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The purpose of this study was to use the Theory of Planned Behavior to predict older adults' intentions and related factors of getting COVID-19 booster vaccinations and compare gender differences. A cross-sectional study was conducted, and 147 adults aged 65 years or older were recruited by convenience sampling in Taiwan. Results revealed that 57.1 % of participants had positive intentions of getting a COVID-19 booster vaccination. Attitudes, subjective norms, and perceived behavioral control explained 86.0 % of the behavioral intentions of getting a COVID-19 booster vaccination. Perceived behavioral control was the most important factor, followed by attitudes. Differences in intentions of getting the COVID-19 booster vaccination between males and females were not significant. The Theory of Planned Behavior and its main constructs can be appropriately applied to predict intentions to receive COVID-19 booster vaccinations among older adults., Competing Interests: Declaration of competing interest The authors report no conflict of interest pertaining to this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

AbstractInteractions between and within abiotic and biotic processes generate nonadditive density-dependent effects on species performance that can vary in strength or direction across environments. If ignored, nonadditivities can lead to inaccurate predictions of species responses to environmental and compositional changes. While there are increasing empirical efforts to test the constancy of pairwise biotic interactions along environmental and compositional gradients, few assess both simultaneously. Using a nationwide forest inventory that spans broad ambient temperature and moisture gradients throughout New Zealand, we address this gap by analyzing the diameter growth of six focal tree species as a function of neighbor densities and climate, as well as neighbor × climate and neighbor × neighbor statistical interactions. The most complex model featuring all interaction terms had the highest predictive accuracy. Compared with climate variables, biotic interactions typically had stronger effects on diameter growth, especially when subjected to nonadditivities from local climatic conditions and the density of intermediary species. Furthermore, statistically strong (or weak) nonadditivities could be biologically irrelevant (or significant) depending on whether a species pair typically interacted under average or more extreme conditions. Our study highlights the importance of considering both the statistical potential and the biological relevance of nonadditive biotic interactions when assessing species performance under global change.

The application of chimeric antigen receptor T cell (CAR-T) immunotherapy has ushered in a new era in cancer therapy, especially in the treatment of many kinds of refractory malignant tumors. The curative effect is significant for refractory/recurrent hematologic malignancies, such as acute leukemia, lymphoma, and multiple myeloma (MM). Tumor microenvironment (TME) is closely related to the efficacy and adverse reactions of CAR-T therapy. TME not only affects the activity of CAR-T cells, reduces their anti-tumor ability, but also directly involved in the occurrence and development of CAR-T cell therapy-related adverse reactions, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Therefore, a deeper understanding of the role of blood TME in the process of CAR-T immunotherapy and the occurrence and development of adverse reactions is helpful for the application of CAR-T therapy in hematological malignancies. In this review, the influence of blood TME on the efficacy and adverse reactions of CAR-T immunotherapy was briefly summarized, aiming to provide evidence-based support for the clinical optimization of therapeutic regimen of refractory/recurrent hematologic malignancies.

Background: The prevalence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world. Although kidney transplant is the most effective treatment for ESRD, the willingness of patients with ESRD to undergo kidney transplantation is low in Taiwan. The factors associated with willingness to accept kidney transplantation remain unclear, and studies on kidney transplant willingness and associated factors among Taiwanese patients with ESRD are scarce., Purpose: The aim of this study was to assess willingness to undergo a kidney transplant and related factors among patients with ESRD in Taiwan., Methods: A cross-sectional design was employed. Two hundred fourteen participants from a single medical center in Taiwan were recruited, and 209 valid questionnaires were collected (valid response rate: 97.7%). The study instruments included a kidney transplant knowledge scale, a kidney transplant attitude scale, and a kidney transplant willingness scale. Data were analyzed using Pearson's product-moment correlations, t tests, one-way analyses of variance, and multiple regressions., Results: The mean kidney transplant willingness in the sample was 13.23 (out of 20). Being male, younger, married, or employed; having a college education or above; and having a shorter dialysis duration were all associated with higher kidney transplant willingness. Sociodemographics, dialysis duration, knowledge, and attitudes explained 45.4% of the variance in kidney transplant willingness, with two of these, kidney transplant attitudes (β = .61, p < .001) and dialysis duration (β = -.11, p = .041), identified as significant., Conclusions/implications for Practice: The findings support the important role of cultivating positive attitudes in patients with ESRD to increasing willingness to undergo kidney transplantation interventions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Despite the development of network science, we lack clear heuristics for how far different disturbance types propagate within and across species interaction networks. We discuss the mechanisms of disturbance propagation in ecological networks, and propose that disturbances can be categorized into structural, functional, and transmission types according to their spread and effect on network structure and functioning. We describe the properties of species and their interaction networks and metanetworks that determine the indirect, spatial, and temporal extent of propagation. We argue that the sampling scale of ecological studies may have impeded predictions regarding the rate and extent that a disturbance spreads, and discuss directions to help ecologists to move towards a predictive understanding of the propagation of impacts across interacting communities and ecosystems., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This cross-sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self-rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment-Short Form, and the International Physical Activity Questionnaire-Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate-to-vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes., (© 2023 John Wiley & Sons Australia, Ltd.)

BCR-ABL T315I mutation is the main mechanism of resistance to the first and second generation tyrosine kinase inhibitor (TKI) for patients with chronic myeloid leukemia (CML). Ponatinib as the third generation TKI has been found that can significantly improve the prognosis of CML patients with T315I mutation. However, the latest report has discovered that the T315I compound mutant is even resistant to ponatinib, which aroused the enthusiasm of research on the mechanism of CML resistance and targeted therapy once again. Previous studies have shown that TKI combined with other targeted drugs is effective to CML patients with drug resistance or relapse due to T315I mutation. The latest research has found that the allosteric inhibitor asciminib combined with TKI therapy is equally effective to CML patients with T315I compound mutant, but the specific mechanism is not yet clarified. This review will focus on the latest research progress of therapy for CML with BCR-ABL T315I mutation, hoping to provide reference for researching new drugs and improve therapy for treating CML with T315I mutation.

Aim: The aim of this study was to explore predictors of nurses' willingness to handle abuse of older people., Background: Abuse of older people is a long-discussed healthcare issue worldwide. Although nurses are considered capable of identifying and reporting cases of abuse of older people, no study has been conducted in Taiwan on nurses' willingness to handle abuse of older people., Design: A cross-sectional design was used., Methods: The study was conducted from May to June 2019. A convenience sampling was adopted to survey 555 nurses from a medical center in Taiwan. Data were collected using the Knowledge of Abuse of Older People Scale, Attitudes Towards Older People Scale, Attitudes Towards Handling Abuse of Older People Scale, Willingness to Handle Abuse of Older People Scale, and personal characteristics. Pearson correlation coefficient analysis, independent sample t-test, one-way analysis of variance, and multiple linear regression were performed., Results: Participants scored an average of 2.98 out of 4 on the Willingness to Handle Abuse of Older People Scale, indicating that they were inclined to do so. Attitudes towards older people, knowledge, attitudes towards handling abuse of older people, awareness of the hospital's reporting procedure and dissemination of information related to abuse of older people, sex, age, and clinical work experience explained 41.4% of the variance of willingness. Participants' attitudes toward handling abuse of older people was the most important predictor of their willingness to do so., Conclusions: To improve nurses' willingness to handle cases of abuse of older people, particularly that of male nurses, hospital authorities should provide in-service training and education and disseminate information on the subject matter. Nursing schools should prioritize offering gerontological nursing courses to foster nursing students' positive attitudes toward older adults and handling abuse of older people., Tweetable Abstract: Nurses' attitudes toward handling abuse of older people were the most important predictor of their willingness to handle abuse of older people., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Physicians should be equipped with professional competence in health literacy to communicate more effectively with patients with limited health literacy. However, the health literacy curriculum has not yet been refined globally, and is scarce in Taiwan's medical education. We implemented an innovative instructional module to attain professional competence in health literacy among medical students and investigated its effects., Methods: We adopted a quasi-experimental design and recruited 204 fifth-year Taiwanese medical students between December 2019 and May 2020. Participants who worked as clerks at the Department of Family Medicine of three medical schools in northern Taiwan were assigned to the experimental group through convenience sampling. A total of 98 students received a three-hour innovative instruction, including medical simulation videos, role-playing, and board games. Both the experimental and control groups completed the online pre-test and mail-in post-test. A generalized estimating equation was applied to measure the effects of the intervention., Results: There was a significant difference between the experimental and control groups in terms of professional competence in health literacy in all three aspects. In terms of knowledge, the experimental group improved 12% more than the control group (𝛽=0.12, 95% CI: 0.05 ~ 0.19, p = 0.001). In terms of attitude, the experimental group improved by an average of 0.27 more points per question than the control group (𝛽=0.27, 95% CI: 0.08 ~ 0.46, p = 0.007). As for skill, the experimental group improved by an average of 0.35 more points per question than the control group (𝛽=0.35, 95% CI: 0.14 ~ 0.55, p = 0.001)., Conclusion: The proposed innovative instructional module significantly improved fifth-year medical students' professional competence in health literacy, which is expected to benefit their future medical practices., (© 2022. The Author(s).)

Growth in individual size or biomass is a key demographic component in population models, with wide-ranging applications from quantifying species performance across abiotic or biotic conditions to assessing landscape-level dynamics under global change. In forest ecology, the responses of tree growth to biotic interactions are widely held to be crucial for understanding forest diversity, function, and structure. To date, most studies on plant-plant interactions only examine the additive competitive or facilitative interactions between species pairs; however, there is increasing evidence of non-additive, higher-order interactions (HOIs) impacting species demographic rates. When HOIs are present, the dynamics of a multispecies community cannot be fully understood or accurately predicted solely from pairwise outcomes because of how additional species "interfere" with the direct, pairwise interactions. Such HOIs should be particularly prevalent when species show non-linear functional responses to resource availability and resource-acquisition traits themselves are density dependent. With this in mind, we used data from a tropical secondary forest-a system that fulfills both of these conditions-to build an ontogenetic diameter growth model for individuals across 10 woody-plant species. We allowed both direct and indirect interactions within communities to influence the species-specific growth parameters in a generalized Lotka-Volterra model. Specifically, indirect interactions entered the model as higher-order quadratic terms, i.e., non-additive effects of conspecific and heterospecific neighbor size on the focal individual's growth. For the whole community and for four out of 10 focal species, the model that included HOIs had more statistical support than the model that included only direct interactions, despite the former containing a far greater number of parameters. HOIs had comparable effect sizes to direct interactions, and tended to further reduce the diameter growth rates of most species beyond what direct interactions had already reduced. In a simulation of successional stand dynamics, the inclusion of HOIs led to rank swaps in species' diameter hierarchies, even when community-level size distributions remained qualitatively similar. Our study highlights the implications, and discusses possible mechanisms, of non-additive density dependence in highly diverse and light-competitive tropical forests., (© 2021 The Ecological Society of America.)

Purpose: This study applied the Theory of Planned Behavior to predict exercise behaviors and intentions of teenagers and analyzed sex differences., Design and Methods: A prospective study design was employed to survey tenth-grade students in Taipei, Taiwan. The 951 participants reported their exercise attitudes, subjective norms, perceived behavioral control (PBC), and intentions, and their exercise behaviors were tracked 6 months later., Results: Results revealed that 22.1% of all students and more male students than female students exercised for ≥30 min/day on 5 or more days/week. Hierarchical multiple regression analyses demonstrated that intentions, PBC, attitudes, and subjective norms explained 32.5% of the variation in exercise behavior (p < .001). Intentions, attitudes, and PBC were related to exercise behavior regardless of sex. Attitudes, subjective norms, and PBC explained 67.0% of the variation in intentions (p < .001). Attitudes and PBC were related to intentions regardless of sex., Conclusions: The findings support that the main constructs of the Theory of Planned Behavior can effectively predict regular exercise intentions and behaviors among adolescents., Practice Implications: The results can serve as a reference for nurses and other healthcare professionals when formulating effective strategies to encourage adolescents to engage in exercise practices., Competing Interests: Declaration of Competing Interest No conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

We introduce the AusTraits database - a compilation of values of plant traits for taxa in the Australian flora (hereafter AusTraits). AusTraits synthesises data on 448 traits across 28,640 taxa from field campaigns, published literature, taxonomic monographs, and individual taxon descriptions. Traits vary in scope from physiological measures of performance (e.g. photosynthetic gas exchange, water-use efficiency) to morphological attributes (e.g. leaf area, seed mass, plant height) which link to aspects of ecological variation. AusTraits contains curated and harmonised individual- and species-level measurements coupled to, where available, contextual information on site properties and experimental conditions. This article provides information on version 3.0.2 of AusTraits which contains data for 997,808 trait-by-taxon combinations. We envision AusTraits as an ongoing collaborative initiative for easily archiving and sharing trait data, which also provides a template for other national or regional initiatives globally to fill persistent gaps in trait knowledge., (© 2021. The Author(s).)

Purpose: The primary purpose of this study was to investigate changes in exercise intentions and behaviors among children across time. Then, we investigated how determinants in the Theory of Planned Behavior (TPB) predicted exercise intentions and behaviors, and explored if demographic predictors contributed to predicting behaviors., Design and Methods: A three-wave, 12-month longitudinal study was conducted. A proportional stratified random sampling method was adopted, and 1997 children from 11 elementary schools in Taipei City were recruited. Numbers of participants were 1074, 1064, and 995 at times 1, 2, and 3, respectively., Results: Children's exercise intentions and behaviors significantly changed (both p < .05) during a 6-month interval. Attitudes, subjective norms, and perceived behavioral control (PBC) at time 1 could respectively explain 51.0% and 17.1% of the variance in time 1 and 2 intentions (F (3, 1068)  = 372.20, F (3, 1059)  = 73.92, both p < .001). PBC was the strongest predictor of the intention to exercise. Intentions were the immediate determinant of exercise behaviors. PBC not only indirectly affected exercise behaviors through intentions but also directly affected exercise behaviors. Gender and sports club participation directly affected children's exercise behaviors., Conclusions: The findings support the TPB model being suitable for use in longitudinal studies; its core constructs significantly predicted children's exercise intentions and behaviors., Practice Implications: This study highlights that clinical practitioners and school nurses working with children can help youth engage in regular exercise by enhancing their intentions and perceived behavioral control, and cultivating positive attitudes and subjective norms when planning exercise intervention programs., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents., Methods: A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants' knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention., Results: After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of <14.62, <110.27, and <41.5, respectively., Conclusions: An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents., Practice Implications: In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest pertaining to this manuscript., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Elevated levels of airborne particulate matter (PM) pose health risks to populations living in many cities worldwide. To remediate the impact of air pollution, urban greening has been increasingly explored as a possible way to remove PM from the surroundings. However, existing research focuses mainly on species-specific assessments within temperate climates that may not necessarily grow outside of their local regions. To address sampling limitations associated with the great species diversity in the tropics, our study quantified three key functional traits-leaf hairiness, average leaf area (ALA) and specific leaf area (SLA)-each spanning a wide range of values across 20 tropical species. Wind-tunnel experiments were used to assess surface deposition velocity on leaves; the size fractions PM 10 and PM 2.5 were measured through multiple rounds of filtration and gravimetric analysis. The effects of upper- and lower-surfaces of leaves on deposition velocity and their interactions with hairiness were also investigated. Results show that greater upper-surface hairiness and a low SLA were consistent predictors of higher deposition velocity for both PM-size fractions. Hairs on leaves serve as obstacles while low SLA tends to be associated with smaller and thicker leaves, together favoring the deposition and retention of PM. The possible mechanisms behind important plant traits and their interactions are discussed. By testing quantifiable effects of specific plant traits, we provide generalizable findings that may be applied to urban greening efforts. Future work to consider other gaseous pollutants and plant-scale effects can help ensure a more comprehensive evaluation of plant suitability for pollutant mitigation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Single- and five-item measures have been used prevalently to assess exercise stages of change. Few studies have investigated the development of instruments that are able to continuously measure exercise stages of change and have conducted associated psychometric analyses., Purpose: This study aimed to translate the original, English-language version of the University of Rhode Island Change Assessment-Exercise 2 (URICA-E2), a continuous exercise stages of change assessment instrument, into Chinese and then to test the validity and reliability of the translated version., Methods: A cross-sectional descriptive study was conducted. Participants consisted of 325 adults from Taipei, Taiwan. The URICA-E2 was translated into Chinese using a standardized procedure. Psychometric analyses, including validity, reliability, and cluster analysis, of the Chinese-version instrument were conducted., Results: The content validity index was .987. Confirmatory factor analysis confirmed that the overall model fit was standardized, as the factor loadings of all of the items and the composite reliability and average variance extracted for the six exercise stages of change satisfied the convergent validity criteria. The average variance extracted for each construct of the stages of behavior change satisfied the discriminatory validity criteria. Values of Cronbach's α for the six exercise stages ranged from .80 to .94. The intraclass correlation coefficients for test-retest reliability after 2 weeks ranged between .74 and .87., Conclusions: The Chinese-language version of the URICA-E2 developed in this study exhibited excellent validity and reliability. This instrument may be used by healthcare professionals and the academic community to effectively and continuously measure the intentions and attitudes of adults at various exercise stages of change and to guide the provision of appropriate interventions.

Background: Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships., Methods: This study adopted a cross-sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent., Results: Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions., Conclusion: Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction., (© 2018, American School Health Association.)

Secondary forests are important carbon sinks, but their biomass dynamics vary markedly within and across landscapes. The biotic and abiotic drivers of this variation are still not well understood. We tested the effects of soil resource availability and competition by lianas on the biomass dynamics of young secondary tropical forests in Panama and assessed the extent to which liana effects were mediated by soil resource availability. Over a five-year period, growth, mortality, and recruitment of woody plants of ≥1 cm diameter were monitored in 84 plots in 3-30-year-old secondary forests across the Agua Salud site in central Panama. Biomass dynamics and the effects of lianas and soil resources were examined using (generalized) linear mixed-effect models and a model averaging approach. There was strong spatial and temporal variation in liana biomass within and across the plots. The relative biomass of lianas had a strong negative effect on overall tree growth, growth of understory trees decreased with soil fertility and dry season soil water content, and the effect of lianas on tree mortality varied with soil fertility. Tree recruitment was not associated with any of the predictor variables. Our model indicates that tree biomass growth across our landscape was reduced with 22% due to competition with lianas, and that the effect of lianas increased during succession, from 19% after five years to 32% after 30 years. The projected liana-induced growth reduction after 60 years was 47%, which was consistent with data from a nearby site. Our study shows that the observed liana proliferation across tropical forests may reduce the sequestration and storage of carbon in young secondary forests, with important implications for the carbon balance of tropical forest landscapes and consequently for global climate change. Our study highlights the need to incorporate lianas and soil variables in research on the biomass dynamics of secondary forest across tropical landscapes, and the need for well-replicated longitudinal studies to cover landscape-level variability in the relevant abiotic and biotic components., (© 2017 by the Ecological Society of America.)

Background: A good classroom environment can promote students' learning motivation and affect their academic efficacy and adaptation. This study compares the perceptions of Taiwanese middle school students regarding actual and preferred classroom environments and explores the association with sex and grade level., Methods: Data were collected using cross-sectional research design from a national sample of 1932 middle school students. Data of 1897 valid questionnaires from the Chinese Elementary and Middle School Inventory of Classroom Environment were analyzed., Results: The actual and preferred classroom environments perceived by students differed significantly (p < .001). The overall mean score of actual classroom environment was lower than that of preferred classroom environment. Differences between the actual and preferred environments were greater for girls than for boys (p < .001). Moreover, girls had higher scores than those of boys for both actual (p = .036) and preferred (p < .001) environments. After adjusted for region, seventh- and eighth-grade students had a higher score than that of ninth-grade students on preferred classroom environment (p = .002)., Conclusions: This study identified a gap between the ideal and actual classroom environments. We suggest that the government, schools, and health education teachers improve classroom environments during school health programs to satisfy students' expectations and thus increase their learning efficacy and overall well-being., (© 2015, American School Health Association.)

Alien plant species are known to have a wide range of impacts on recipient communities, from resident species' exclusions to coexistence with resident species. It remains unclear; however, if this variety of impacts is due to different invader strategies, features of recipient communities or both. To test this, we examined multiple plant invasions of a single ecosystem in southwestern Australia. We used extensive community data to calculate pairwise segregation between target alien species and many co-occurring species. We related segregation to species' positions along community trait hierarchies and identified at least two distinct invasion strategies: 'exploiters' which occupy high positions along key trait hierarchies and reduce local native species diversity (particularly in nutrient-enriched situations), and 'coexisters' who occupy intermediate trait positions and have no discernable impact on native diversity. We conclude that trait hierarchies, linked to measures of competition, can provide valuable insights about the processes driving different invasion outcomes., (© 2015 John Wiley & Sons Ltd/CNRS.)

Aims and Objectives: To explore health literacy status in asthma patients and to examine the causal model linking health literacy to health outcome-related factors via mediator and moderator variables., Background: Understanding how low health literacy may influence health outcomes is important., Design: This is a cross-sectional survey study., Methods: A total of 326 asthma patients aged 20 years and older (average: 51 ± 18·3 years) were recruited by purposive sampling from pulmonary medicine outpatient departments at three medical centres and a regional teaching hospital in northern Taiwan. Data were collected via structured questionnaires, including measures of socio-demographic and disease characteristics; medical decision-making; asthma knowledge, attitudes and self-efficacy; healthcare experience and health outcome-related factors (metered-dose inhaler/dry-powder inhaler usage proficiency, medical use, self-management behaviour). Three hundred patients who met the inclusion criteria and completed the questionnaire survey were analysed., Results: Overall, 217 subjects (72·3%) had adequate functional health literacy, 42 (14%) had inadequate functional health literacy, and 41 (13·7%) had marginal functional health literacy. Subjects' average asthma knowledge, attitudes and self-efficacy scores were 7·23 ± 2·69, 51·46 ± 6·18 and 58·31 ± 8·10, respectively. Health literacy correlated positively with asthma knowledge (r = 0·605), attitudes (r = 0·192) and medical decision-making (r = 0·413)., Conclusions: Health literacy is positively associated with proficiency in metered-dose inhaler usage, asthma knowledge, attitudes and medical decision-making, but is not significantly associated with medical care use and self-management behaviour. Health literacy had an indirect effect on self-management behaviour through the mediation effect of asthma attitudes. No moderator was found for the effect of health literacy on health outcome-related factors., Relevance to Clinical Practice: Results of this study may help to develop adequate intervention strategies to improve the health outcomes of asthma patients., (© 2013 John Wiley & Sons Ltd.)

Background: Wrong-site surgeries (including wrong-site, wrong-person and wrong-procedure errors) remain the number one problem among adverse events of health care delivery. Patients and/or family members should be involved when possible to help prevent such errors., Aims: 1) Design an educational animation program about patient safety for patients and/or family members to help eliminate wrong-site surgery errors. 2) Evaluate its educational effect., Methods: The animation developed for this study includes an introduction, hypothetical story, and guided information, and was presented at a tertiary medical center in northern Taiwan. A single-group pretest and posttest design was used., Results: Forty-six patients and 48 family members participated in the study. The pre-training score was 3.6 (on a scale of 1-4). After watching the animation, there was no significant increase (0.08 ± 0.5) for the patient group, but the family member group showed significant improvement (0.21 ± 0.6, P = .0309). Most participants (98.9%) were satisfied with the animation., Conclusion: The majority of participants reported good practices for avoiding wrong-site surgery mistakes before an operation. A significant improvement of post-training scores in the family member group was seen. The high satisfaction rating given by the participants after seeing the animation indicates that it was generally acceptable., (Copyright © 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The purpose of this study was to identify and describe the knowledge and attitudes of cigarette smoking that are associated with smoking habits among young military conscripts in Taiwan., Methods: We conducted a cross-sectional survey of young conscripts in southern and eastern Taiwan between August 1 and December 31, 2001. We selected 3,249 young military conscripts who had served more than 1 month in the military, based on specific criteria. We used a standard structured questionnaire to collect information about the respondents' sociodemographic characteristics, lifestyle, knowledge, attitude, and cigarette smoking practices., Results: Our findings showed that among smoking young military conscripts, knowledge about smoking was lower and attitudes toward smoking were more negative when compared with the non-smokers. Knowledge and attitudes about smoking varied with sociodemographic characteristics (age, education level, residential area) and lifestyle (cigarette smoking, betel nut chewing, alcohol drinking), all p < 0.05. Subjects with greater knowledge about smoking had a lower risk of smoking (odds ratio, 0.88; 95% confidence interval, 0.86-0.91). But this characteristic diminished after being adjusted for potential confounders. In addition, subjects with a higher attitude score about smoking had relatively lower risk for cigarette smoking when compared to those with a lower attitude score, even after adjusting for potential confounders (odds ratio, 0.93; 95% confidence interval, 0.91-0.94)., Conclusion: Knowledge and attitudes about smoking are significantly associated with the status of cigarette smoking. These findings can help public health professionals develop effective policies and smoking prevention and cessation programs among young military conscripts in Taiwan., (Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

Background: Patient education is a critical component of asthma management. Limited data from longitudinal research studies are available from Taiwan to show the effect of asthma education on knowledge and health-related quality of life (HRQOL) in asthma patients., Purpose: This study was designed to determine the effectiveness of an asthma education program on asthma general knowledge and HRQOL in Taiwanese patients with asthma during a 6-month follow-up period., Methods: One hundred eighteen patients were recruited using purposive sampling, 42 of whom were enrolled in an asthma education program and 76 of whom received routine care. Measurements were completed at baseline and at 1, 3, and 6 months after enrollment. Over the 6 months of follow-up, asthma knowledge was measured using the Chinese language version of the asthma general knowledge questionnaire for adults, whereas HRQOL was measured using the St. George's Respiratory Questionnaire (SGRQ)., Results: Asthma knowledge increased significantly in the intervention group as compared with the comparison group (p < .001), and Group x Month interaction effects were found. Total SGRQ mean score and the three subscales showed no significant differences between intervention and comparison groups. However, overall SGRQ trends and subscale scores for both groups decreased significantly through the first, third, and sixth months., Conclusions and Implications for Practice: We observed an increase in asthma general knowledge but no significant improvement in HRQOL using an asthma structured-education program.

Deoxycytidine analogs are an important class of clinically active antiviral and anticancer agents. The stepwise phosphorylation of these analogs to triphosphate metabolites is crucial for biological action. Human UMP/CMP kinase (UMP/CMPK; cytidylate kinase; EC 2.7.4.14) is thought to be responsible for phosphorylation of UMP, CMP, and dCMP and may also play an important role in the activation of pyrimidine analogs. However, no evidence has verified this notion in intact cells. In this study we explored the functional roles of UMP/CMPK in natural pyrimidine synthesis and metabolism of deoxycytidine analogs, as well as 5-FU in HeLa S3 and HCT8 cells. The amounts of UMP/CMPK protein in different cell lines correlated with UMP, CMP, and dCMP kinase activities and amounts of UMP/CMPK RNA. Modulation of UMP/CMPK by overexpression or down-regulation had no impact on natural pyrimidine nucleotides and cell growth. However, down-regulating UMP/CMPK expression by siRNA led to a decrease in the formation of the triphosphate metabolites, resulting in cellular resistance to these analogs. More diphosphate and triphosphate metabolites of deoxycytidine analogs were detected and cellular sensitivity to these agents was increased in the UMP/CMPK-overexpressing cells. This study indicates that the second step enzyme (UMP/CMPK) is responsible for the phosphorylation of pyrimidine analogs and also has an impact on cellular sensitivity to these analogs in those cell lines.

Background: Self-esteem, a key construct of personality, influences thoughts, actions, and feelings. Adolescence is a critical stage to the development of self-esteem. Taiwan currently offers no self-esteem building curriculum in the public education system. Therefore, incorporating self-esteem-related teaching activities into the existing curriculum represents a feasible approach to enhance self-esteem in middle school students., Purpose: This study aimed to explore the effects on junior high school students' self-esteem of a self-esteem program incorporated into the general health and physical education curriculum., Methods: A quasi-experimental research design was used, and 184 seventh-grade students at two junior high schools in Taipei City were randomly selected and separated into two groups. The experimental group received one 32-week self-esteem program incorporated into their regular health and physical education curriculum, which was administered in three 45-minute-session classes each week. The control group received the regular health and physical education with no specially designed elements. During the week before the intervention began and the week after its conclusion, each participant's global and academic, physical, social, and family self-esteem was assessed. Data were analyzed using analysis of covariance., Results: For all participants, the experimental group was significantly superior to the control group in respect to physical self-esteem (p = .02). For girls, the experimental group was significantly superior to the control group in family self-esteem (p = .02). However, there was no significant difference between the two groups in terms of global self-esteem., Conclusions and Implications for Practice: This study provides preliminary evidence that incorporating self-esteem activities into the regular school health and physical education curriculum can result in minor effects in students' physical self-esteem and family self-esteem. Findings may provide teachers and school administrators with information to help them design programs to improve students' self-esteem. This study also reminds health professionals to focus on providing self-esteem-building programs when working with adolescent clients.

Background: Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited., Purpose: This study aimed to explore perceptions of exercise held by obese school-aged children., Methods: This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1,714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes., Results: Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise., Conclusions/implications for Practice: Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.

Background: The purpose of this study was to identify the most important risk factors that influence cigarette smoking among young adult military conscripts in Taiwan., Methods: A cross-sectional survey was conducted among young conscripts (19-25 years old) in Taiwan from August to December 2001. A total of 3,569 conscripts who had served more than 1 month in the military were chosen. Information regarding cigarette smoking and other factors was collected using a standard structured questionnaire., Results: Subjects whose lifestyles included betel-nut chewing (OR, 16.81; 95% CI, 11.35-25.91) and alcohol drinking (OR, 2.11; 95% CI, 1.54-2.90) were more likely to smoke compared to subjects without these adverse behaviors. Subjects whose education stopped at junior high school or before were more likely to smoke compared to those with a university degree (OR, 5.36; 95% CI, 3.77-7.69). Subjects who had a higher proportion of peers who smoked were more likely to smoke compared to those with no peers who smoked (OR, 3.16; 95% CI, 2.42-4.15). Subjects whose parents and peers approved of smoking were also at a higher risk for smoking compared with those whose parents and peers disapproved (father's approval---OR, 3.28 and 95% CI, 2.02-5.43; mother's approval---OR, 3.11 and 95% CI, 1.47-7.12; peer approval---OR, 2.27 and 95% CI, 1.60-3.22)., Conclusion: From this study, we found that education level, betel-nut chewing, alcohol intake, smoking behavior of peers, and the attitudes of parents and peers toward smoking are all associated with the risk of a young adult conscripts becoming a habitual cigarette smoker. These results provide insight for targeting critical risk factors in helping these individuals control or cease their cigarette smoking habit in the future.

Background: This study aimed at exploring the impacts of a school-wide no smoking strategy and a classroom-based smoking prevention curriculum on smoking-related knowledge, attitude, behavior, and skill of junior high school students., Methods: Using a pre-post quasi-experimental design, 469 seventh-to ninth-grade students at four junior high schools in Taiwan, were selected and separated into three groups according to class unit. Experimental group A experienced a school-wide no smoking strategy and a six-session smoking prevention curriculum. Experimental group B experienced only the school-wide no smoking strategy. The control group experienced no intervention. The students were tested 1 week before intervention began and 1 week after it ended., Results: Experimental group A exhibited a better understanding than either experimental group B or the control group of the dangers of smoking and of techniques for refusing cigarettes; and in fact, group A indicated low smoking intention than experimental group B. Experimental group A also had a better attitudes towards resisting smoking than the control group. However, the intervention had no demonstrable effect on the smoking behavior and on the smoking substitution methods of students., Conclusions: To reduce the smoking rates among junior high school students, diversified school-wide no smoking strategies and standardized, diversified instruments should be adopted so that outcomes of smoking prevention work may be assessed more objectively and effectively.

The authors studied the prevalence of the aggregation in common lifestyle habits, namely, cigarette smoking, alcohol drinking, and betel-nut chewing and the demographic correlates of individual aggregation in these lifestyle behaviors among young military conscripts in Taiwan. Cross-sectional screening was conducted among conscripts in southern and eastern sections of Taiwan from Aug. 1st to Dec. 31st 2001. Totally, 3913 conscripts who had more than 1 month of service were included in this multistage sampling study. Information on smoking, drinking, and betel-nut chewing habits were ascertained as part of a self-administered questionnaire completed by examinees at the service unit. Aggregation in lifestyle habits was studied by comparing the observed and expected proportions (O/E ratio) with their 95% confidence intervals (CI) for zero, one, two, and three simultaneously occurring lifestyle habits. The study results showed a significant clustering of lifestyle habits studied; the number of subjects was greater than expected in groups with two (for cigarette smoking and betel-nut chewing, O/E ratio=1.17, 95%CI=1.06-1.28), and three (O/E ratio=5.63, 95%CI=5.06-6.20) lifestyle habits. Determinants for this clustering of lifestyle habits included lower educational levels and residential area in southern and eastern sections of Taiwan. There was a significant individual aggregation in lifestyle habits including cigarette smoking, alcohol drinking, and betel-nut chewing in the health survey among young military conscripts. In addition, young military conscripts with low educational levels and residential area in southern and eastern sections of Taiwan had an apparent tendency toward the aggregation in these lifestyle habits.

One of the responsibilities of a public health nurse is to provide asthma education to local residents. However, there have been no comprehensive education programs for public health nurses on asthma care in the past. This study aimed to determine level of competence of public health nurses on asthma care in order to improve their capability through a one-day national asthma education course. In addition to lectures on updated asthma management information, data was obtained through demonstrations and practice on inhalation techniques of various kinds of inhaled devices, including the ability to use and interpret the data of a peak flow meter. Two written examinations with the same questions were given to participants before and right after the lectures. All of the 560 public health nurses in the 392 public health bureaus were invited to join the program and 522 (93.2%) participated. Five hundred and six completed both the pre- and post-tests. Before the national education program, only 10.9% of the participants knew the purpose of the peak flow meter, while 62.6% had never heard of it. Initially, they showed less confidence on teaching patients on the use of inhaled devices (2.36 and 2.59 in 5 scales). Comparing the two tests, there was a significant increase in the public nurses' knowledge as regards: 1) the general concept of asthma, 2) prevention of trigger factors and environmental control, 3) proper medication knowledge, 4) peak flow meter (PEF) monitoring, and 5) intervention after acute exacerbation of asthma (p < 0.001). A well-designed course on asthma management is an efficient scheme to improve public health nurses' knowledge and confidence on asthma care.

Aims: This 3-year longitudinal study examined changes in patterns of risk factors and protective factors of smoking initiation and cessation among vocational high school students in Taipei, Taiwan., Design and Setting: In 2000, a total of 2151 10th grade students from 16 vocational high schools were assessed and followed up in the 11th and 12th grades. Self-administered questionnaires were collected in each year to assess the pattern of changes in smoking behaviors, and risk and protective factors., Findings: Of the 1654 non-smokers in the 10th grade, 227 students initiated smoking by the 12th grade. Higher risk factors such as peer smoking, peers offering cigarettes, alcohol use and lower protective factors, such as refusal self-efficacy, antismoking attitude and belief in the 10th grade predicted youth initiation by grade 12. Increases in risk factors and decreases in protective factors during the years from 10th to 12th grades were associated significantly with youth smoking initiation. Of the 494 smokers in the 10th grade, 76 students quit smoking by the 12th grade. Lower risk factors and higher protective factors in 10th grade smokers predict youth smoking cessation by grade 12. Decreases in risk factors and increases in protective factors were associated significantly with youth smoking cessation., Conclusions: The risk factors (i.e. social influences) and protective factors (i.e. self-efficacy) examined in this study predict both youth smoking initiation and youth smoking cessation.

This study investigated and compared Taiwanese dental students' knowledge of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection, attitudes toward infected patients, and important factors associated with the willingness to treat infected patients. In 2001, a self-administered questionnaire survey was conducted on all 1930 dental students enrolled from seven dental schools in Taiwan, with a response rate of 54.4%. Multiple logistic regression analysis was applied to assess the relationship between multiple factors and willingness to treat. Multivariate analysis was used to compare knowledge levels and the willingness. Of the respondents, 80%, 75%, and 49% were willing to treat HBV-, HCV-, and HIV-infected patients, respectively, and differences among the percentages were statistically significant. Students were less knowledgeable about HCV infection compared to HBV and HIV infection. Factors significantly associated with willingness to treat HBV- or HCV-infected patients were: feeling morally responsible and being able to treat infected patients safely. Those feeling morally responsible (odds ratio [OR] = 33.0, 95% confidence interval [CI] = 15.2, 71.8) and those being able to treat infected patients safely (OR = 4.1, 95% CI = 1.7, 9.9) were more willing to treat HIV patients. Taiwanese dental students were more willing to treat HBV- and HCV-infected patients than to treat HIV-infected patients.