discrimination was 0.44–2.65. Item information peaked when the ability value was approximately −1.8. Furthermore, HL scores had a significant positive correlation with health behaviors. Conclusions: Overall, the test was found to be reliable and valid, with a low level of difficulty for basic HL ability. The present results can be used as a reference by government health education units to investigate national HL in children.

Background Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people’s control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan’s sixth grade school children. Methods Using a population-based survey, 162,209 sixth grade (11–12 years old) school children were assessed. The response rate at school level was 83 %, with 70 % of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates. Results The sample consisted of 48.9 % girls, 3.8 % were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6 % of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2 %. Children in the highest health literacy quartile were less likely to be obese (12.4 %) compared with the lowest quartile (17.4 %). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR) = 0.94, p 1.10, p

BACKGROUND: Taiwan has advocated health-promoting schools (HPS) since 2001 and established the Health-Promoting School Supporting Network (HPSSN) in 2005 to offer administrative support and consultation. Respondents' opinions about HPSSN and the relationship between these perceptions and HPS implementation were examined. METHODS: In 2011, 800 primary and middle schools were selected through stratified random sampling. School staff members (N = 656) in charge of HPS programs reported their impressions of the HPSSN's support. RESULTS: Respondents were most satisfied with consultants and schools' recognition of responsibilities and rules and their interactions with HPSSN administrators. They were least satisfied with the extent of their HPSSN consultant interaction and believed HPSSN provided insufficient resources to establish HPS. Respondents' consultant partnerships and satisfaction with HPSSN administration significantly predicted HPS implementation. Additionally, the predictive values of healthy policies and school-community relationships were greater than the other 6 HPS components. CONCLUSIONS: HPSSN positively influenced HPS implementation; however, consultant/school partnerships and school resource allocations must be improved. Language: en

Background Nurses often do not adhere to health-promoting lifestyles, compromising their health status and quality of care. This study aimed to evaluate health-promoting effects of an eHealth intervention among nurses compared with conventional handbook learning. Methods This controlled before/after study enrolled 105 nurses, 55 in an experimental group and 60 in a control group, for 3 months of intervention. Both groups completed pre- and postintervention questionnaires of the Health-Promoting Lifestyle Profile and Short-Form Health Survey. Subjects’ height, weight, and body mass index were recorded. Discussion The eHealth education intervention had the effect of significantly increasing nurses' postintervention Health-Promoting Lifestyle Profile total scores. No significant changes were observed in the postintervention scores of the control group subjects. The experimental group also had significant postintervention decreases in BMI, but no similar changes were observed in the control group. Conclusions Tailored eHealth education is an effective and accessible intervention for enhancing health-promoting behavior among nurses.

Aims and objectives. The purpose of this study is to develop and evaluate the psychometric properties of the Chinese version of short-form Test of Functional Health Literacy in Adolescents. Background. Assessing health literacy is vital to design health education programme; however, there are no measurement tools exist for use specifically in Chinese adolescents. Design. A non-experimental design was used to test the psychometric properties of the Test of Functional Health Literacy in Adolescents. Methods. The short-form Test of Functional Health Literacy in Adolescents was translated and back translated into a Chinese language version. Thirty high school students were recruited to validate the scenario of Test of Functional Health Literacy in Adolescents. Based on the multiple-stage stratified random sampling method, 300 high school students from four counties in Taiwan were invited to participate in this study to evaluate the psychometric properties of Test of Functional Health Literacy in Adolescents. Results. The Functional Health Literacy in Adolescents had good internal consistency reliability and excellent test–retest reliability. Confirmatory factor analysis resulted in a one-factor solution. Conclusion. Contrary to the original version of the Test of Functional Health Literacy in Adolescents, the findings revealed that the 36-item, one-factor model for the Test of Functional Health Literacy in Adolescents is the best-fit model. Relevance to clinical practice. This is a suitable instrument to assess health literacy levels in Chinese adolescents before health education programmes can be appropriately planned, implemented and evaluated.

Background/aims The objective of this study is to examine if interpersonal support and digital vaginal palpation (DVP) as part of the pelvic floor muscle exercise (PFME) training is more effective for stress urinary incontinence (SUI) than PFME with a printed handout instruction. Methods 108 women who presented to the family medicine outpatient clinic without having urine leakage as a chief complaint were selected. They were randomized to either the group who received interpersonal support and DVP as part of the PFME training (experimental group), or the group who received PFME with a printed handout instruction (control group). The effects were assessed with 1-h pad tests. Results A total of 99 patients (50 experimental, 49 control) completed the study. The patients' mean age was 55.35±9.60 years, ranging from 20 to 80 years. All patients without urinary leakage listed as a chief complaint exhibited more or less urine leakage during the 1-h pad test. A significant decrease in the weight of 1-h pad test from baseline was observed in the experimental group ( p p =0.514). Conclusion Interpersonal support and DVP as part of the PFME training is more effective than PFME with a printed handout instruction. PFME, performed correctly and consistently, is effective even in patients who have very few symptoms of SUI.

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

The aim of this study was to illustrate the empowering process for cancer patients through Freire ' s dialogical interviewing. Fifteen interviewees participated in interviews over a period of three months. Five themes of dialogical interviewing for the empowering process were adopted including building rapport, assessing disempowerment issues, facilitating critical thinking, joint creation, resource connecting and positive feedback. Open-ended questions and participatory observation with reflective notes written by participants were used for data collecting. Constant comparison and content analysis were used for data analysis. The empowered outcomes at a personal level included redefining health, being confident, active involvement, revitalizing the sense of self, and the desire to live for themselves, negotiating the goals of one ' s care plan and having the strength to help others. On the basis of the empowered outcomes achieved through dialogical interviewing in this study, health professionals should apply this process to build partnerships with patients and help them to overcome the suffering caused by cancer.

Taiwan launched its evidence-based health-promoting school (HPS) program via an action-research approach in 2010. The program featured a collaborative partnership between schools, local education authorities and university support networks. This study was focused on examining whether an HPS action-research approach was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011, questionnaires were sent to 900 sample schools in Taiwan. A total of 621 schools returned the questionnaire, including 488 primary schools and 133 middle schools. The response rate was 69%. This study compared the difference in HPS implementation status, perceived HPS impact and perceived HPS efficacy between those schools that had implemented action-research HPS (138 schools) and those that had not (483 schools). The univariate analysis results indicated that the HPS implementation levels for components that included school health policies, physical environment, social environment, teaching activities and school-community relations were significantly higher in action-research schools than in non-action-research schools. Teachers in action-research schools reported significantly higher levels of HPS impact and HPS efficacy than non-action-research schools. The multivariate analysis results indicated that after controlling for school level and HPS funding, the HPS action-research approach was significantly positively related to greater levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Aim and objectives. The aim of this study was to examine the effects of an empowerment-based education program (EBEP) on employee empowerment, job satisfaction, job productivity and innovative behaviours for public health nurses (PHN) in Taiwan. Background. Empowerment is an important consideration among nurses trying to function in ever-changing health care and education settings. Several studies focused on the trend of public health nursing revealed that PHN have experienced a severe feeling of powerlessness. Developing empowerment strategies through organisations may be a means of helping employees recognise powerlessness in difficult situations and take appropriate action. Design. Quasi-experimental design. Methods. PHN in two health bureaus in Taiwan were assigned into an empowerment group (n = 29) and a control group (n = 32). Twenty-four hours of the EBEP lasted four weeks included four empowerment classes and four group workshops following each curriculum for PHN to apply principles of empowerment in their work environment. Data were collected at baseline and four weeks after the intervention. Analysis of covariance (ancova) was used to examine the intervention effect. Results. The experimental group reported significantly higher psychological empowerment [F (1,47) = 5·09, MSE = 3·25, p = 0·001, η2 = 0·18] and competence [F (1,47) = 3·96, MSE = 28·78, p = 0·05, η2 = 0·22] and impact [F (1,47) = 4·98, MSE = 44·79, p = 0·002, η2 = 0·20] subscales, job productivity [F (1,47) = 4·88, MSE = 5·18, p = 0·002, η2 = 0·19] and innovative behaviours [F (1,47) = 5·09, MSE = 3·25, p = 0·001, η2 = 0·24] than the control group after the EBEP. Conclusion. The EBEP had significant effect on psychological empowerment and subscales of competence and impact, innovative behaviour and job productivity but no effect on organisational empowerment and job satisfaction for PHN. Relevance to clinical practice. Our findings suggest public health administration could design empowerment-based education to improve employee empowerment and job productivity for PHN. Furthermore, using multiple components to design empowerment education should be considered in further studies.

The objective of this study was to evaluate comorbidity and risk factors associated with female urinary incontinence and to assess quality of life for women with different types of urinary incontinence. Subjects included 551 consecutive females who attended the outpatient clinic from 9 March to 8 July 2006 and did not have a chief complaint of incontinence. A four-item incontinence questionnaire and a Chinese version of the Incontinence-Quality of Life (I-QOL) questionnaire were completed in the waiting room. Patient characteristics and medical conditions were summarized from outpatient electronic databases. A total of 371 females were included for statistical analysis. Among them, 114 patients (30.7%) did not indicate any urinary incontinence, while 257 (69.3%) patients indicated symptoms of urge incontinence, stress incontinence, or mixed incontinence. Comorbidities significantly associated with incontinence included osteoarthritis (P = 0.001), peptic ulcer disease (P = 0.031), obesity (P < 0.001), and cardiac disease (P < 0.001). After multiple logistic regression analysis, obesity (OR 3.38, 95% CI 1.94-6.98) and postmenstrual status (OR 2.17, 95% CI 1.35-3.50) were found to be risk factors of incontinence (P < 0.001). Mixed incontinence patients exhibited the least satisfaction in quality of life, while no significant differences were observed between patients with urge incontinence and stress incontinence. In conclusion, the incidence of urinary incontinence may be greater in the outpatient population than previously thought. Osteoarthritis, peptic ulcer disease, and cardiac disease are more common in women with urinary incontinence, obesity and postmenopausal status appear predictive of incontinence, and women with mixed incontinence exhibit the least satisfying quality of life.

Background Employee empowerment is an important organizational issue. Empowered employees with new ideas and innovative attributes may increase their ability to respond more effectively to face extensive changes in current public health care work environments. Objectives The objective of this study was to investigate the relationships between employee empowerment, innovative behaviors and job productivity of public health nurses (PHNs). Design This study conducted a cross-sectional research design. Settings and participants Purposive sampling was conducted from six health bureaus in northern Taiwan. 670 PHNs were approached and 576 valid questionnaires were collected, with a response rate of 85.9%. Methods Structured questionnaires were used to collect data by post. Results Meaning and competence subscales of psychological empowerment, information and opportunity subscales of organizational empowerment, and innovative behaviors were the predictors of job productivity, only accounting for 16.4% of the variance. The competence subscale of psychological empowerment made the most contribution to job productivity ( β =0.31). Meaning subscale of psychological empowerment has a negative impact on job productivity. Conclusions Employee empowerment and innovative behavior of PHNs have little influence on job productivity. Employees with greater competence for delivering public health showed higher self-evaluated job productivity. The negative influences on job productivity possibly caused by conflict meaning on public health among PHNs in current public health policy. It should be an issue in further researches. Public health department should strengthen continuing educations to foster competence of psychological sense of empowerment and innovative behavior to increase job productivity.

Health Report (Personal hygiene). (DOC 230 kb)