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Abstract Stroke and cognitive impairment are common in older population. They often occur together and their combined effects significantly increase disability in both basic (BADLs) and instrumental (IADLs) activities of daily living. We investigated the individual and combined impacts of stroke and cognitive impairment on BADLs and IADLs. A total of 3331 community-dwelling older adults were enrolled from the Taiwan longitudinal study on aging in 2011. Both BADLs and IADLs were analyzed. Combination of stroke and cognitive impairment increased severity of ADL disabilities, but similar prevalence, similar numbers of summed BADL and IADL tasks with disability, and similar levels of difficulty for each BADL and IADL task were found between the stroke group and cognitive impairment group. The former had more difficult in dressing while the latter had more difficult in using the telephone, transport, and managing finances. A hierarchy of ADLs was also observed in all groups. ADL skill training supplemented with cognitive and physical interventions should focus on secondary prevention of dementia and improve motor functional capacity to reduce loss of ADLs.

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

COVID-19 epidemic bring a great threat to human physical and mental health. This study aimed to investigate the effectiveness of an online mindfulness platform in improving mental status. Patients from a regional hospital were randomly divided into the experimental and control groups. The experimental group received online mindfulness interventions, and control group received general health education. There were no significant differences in the stress or depression scores between the two groups (P > 0.05). Intervention group had significantly lower anxiety scores than control group at fourth and eighth weeks (P<0.001). There was no significant difference in the emotion change over time in control group (P > 0.05). The anxiety in the intervention group was significantly improved at the 4th and 8th weeks (P<0.05). Moreover, the stress and depression in the intervention group were significantly improved at the 8th week (P<0.05). Online mindfulness intervention can effectively improve emotional status. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects that listening and not listening to music had on pain relief, heart rate variability (HRV), and knee range of motion in total knee replacement (TKR) patients who underwent continuous passive motion (CPM) rehabilitation. We adopted a single-group quasi-experimental design. A sample of 49 TKR patients listened to music for 25 min during one session of CPM and no music during another session of CPM the same day for a total of 2 days. Results indicated that during CPM, patients exhibited a significant decrease in the pain level (p < .05), an increase in the CPM knee flexion angle (p < .05), a decrease in the lowfrequency/high-frequency ratio (LF/HF) and normalized LF (nLF) of the FHRV (p < .01), and an increase in the normalized HF (nHF) and standard deviation of all normal-to-normal intervals (SDNN; p < .01) when listening to music compared with no music. This study demonstrated that listening to music can effectively decrease pain during CPM rehabilitation and improve the joint range of motion in patients who underwent TKR surgery. [ABSTRACT FROM AUTHOR]

Background : The Internet has been gaining worldwide popularity in recent years, but a loss of control over Internet use might lead to negative impacts on our daily lives. Objectives : This study explored the effects of Internet addiction on autonomic nervous system function through heart rate variability (HRV) analysis. Methods : This was a cross-sectional design. Data were collected from 240 school-aged children who completed the Chinese Internet Addiction Scale and Pittsburgh Sleep Quality Index questionnaires. Spectral analysis was used to measure HRV. Independent t test was used to compare differences in characteristics and HRV between groups. A 2-way analysis of variance was used to examine group differences in HRV. Results: Internet addicts had significantly lower high frequency (HF) percentage, logarithmically transformed HF, and logarithmically transformed total power and significantly higher low frequency percentage than did nonaddicts. Internet addicts who had insomnia had higher low frequency percentage and lower HF percentage, logarithmically transformed HF, and logarithmically transformed total power compared with nonaddicts who did not have insomnia. Conclusions : Internet addiction is associated with higher sympathetic activity and lower parasympathetic activity. The autonomic dysregulation associated with Internet addiction might partly result from insomnia, but the mechanism still needs to be further studied. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to (a) to compare hospitalized patients' and nurses' perceptions of the hospital environment, nurse--physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables. Background. Quality of care is a function of many factors and includes elements of the hospital environment and nurse--physician relationships. However, comparisons between patients' and nurses' perceptions are relatively limited. Methods. This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis. Results. Overall, patients' mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3.05 vs. 2.65 points), nurse--physician relationships (7.88 vs. 6.53 points) and quality of care (7.91 vs. 6.63 points) (P < 0.001). Both the hospital environment and nurse--physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse--physician relationships and years of education for patients (P < 0.05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse--physician relationships (P < 0.05). Conclusion. These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients' and nurses' expectations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined factors which influence nurses to leave their jobs. The results of a survey given to nurses in Taiwan to rate the quality of patient care in their units, job satisfaction, and whether they were considering leaving their jobs are examined. Researchers found that factors such as wage dissatisfaction and work shift should be addressed by hospital administrators.

Objectives: The purpose of this study was to investigate the demographics, training, and practice patterns of folk medicine practitioners, their opinions toward statutory regulation of folk medicine, and the formal education and credentialing for folk medicine providers in the metropolitan Taipei area. Design: A cross-sectional survey design was used. Subjects: Included in the survey were 200 folk medicine practitioners in Taipei city and 200 folk medicine practitioners in Taipei county. Instrument: The survey questionnaire consisted of 3 domains including demographics and training; practice patterns; and opinions toward statutory regulation of folk medicine and formal education and credentialing for Tuina, Ba Guan, Gua Sha, and reflexology providers. Results: The response rates ranged from 86.3% to 99.5%. A typical folk medicine provider in the Taipei metropolitan area was a middle-aged man with a high school degree who worked about 50 hours a week. The majority of the providers in the Taipei metropolitan area received their training through apprenticeship. Years of training and experience varied widely among these practitioners. About 80% had received more than one year of training prior to starting their practice. Adult men and women were their major clientele. The major treatment modalities they offered were Tuina, Gua Sha, Ba Guan, reflexology, and meridian massage. The majority of the respondents agreed that practitioners should receive formal education and training and agreed that certifying the qualifications of folk medicine practitioners is necessary. Conclusion: Findings from the present survey provide an understanding of the training and practice patterns of Taiwanese folk medicine practitioners, highlight folk medicine practitioners' needs for formal education and training, and stress the importance of statutory regulation of folk medicine in Taiwan. [ABSTRACT FROM AUTHOR]

Health-related quality of life measures are increasingly being used in evaluating health care outcome around the world. There is a demand for the development of quality of life measures to be used cross-culturally. The aim of this study is to evaluate the psychometric properties of the Taiwanese version of Kiddo-KINDL®, a health-related quality of life questionnaire. The original German-version of Kiddo-KINDL® was translated into Chinese (Taiwanese) via the forward/backward translation process. Psychometric testing was performed with a national sample of 1,985 healthy students between the ages of 12 and 16. Data were analyzed based on 1,675 usable questionnaires. The reliability coefficients were α = 0.81 (overall) and −0.31 to 0.84 for six subscales. The subscales with low Cronbach’s α were “school” and “friends.” Test–retest reliability was 0.77. Convergent validity was examined with the broadly used Taiwanese version of the Adolescent Depressive Mood Self-Detecting Scale. The result was satisfactory. Construct validity was further examined with exploratory factor analysis. The six-factor solution explained 45.2% of the variance. The construct of Kiddo-KINDL® (Taiwanese version) appeared to be appropriate for measuring health-related quality of life in healthy adolescents. Kiddo-KINDL® (Taiwanese version) is a relatively reliable and valid questionnaire of adolescents’ health-related quality of life. However, items in the “school” and “friends” subscales need to be further modified to be more culturally appropriate. [ABSTRACT FROM AUTHOR]

Background: The issue of active and passive cigarette smoking among pregnant women at home has become a major source of debate. The purpose of this study was to explore the knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke and related factors among pregnant women in Taiwan. Methods: A cross-sectional research design was used. Women ( n = 281) visiting the outpatient antenatal clinics of one regional hospital and two medical centers in Taipei for routine obstetrical care volunteered to fill out questionnaires. Results: Participants on average had little knowledge of this issue and felt less than “very confident” in resisting environmental tobacco smoke and indicated that it was only “usually true” that they practiced avoidance behaviors. The knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke were all related to both the woman and her partner's educational levels. There were significant differences in mean knowledge, self-efficacy, and avoidance of environmental tobacco smoke scores among different household smoking groups. A multiple regression revealed that overall avoidance of environmental tobacco smoke was positively associated with self-efficacy, with a no-smoking policy at home, and with both a woman and her partner's educational levels. Conclusions: The high prevalence of subjects suffering from active (6.05%) and passive smoking (58.72%) suggests that clinicians can target interventions designed to increase pregnant women's self-efficacy and to advise them to try to set up their own smoking policy at home. [ABSTRACT FROM AUTHOR]

Objective: This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension. Methods: Participants in the active biofeedback group ( n = 20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group ( n = 18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training. Results: The decreases in systolic (12.6 ± 8.8 versus 4.1 ± 5.7) and mean BP (8.2 ± 6.9 versus 3.3 ± 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group ( p = 0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP ( p = 0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group ( p = 0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged. Conclusions: BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress. [ABSTRACT FROM AUTHOR]

This is a cross-sectional study that purposely selected healthy community centers (HCC) in Taipei City to explore factors affecting volunteers' health training program participation (HTPP). The major objectives were to: (1) examine volunteer's HTPP; (2) explore relationships among volunteers' HTPP, self-efficacy (SE) in healthy community building, and community activities participation (CAP); and (3) identify key factors affecting volunteers' HTPP. A self-developed instrument with validity (content validity index > .91) and reliability (α = .63~.87) was used. A total of 250 participants were recruited. Study results revealed that a majority of the volunteers were middle-aged women who held at least a high school education, worked part-time, held Buddhist religious beliefs, were married and were middle class in terms of income. The average HTPP value was 19, with Xin Yi, Zhong Zhen and Bei Tou HCCs exhibiting higher HTPP values. Those not currently employed and housewives volunteers had lower HTPP values. 66.4% of volunteers participated at community activities after training and contributed 60~120 service hours a year. Volunteers' SE in healthy community building was low (M = 2.01, SD = 1.01), which, however, could explain 21% variance of HTPP. Factors affecting HTPP included HCC site, SE and CAP, which accounted for 57% of variance. Study results indicated that SE and CAP could serve as training evaluation indicators and a well-organized training program could increase volunteers' SE. Standard health training programs should incorporate three programs, including volunteerism perception, health promotion, and middle aged and elderly care to thus further improve volunteer' participation in community health activities. [ABSTRACT FROM AUTHOR]

Background: The Internet has been gaining worldwide popularity in recent years, but a loss of control over Internet use might lead to negative impacts on our daily lives., Objectives: This study explored the effects of Internet addiction on autonomic nervous system function through heart rate variability (HRV) analysis., Methods: This was a cross-sectional design. Data were collected from 240 school-aged children who completed the Chinese Internet Addiction Scale and Pittsburgh Sleep Quality Index questionnaires. Spectral analysis was used to measure HRV. Independent t test was used to compare differences in characteristics and HRV between groups. A 2-way analysis of variance was used to examine group differences in HRV., Results: Internet addicts had significantly lower high frequency (HF) percentage, logarithmically transformed HF, and logarithmically transformed total power and significantly higher low frequency percentage than did nonaddicts. Internet addicts who had insomnia had higher low frequency percentage and lower HF percentage, logarithmically transformed HF, and logarithmically transformed total power compared with nonaddicts who did not have insomnia., Conclusions: Internet addiction is associated with higher sympathetic activity and lower parasympathetic activity. The autonomic dysregulation associated with Internet addiction might partly result from insomnia, but the mechanism still needs to be further studied.