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Background Gout is triggered by high urate levels and causes inflammation, pain, and an impaired quality of life. Immersion in water at 20–30°C reduces inflammation and pain in arthritis. Yet, relationships of immersion in water at 20–30°C with urate levels and the nucleotide-binding domain (NOD)-like receptor protein 1 (NLRP1) inflammasome have never been clarified. Objectives We aimed to investigate the effects of immersion in water at 20–30°C on urate levels, the NLRP1 inflammasome, pain, and quality of life among acute gout patients. Methods A community-based randomized control trial design was used with 2 parallel-intervention groups: immersion in water at 20–30°C (20 min/day for 4 weeks) group and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were assigned using block randomization. We analyze the results (coef. β) and 95% confidence intervals (CIs) using a generalized estimating equation model. We analyzed mediating effects using a path analysis. Results Significant pain alleviation ( β = −2.06 [95% CI = −2.67∼-1.45]; β = −2.42 [95% CI = −2.97∼-1.87]) and improved quality of life ( β = 5.34 [95% CI = 3.12–7.57]; β = 9.93 [95% CI = 7.02–12.83]) were detected at 2 and 4 weeks of follow-up compared to the pre-test and control group. Urate levels ( β = −0.34 [95% CI = −0.52∼-0.16]) were reduced at the 2-week follow-up, but there was no significant change in the NLRP1 inflammasome compared to the pre-test and control group after immersion in water at 20–30°C. Both the NLRP1 inflammasome ( β = −0.48 [95% CI = −0.63∼-0.34]); water 0.01) and urate levels ( β = −0.11 [95% CI = −0.24∼-0.03]; p < 0.01) had partial indirect (mediating) effects on the link between immersion in water at 20–30°C and pain at the 4-week follow-up. Conclusions Immersion in water at 20–30°C significantly decreased pain and increased the quality of life. Immersion in water at 20–30°C mediated NLRP1 and urate levels to decrease pain, although it had no significant effect on the NLRP1 inflammasome concentration after 4 weeks of follow-up and reduced urate levels only at 2 weeks after immersion in water at 20–30°C.

In this study we examined the phenomena of smartphone addiction, online harassment, and school bullying/victimization to predict the prospective influence these could have on the onset and persistence of sleep problems and depression among children.Responses from 2155 fifth-grade children recruited from 30 primary schools in Taipei were assessed, and a follow-up was performed in the 6th grade. Self-administered questionnaires were collected for each year.Children who reported smartphone addictions, online harassment, and school bullying/victimization coupled with an increase in those factors were more likely to experience the onset and persistence of sleep problems. In addition, children who reported smartphone addiction, online harassment, school bullying/victimization, and poor sleep quality were more likely to experience the onset and persistence of depression.School nurses or pediatric nurses should be able to assess children's Internet use and risks to understand potential influences on sleep quality and mental status and provide recommendations for children, parents and schools.

Purpose To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients. Design A cross-sectional descriptive design was employed. Methods A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care. Results Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self-identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space. Conclusions Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities. Clinical relevance This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients.

PURPOSE The views of butch- and femme-identified lesbians toward their own breasts, breast cancer, breast cancer screenings, and their behavior and intentions toward breast health care were examined and compared in this study. METHODS A total of 208 Taiwanese lesbians (134 butch-identified lesbians and 78 femme-identified lesbians) completed an online survey. RESULTS Butch-identified lesbians were more likely to hold negative views regarding their own breasts, which were found to be significantly and negatively associated with their actions in performing breast self-examinations when compared with femme-identified lesbians. CONCLUSIONS Healthcare providers should be aware of and provide culturally competent care to lesbians with different identities. CLINICAL RELEVANCE The results can be employed as evidence for promoting lesbians' breast health, particularly butch-identified lesbians. Healthcare providers should provide a supportive environment in order to promote a positive body image and improve breast health among lesbians.

This study examined the relationships between children’s mobile gaming preferences, online risks, and mental health. Data were obtained from a sample of 2,702 third and fourth grade students from 16 elementary schools in Taiwan and 9 schools in China. A self-administered questionnaire was used. The mental state of the children who participated in the study was assessed using the Strengths and Difficulties Questionnaire (SDQ), while mobile gaming addiction was assessed using the short form of the Internet Gaming Disorders Scale (IGDS9-SF). The results showed that about 54% of children played mobile games with others (multi-player), while 31% played mobile games alone, and 15% did not play mobile games. Multiple logistic regression results indicated that behaviors such as participating in multi-player games, playing violent games, a poor parent-child relationship, and living in a rural area were associated with a greater risk of mobile gaming addiction. Involvement in multi-player games, playing violent games, mobile gaming addiction, and exposure to mobile violence/pornography were associated with greater risks of cyber aggression/victimization. Multiple regression results showed that being a multi-player, playing violent games, mobile gaming addiction, exposure to violence/pornography, exposure to cyber aggression/victimization, and having a poor parent-child relationship were associated with emotional and behavioral problems.

Purpose To examine suicide attempts and the influencing factors among Taiwanese lesbian, gay, bisexual, and transgender (LGBT) adults during the 2018 Taiwanese referendum on same-sex issues. Research design and methods The 2018 Taiwanese referendum was held on November 24. A cross-sectional online survey was conducted between October 2018 and February 2019. A total of 1012 self-identified LGBT adults were included in the final sample. Results Among the 1012 Taiwanese LGBT adults, the rates of suicide attempts ranged from 9.1% to 24.4%. A younger age, being a student, having low income, having mental health issues, and having a high level of depressive symptoms were associated with a significantly higher risk of suicide attempts in the participants. Conversely, having a postgraduate degree, having high self-esteem, and perceiving support from friends and family were associated with a lower risk of suicide attempts. Conclusion This is the first study to investigate suicide attempts among LGBT individuals and the influencing factors within the context of a same-sex marriage referendum in an Asian country. The results of this study demonstrate the importance of suicide prevention measures for the LGBT community, particularly during times of increased social stress and conflict between social groups with diverse sexual and gender identities. Clinical relevance The results of this study suggest that nurses' and health-care providers' sensitivity toward LGBT patients and their knowledge and skills in providing culturally competent care are key factors in suicide prevention for LGBT adults. Therefore, nurses and health-care providers must be provided with training courses on culturally competent care.

Past studies have shown that acculturation and self-efficacy can affect respite care knowledge, which are notable issues among immigrant caregivers due to the rapid increasing aging family members. The aim of this study was to investigate relationships among acculturation, self-efficacy, and respite care knowledge in immigrant caregivers, and to determine the mediating effects of self-efficacy on the relationship between acculturation and respite care knowledge. A cross-sectional design was used. We enrolled 134 female immigrant caregivers who had married Taiwanese men and lived with care recipients who used LTC services. Based on Baron and Kenny’ mediating analytic framework, multiple regression and Sobel tests were used to examine whether self-efficacy mediated the relationship between acculturation and respite care knowledge. The findings showed that after controlling for confounding factors, acculturation and self-efficacy separately affected respite care knowledge (B = 0.229, standard error (SE) = 0.084, B = 0.123, SE = 0.049, respectively). Acculturation had a positive impact on respite care knowledge through self-efficacy (B = 0.181, SE = 0.084). Therefore, self-efficacy partially mediated the effect of acculturation on respite care knowledge, and accounted for 20.9% of the total mediating effect in this study. Acculturation predicted immigrant caregiver’ respite care knowledge partially through self-efficacy. The association between acculturation and respite care knowledge was partially mediated by immigrant caregivers’ self-efficacy. As a result, it was proposed that boosting self-efficacy could increase and drive immigrant caregivers’ respite care knowledge. To assist this population in obtaining enough resources, targeted educational programs to promote immigrant caregivers’ self-efficacy should be designed and implemented. Furthermore, health care practitioners should be aware of the relevance of immigrant caregivers’ acculturation.

Sexual and gender minority older adults receive less social support than does the general population, leading to reliance on long-term care services. On May 24, 2019, Taiwan became the first country in Asia to legalise same-sex marriage. Sexual and gender minority older adults are becoming more visible in Taiwanese society. However, healthcare providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults and factors affecting their behaviour and intention in Asian culture remain unclear.This study determined factors associated with healthcare providers' behaviour and intention to offer culturally competent care to Taiwanese sexual and gender minority older adults and identified related training requirements.A qualitative descriptive study was conducted.This study recruited participants from 14 lesbian, gay, bisexual, and transgender organisations; long-term care facilities; and community healthcare centres. This study was approved by the Research Ethics Committee of National Taiwan University Hospital (Ref. 201811049RIND).A total of 25 providers were interviewed: 12 nurses, 10 social workers, and 3 staff members from lesbian, gay, bisexual, and transgender organisations.Semistructured interviews were conducted between May 2019 and September 2019. Interview data were analysed using the socio-ecological model and the constant comparative technique.Factors associated with the providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults were categorised by the socio-ecological model level: 1) intrapersonal factors, namely providers' attitudes towards sexual and gender minority older adults, knowledge regarding sexual and gender minority populations, and experiences of providing care for sexual and gender minority older adults; 2) interpersonal factors, namely providers' concerns regarding interactions among staff, sexual and gender minority older adults, nonsexual and gender minority residents, and nonsexual and gender minority residents' families; 3) community factors, namely resources, training courses, and support from managers and organisations; and 4) societal factors, namely social environment and policies.This study identified multilevel factors associated with the providers' cultural competence in caring for sexual and gender minority older adults in Taiwan. These factors may lead to disparities in quality of life and health for sexual and gender minority older adults. Recommendations to address multilevel barriers to reduce health disparities and improving quality of life in sexual and gender minority older adults have been provided.

The aim of this study was to explore predictors of nurses' willingness to handle abuse of older people.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.A cross-sectional design was used.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.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.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.Nurses' attitudes toward handling abuse of older people were the most important predictor of their willingness to handle abuse of older people.

Objective This study assessed the prevalence of children's and adolescents' pain experiences and use of medicine and examined the relationships between pain experiences, medication knowledge, literacy, and use of medicine. Method A probability-proportionate-to-size sampling method was used to systematically draw a random sample of schools. In 2014, a national representative sample of 2309 students from 35 primary schools (5th–6th grade), 2700 students from 30 middle schools, and 2013 students from 20 high schools completed the online survey. Results Overall, 85.6% of children and adolescents reported experiencing pain during the past year that included headache (63.0%), throat ache (59.3%), muscle ache (58.3%), stomach pain (42.9%), menstrual pain (girls: 42.1%), and dental pain (38.5%). Children and adolescents had taken cold/cough medicine (48.1%), acetaminophen (15.0%), antacids (14.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%) in the past year. Multivariate analysis results indicated that after controlling for pain experiences children and adolescents who had lower levels of medication knowledge and literacy were more likely to use pain medication and antacids more frequently. In addition, children and adolescents who had lower medication knowledge, lower literacy, asked doctors to prescribe antacids, and co-administered with antacids were more likely to report long-term use of antacids. Conclusions Lower levels of medication knowledge and literacy among children and adolescents were associated with more frequent use of pain medication and antacids.

Little is known about the changes of people with schizophrenia disability in Taiwan who receive routine treatments under the current mental healthcare system. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess and track changes in the degree of disability in people with schizophrenia before and after 4 years of follow-up. Data on 4497 people with schizophrenia were acquired from the Taiwan Data Bank of Persons with Disability. The WHODAS 2.0 was used for disability assessment, and the chi-square test, logistic regression and generalised estimating equations were adopted for statistical analysis. People with schizophrenia exhibited improvement in cognition, mobility and participation among the six domains as well as in the overall score. The degree of disability in all domains remained mild to moderate among people aged 18-64 years; the degree of disability in cognition declined from moderate to severe among patients aged ≥65 years. The degree of disability in all domains remained mild to moderate among people with mild to moderate impairment; among those with severe impairment, the degree of disability in the domains of cognition and life activities declined from moderate to severe and the degree of disability in the domain of mobility declined from mild to moderate. Community-dwelling patients exhibited less degree of disability in all domains than their institutionalised peers. Early detection and treatment and an emphasis on communication and social problem-solving skills in rehabilitation programmes are recommended for people with schizophrenia.

This study assessed the prevalence of smartphone addiction among children in Taiwan and examined the related factors. A total of 2621 fifth-grade students and 2468 parents from 30 primary schools in Taipei, Taiwan completed self-administered questionnaires in 2016. The results showed that fifth-grade students spent 11 h per week using either smartphones or tablets. The prevalence of smartphone addiction among fifth-grade students was 15.2%. Multivariate analysis results showed that parents who had high levels of risk perception and mediation efficacy were more likely to implement restrictive mediation of their children's use of the Internet and mobile devices. In addition, multivariate analysis results showed that children who had poor academic performance, depression, owned smartphones, frequently played smartphone/tablet gaming, and regularly used SNSs and instant messaging, had low levels of parental restrictive mediation, and had lower levels of self-reported Internet safety literacy were more likely to experience smartphone addiction.

Studies have assessed attitudes toward, knowledge of, and beliefs regarding providing care for lesbian, gay, bisexual, and transgender (LGBT) patients among student nurses, nurses, and nursing educators individually, but few studies have compared these aspects among these groups.To examine the attitudes toward, knowledge of, and beliefs regarding providing care for LGBT patients among student nurses, nurses, and nursing educators in Taiwan.Cross-sectional survey.The study was advertised in 8 nursing schools, 14 nursing associations, 209 nursing homes, and 2 online chatrooms in Taiwan.A total of 1150 participants were recruited: 447 student nurses, 475 nurses, and 228 nursing educators.Data were collected between August 2021 and January 2022 through a questionnaire with five sections: demographics, knowledge of LGBT health, the Knowledge about Homosexuality Questionnaire, the Attitude Toward Lesbian and Gay Men Scale, and the Gay Affirmative Practice Scale.The results suggest that the participants had limited knowledge of LGBT health. The nursing educators had the lowest scores for knowledge of LGBT health and homosexuality and the most negative attitudes toward lesbians and gay men among the groups; however, they were most likely to report their beliefs regarding providing nursing care to LGBT patients than the other two groups.The results indicate the importance of providing nursing educators with training courses and resources related to culturally competent care to improve education for nursing students and care for LGBT patients.

In this study, we examined excessive online gaming by adolescents and the resultant effects of their exposure to the online marketing of energy drinks and alcohol, and whether marketing literacy could serve as a mitigating factor. This cross-sectional study was conducted in 2020. Data were obtained from a sample of 2613 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted. The results showed that nearly 18% of the adolescent respondents had used energy drinks, while 75% reported seeing energy-drink advertisements on the internet in the past year. Multiple regression results indicated that factors such as being male, reporting excessive gaming, being exposed to higher levels of online energy-drink marketing, and reporting alcohol use were positively associated with energy-drink consumption. A higher level of online energy-drink marketing-affective literacy, however, was negatively associated with energy-drink consumption. In conclusion, factors that predicted energy-drink consumption among adolescents included excessive gaming and exposure to online energy-drink marketing, but marketing-affective literacy tended to lessen the impact of such advertising.

PURPOSE To examine the health status and quality of life of middle-aged and older sexual and gender minority adults in Taiwan. RESEARCH DESIGN AND METHODS A cross-sectional online survey was conducted between May and December 2019. A total of 535 self-identified lesbian, gay, bisexual, and transgender (LGBT) men and women ≥40 years of age were included in the final sample. An online questionnaire, which included the following three sections, was used to collect data in this study: (a) demographics, (b) the World Health Organization Quality of Life-Brief Taiwan version, and (c) physical and psychological health status. RESULTS Middle-aged and older Taiwanese LGBT adults who were single, were unemployed, and earned monthly incomes of

WHAT IS KNOWN ON THE SUBJECT?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals. Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non-western countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best our knowledge, this is the first study examining internalized homophobia, self-esteem, social support and depressive symptoms among sexual minority women in Taiwan. Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self-esteem and fewer support from partners, friends, and families. Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self-esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation. LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. ABSTRACT: Introduction Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non-western countries. Aim This study examined internalized homophobia, self-esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method A total of 581 Taiwanese sexual minority women (Age range 20-48 years old, Mean 26.96, SD 5.718) completed an online survey. Results Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self-esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion Mental health interventions are essential for sexual minority women with internalized homophobia and low self-esteem. Implications for Practice Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms.

Background: The assessment of symptoms distress is an important strategy for symptoms management and treatment of patients with liver cirrhosis (LC); however, appropriate instruments are limited. Objective: The objective of this study was to validate a symptoms distress scale (SDS) by confirming the appropriateness of each item using item response theory. Methods: A cross-sectional and convenience sampling was conducted to recruit eligible cirrhotic outpatients from the gastroenterology outpatient department of a single medical university hospital. In total, 163 patients with LC completed the 21-itemSDS. A graded response model with two-parameter (discrimination and difficulty) estimation was used for data analysis. Results: The item response theory model identified the validity of the SDS and found that most of the items in the SDS represented a high level of symptoms distress; moreover, three items of bruising, drowsiness, and dark urine were reported in cirrhotic patients with severe symptom distress. Four items comprising bodily pain, right upper quadrant pain, muscle cramps, and change in appearance can be appropriately represented in cirrhotic patients with mild symptoms distress. Moreover, the amount of test information in the SDS was >0.70, indicating acceptable reliability. Discussion: Items of the SDS can be useful for assessing different levels of symptoms distress; however, using the scale to assess mild symptoms distress in populations with LC should be done with great caution

The objectives of this study were to survey the frequency of engaging in a health-promoting lifestyle in patients with liver cirrhosis, and examine the mediating effects of a health-promoting lifestyle on relationships of symptoms and psychological distress with the quality of life (QOL). A cross-sectional study was conducted to recruit 148 cirrhotic outpatients from the gastroenterology outpatient department of one medical university hospital. All study participants completed self-administered questionnaires comprising a multidimensional symptoms scale, Hospital Anxiety and Depression Scale, short-form Chinese health-promoting lifestyle profile, and the Taiwanese version of the Short-Form 36. Hierarchical linear regression and mediation models were used to evaluate the effect of a health-promoting lifestyle on the QOL. Results showed these cirrhotic outpatients reported low frequencies of health-promoting behaviors in their daily activities and had poor mental health but superior physical health. The hierarchical linear regression model found that depression, anxiety, and a health-promoting lifestyle were significant determinants of mental health. The mediation analysis further identified that a health-promoting lifestyle acted as a significant mediator which ameliorated the effects of depression and anxiety on the mental health aspect of the QOL. A health-promoting lifestyle can improve the mental health of the QOL. Healthcare professionals can develop effective health-promoting interventions to manage and improve the mental health of cirrhotic patients.

Background Immigration is a global issue. Taiwan has a high proportion of immigrant spouses who take care of the aging parents-in-law at home mainly based on filial piety. Difficulties in communication in many aspects of daily life occur between the elderly and immigrant spouses, and result in the elderly becoming vulnerable and thus, influencing their psychological well-being. Although past studies demonstrated that due to cultural differences, employed foreign care providers negatively influenced elder care quality (e.g., care receipts’ health or mortality rates), no studies have explored whether immigrant spouses, as family caregivers, have any influence on elderly suicides due to cross cultural communication differences. Objective To address the above gap, this study was to examine the static relationship between immigrant spouses and elderly suicides. Method National-level authority data, comprising a 10-year longitudinal nationwide sample, were used. The number of immigrant spouses was treated as a proxy of cultural differences. Twelve models of outcomes with and without city- and time-fixed effects were conducted using panel data analysis. Results Descriptive statistics of the study variables are provided. The results revealed that overall the number of immigrant spouses had a positive correlation with suicides in older adults. Further, the gender of immigrant spouses had different impacts on elderly suicides. Conclusions This is the first study to examine relation between immigrant spouses and the elderly suicides. The study results provide another viewpoint of understanding of the role of immigrant spouses in elder care, while promoting elder-caregiver interactions for optimal elder health outcomes.

In the present study, we examined patterns of benzodiazepine (BZD) use in nurses, and compared the characteristics of frequent users with those of infrequent users. Data on all nurses enrolled in the study were derived from the reimbursement claim records in Taiwan's National Health Insurance Research Database for the period 2004-2008. The case group comprised 33 588 nurses with BZD use, and the control group was exactly matched to each case according to age and sex. The patterns of occasional, frequent, and daily BZD use demonstrated an increasing trend from 2004 to 2008. This trend was observed for most of the BZD with a short or intermediate half-life. Older nurses (>45 years) and those with greater experience (≥5 years) were more likely to use BZD frequently. Moreover, the risk of frequent BZD use increased significantly when nurses exhibited comorbid depression (adjusted odds ratio (aOR): 2.58), anxiety (aOR: 1.78), or sleep disorders (aOR: 2.29) compared with infrequent BZD use. The results indicated that nurses with BZD use had comorbidities of anxiety, depression, and sleep disorders. The increasing trend of patterns of BZD use and its association with sleep disorders, depression, and anxiety can be used as references for stress and sleep management in nurses.

Purpose: To explore the differences in sleep parameters between nurses working a slow, forward rotating shift and those working a fixed day shift. Method: A longitudinal parallel-group comparison design was used in this prospective study. Participants (female) were randomly assigned to a rotating shift or a fixed day shift group. Participants in the rotating shift group worked day shift for the first 4 weeks, followed by evening shift for the second and night shift the third. Those in the day shift group worked day shift for all 12 weeks. Each kept a sleep diary and wore an actigraph (actigraph data were used to calculate total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE]) for 12 days, from Workday 1–4 in each of Weeks 4, 8, and 12. Results: TST in nurses working evening rotating shift was higher than that for those working the day or night rotating shift and fixed day shift. WASO was significantly longer on Day 2 for rotating shift participants working evening versus day shift. SOL and SE were significantly shorter and lower in rotating shift nurses working night versus both day and evening shifts. Conclusions: A comprehensive understanding of the sleep patterns and quality of nurses with different work shifts may lead to better management of work shifts that reduces the influence of shift work on sleep quality.

Objectives We aimed to analyze the effects of multidomain attention training on alertness, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment (MCI). Design The design used in this study was a two-arm, parallel group, double-blind randomized controlled trial. Setting and participants The participants of the study were seventy-eight older adults with MCI (mean age: 79.5 ± 7.9 years) from retirement centers and community housing for the elderly. Intervention The participants were randomly assigned to an experimental group (multidomain attention training, n = 39) or an active control group (n = 39). Both groups underwent training sessions for 45 minutes three times per week for 6 weeks (18 sessions in total). Measures The main efficacy indicator was alertness (Trail Making Test Part B), sustained attention (Digit Vigilance Test), and visual-spatial attention (Trail Making Test Part A). The secondary outcome indicators were other cognitive functions (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA] subscales). Measurements were obtained at pretest, posttest, and 3 and 6 months after training. Results The results were analyzed by a generalized estimating equation (GEE), which indicated that attention outcomes (alertness, sustained attention, and visual-spatial attention) of the experimental group did not improve after training. However, the experimental group displayed a significant improvement in the attention, memory, and orientation of MMSE and MoCA subscales over a period of 6 months and also showed superior results compared with the control group. Conclusions Multidomain attention training demonstrated improved alertness and visual-spatial attention for posttest after 6 months. We also outline potential future advances in attention training for improving attention in older adults with MCI.

Objectives To examine the immediate and long-term effects of executive attention training on selective attention, focused attention, and divided attention in older adults with mild cognitive impairment. Methods A double-blind, multisite randomized controlled trial at five sites. Seventy participants (mean age: 78.19 ± 7.22 years) were assigned to an experimental group (executive attention training, n = 35) or an active control group (n = 35). The training duration was the same for both groups (45 minutes per session, 3 times per week, 18 sessions in total). Primary outcome measure was selective attention (Digit Span Task). Secondary outcome measures included focused attention (Stroop Color Word Test) and divided attention (Trail-Making Test Part B). Data were collected at pretest, post-test, 3-month follow-up, and 6-month follow-up. Results In GEE analysis, findings indicated a significant improvement in selective attention at post-test, whereas divided attention showed significant reducing omission error at 3-month follow-up. There was no significant effect of group in focused attention associated with the executive attention training compared with active control group. Conclusion The executive attention training significantly improved selective attention and divided attention performance. Future studies should identify transfer effects of attention training, and that can employ early screening to provide integrated attention training, and decrease its relevant risks on competency in performing daily activities, such as falling and driving.

With the development of electronic technology and forms of communication such as the Internet, it has become increasing difficult for parents to identify and mitigate the new risks to which their adolescent children are exposed. In this article, we compare the ways parents and adolescents living in urban areas use the Internet with those of their counterparts who live in rural areas. We based this comparison on data obtained from a survey of Internet use in Taiwan in 2013. The survey included 1079 junior high school students and 688 parents who lived in urban areas and 838 students and 729 parents who lived in rural areas. We found that parents living in rural areas had lower levels of Internet skills and intervened less in their children’s use of the Internet when compared with parents living in urban areas. We also found that, compared with their urban counterparts, adolescents who live in rural areas have lower levels of Internet literacy but a higher frequency of Internet use and they also engage in r...

The lack of a suitable assessment tool may limit optimal stress management and impair the health-related quality of life of patients undergoing hemodialysis. The purpose of the study was to examine latent constructs and psychometric properties of the Vietnamese Hemodialysis Stressor Scale (HSS-V). In total, 180 patients receiving hemodialysis were recruited. Psychometric properties of the HSS-V, including the construct validity, internal consistency, and test–retest reliability, were tested after the instrument translation. The exploratory factor analysis resulted in a 24-item HSS-V with four extracted factors, which explained 58.32% of the total variance. The construct validity was confirmed by significant negative correlations between scores on the HSS-V and Vietnamese-version Short Form-36. The internal consistency (Cronbach’s α = .82-.91) and test–retest reliability (intra-class correlations coefficient = .91-.94) of the 24-item HSS-V were satisfactory. A simple structure and preliminary acceptable psychometric properties of the HSS-V were established and can serve as a basis for further studies.

Aims and objectives The purpose of this study was to investigate the effects of a music intervention on hospitalised psychiatric patients with different levels of anxiety. Background In clinical practice, psychiatric inpatients and nurses routinely suffer from anxiety. A music intervention may possibly be useful, but knowledge as to how useful and how effective it is in patients with different levels of anxiety is limited. Design The study design was a three-group, repeated-measures experimental study. Methods Subjects were 22 psychiatric patients who were divided into three groups based on their level of anxiety. They listened to 20 minutes of music each day for 10 days and were assessed using the Beck Anxiety Inventory before and after the music intervention and at a one-week follow-up; an electroencephalogram and finger temperature were monitored before and during the music intervention. Results Anxiety levels of all three groups showed a significant difference (p = 0·0339) after the intervention. The difference alpha and beta electroencephalogram percentages for all three groups showed a significant difference (p = 0·04; p = 0·01). The finger temperature showed a non-significant difference (p = 0·41). Conclusions A music intervention can effectively alleviate the anxiety of hospitalised psychiatric patients who suffer from all levels of anxiety. Relevance to clinical practice The study recommends a practice in alleviating anxiety. Effective lower-cost interventions to reduce anxiety in psychiatric inpatient settings would be of interest to nurses and benefit patients.

Background Health-related quality of life (HRQoL) in community-dwelling older adults increases as physical activity improves, and age-related frailty has a negative effect on HRQoL. Research on these associations is lacking. Purpose The aims of this study were to (a) analyze the effect of demographic characteristics on HRQoL, (b) explore the correlation between physical activity and HRQoL, (c) analyze the effect of frailty on HRQoL, and (d) investigate the potential predictors of HRQoL in community-dwelling older adults. Methods In this cross-sectional study, a convenience sample of 150 older adults was recruited from community care sites in Shilin and Beitou Districts in Taipei City, Taiwan. Data were collected at baseline using a demographic characteristics datasheet, the Center for Epidemiologic Studies Depression Scale, the Physical Activity Scale for the Elderly, and the 12-Item Short Form Health Survey. The Senior Fitness Test and hand-grip strength test were also performed. Student t test, chi-square test, analysis of variance, Pearson correlation coefficient, and hierarchical regression were applied to analyze the statistical results using IBM SPSS Statistics Version 22.0. Results Being of older age, experiencing a higher number of falls, having more chronic diseases, and having a higher body mass index were identified as factors that significantly affect HRQoL. Moreover, HRQoL was found to be significantly affected by the performance of physical activity or status of frailty. Furthermore, the prefrail period was shown to be an important predictor of HRQoL after adjusting for demographic variables, history of chronic illness, history of falls, and physical activity. Conclusions/Implications for Practice In this study, HRQoL was found to be significantly affected by upper limb dysfunction and the prefrail period. Community health promotion activities should focus greater attention on the physical functioning of older adults. Furthermore, providing information on age-related frailty and promoting active participation in community activities may increase the attention given by community-dwelling older adults to physical fitness and quality of life.

Aims and objectives To assess the willingness of nurses to receive vaccines as recommended by Taiwan's "Immunization Recommendations for Healthcare Personnel" (IRHCP), as well as the factors associated with their willingness. Background Immunisation for healthcare personnel (HCP) is a means of reducing pathogen transmission. Also, vaccinating HCP reduces personnel and labour costs during an epidemic. Methods A cross-sectional study was conducted. A self-administered questionnaire survey targeting nurses working in various service units at three hospitals was used. In total, 413 nurses completed the questionnaire. The main outcome measure was the willingness to receive vaccines recommended by the IRHCP, and the variables we assessed included knowledge regarding the IRHCP, individual perceptions (perceived risk of contracting the infection, perceived severity of the infection and perceived transmissibility after disease onset), perceived benefits and barriers to the vaccination, cues to the vaccination and demographics. This study followed the STROBE checklist for reporting this study. Results The willingness of nurses to receive vaccines recommended by the IRHCP was high; the highest level of willingness was for the hepatitis B vaccine. The nurses' willingness to receive various vaccines recommended by the IRHCP was predicted by the knowledge regarding the IRHCP and perceived transmissibility after disease onset. Except the diphtheria-tetanus-acellular pertussis vaccine, perceived benefits and perceived barriers were also predictors of the willingness to receive vaccines. Conclusions Our results showed that interventions focusing on increasing the knowledge regarding the IRHCP and perceived transmissibility after disease onset, emphasising the benefits of the vaccination and reducing the perceived barriers to the vaccination are needed to increase nurses' willingness to receive vaccines. Relevance to clinical practice It is suggested using health education courses and mass media broadcasts at the individual and societal levels to raise awareness regarding the benefits of vaccines and enhance nurse' confidence in vaccination programs.

To explore the effects of home-based music intervention (HBMI) on symptom severity, pain intensity and perceived fatigue among patients with breast cancer. In this randomised controlled trial, patients with breast cancer were randomly assigned into an HBMI or control group. The HBMI group was administered 24-week HBMI involving five 30-min sessions per week. The primary outcome was symptom severity; the secondary outcomes were pain and fatigue. A generalised estimating equation was employed to compare the effects after 6, 12 and 24 weeks of intervention between the two groups. A total of 60 patients were recruited. After 6, 12 and 24 weeks, HBMI significantly reduced symptom severity, pain intensity, overall fatigue, general fatigue, emotional fatigue and vigour (p < 0.05). Additionally, HBMI significantly reduced physical fatigue after 6 (p = 0.003) and 12 (p = 0.013) weeks and mental fatigue after 6 weeks (p = 0.001). After 6, 12 and 24 weeks, HBMI reduced symptom severity, pain intensity and overall fatigue. Furthermore, HBMI instantaneously reduced physical and mental fatigue. We recommend that HBMI be administered to patients with breast cancer to reduce their negative thoughts associated with cancer.

Depression is common in patients with chronic kidney disease who are on hemodialysis. Available behavioral modalities for treating depression may not be feasible for patients who receive hemodialysis two or three times per week.The purpose of this randomized controlled trial was to examine the efficacy of a nurse-led, in-center breathing training program in reducing depressive symptoms and improving sleep quality and health-related quality of life in patients on maintenance hemodialysis.Fifty-seven patients on hemodialysis were randomly assigned either to an eight-session breathing training group or to a control group. The Beck Depression Inventory II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Medical Outcome Studies 36-Item Short Form Health Survey (SF-36) were used to assess self-reported depressive symptoms, sleep quality, and health-related quality of life, respectively.The intervention group exhibited significantly greater decreases in BDI-II scores than the control group. No significant differences in PSQI change scores were observed between the groups. SF-36 change scores for both the domain of role limitation due to emotional problems and the mental component summary were significantly higher in the breathing training group than in the control group.This intervention significantly alleviated depressive symptoms, reduced perceived role limitation due to emotional problems, and improved the overall mental health component of quality of life in patients on maintenance hemodialysis.

Objective This study examined the relationships between parental mediation and Internet addiction, and the connections to cyberbullying, substance use, and depression among adolescents. Method The study involved 1808 junior high school students who completed a questionnaire in Taiwan in 2013. Results Multiple logistic regression analysis results showed that adolescents who perceived lower levels of parental attachment were more likely to experience Internet addiction, cyberbullying, smoking, and depression, while adolescents who reported higher levels of parental restrictive mediation were less likely to experience Internet addiction or to engage in cyberbullying. Adolescent Internet addiction was associated with cyberbullying victimization/perpetration, smoking, consumption of alcohol, and depression. Conclusion Internet addiction by adolescents was associated with cyberbullying, substance use and depression, while parental restrictive mediation was associated with reductions in adolescent Internet addiction and cyberbullying.

Purpose: Insomnia, parasomnia, and obstructive sleep apnea have been associated with a number of disease pathologies, but little is known about the relationship of these sleep disorders and cancer. The study explored the risk of sleep disorder (SD)-induced cancer using nationwide population data. Two million data from the National Health Insurance system of Taiwan was used to assess for the relationship. Patients and Methods: Patients with cancer as our cases and patients without cancer as our control group in 2001-20011. The study patients were traced back to seek the exposure risk factor of sleep disorders, which was divided into three categories: insomnia, obstructive sleep apnea (OSA) and parasomnia. Patients were selected excluding patients who had cancer prior to presenting with the sleep disorder and the person-year is less than 2 years. Each case was randomly matched with two cases with the same age, gender, and index year. Results: There were significantly increased risks of breast cancer in the patients with insomnia (AHR=1.73; 95% CI: 1.57-1.90), patients with parasomnia (AHR=2.76; 95% CI: 1.53-5.00), and patients with OSA (AHR=2.10; 95% CI: 1.16-3.80). Moreover, patients with parasomnia had significantly higher risk of developing oral cancer (AHR=2.71; 95% CI: 1.02-7.24) compared with patients without parasomnia. The risk of suffering from nasal cancer (AHR=5.96, 95% CI: 2.96-11.99) and prostate cancer (AHR=3.69, 95% CI: 1.98- 6.89) in patients with OSA was significantly higher than that of patients without OSA. Conclusions: Our findings provided the evidence that people diagnosed with insomnia, parasomnia and OSA are at a higher risk of developing cancers to remind people to improve sleep quality.

To investigate joint functioning and the quality of life (QOL) before and after total knee and total hip replacement and the factors that influence the QOL.A longitudinal study was conducted between August 2015 and January 2017. A questionnaire composed of the EQ-5D, Oxford Hip Score, and Oxford Knee Score was used to collect data before surgery and 6 weeks, 3 months, and 6 months after surgery.A repeated-measures analysis of variance revealed significant differences in the EQ-5D utility index between the preoperative and all 3 postoperative periods (F = 124.195, P .05). There were significant differences in knee functioning (F = 133.859, P .05) and hip functioning (F = 34.717, P .05) between the preoperative and all 3 postoperative periods. The EQ-5D utility index was significantly higher among patients undergoing total knee replacement than those undergoing total hip replacement (F = 15.490, P .05) and higher among female than male patients (F = 7.613, P .05). A positive correlation between the QOL and the perceived convenience of living at home was observed (P .05).The findings are expected to inform patient education for patients undergoing arthroplasty surgery.