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Accessible Summary: What is known on the subject?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses.Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated.Notwithstanding the known impact of certain intrinsic factors (e.g., personality‐related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. What this paper adds to existing knowledge?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses.Certain intrinsic factors, including those personality‐related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. What are the implications for practice?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care.Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on‐the‐job training programmes that involves actual practice and collaboration in a multidisciplinary team. Introduction: Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim: To conduct a questionnaire‐based survey on mental health nurses from eight hospitals. Method: A total of 239 psychiatric nurses were assessed based on (1) "big‐five Mini‐Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results: A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion: Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice: Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on‐the‐job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care. [ABSTRACT FROM AUTHOR]

Today, the various abilities that nurses require to meet patients' healthcare needs adequately are all affected by AI-enabled systems. This research used an experimental study design in which 60 subjects were randomly assigned to either an experimental (AI image e-book guidance) group or a control (text paper guidance) group after meeting the admission conditions and agreeing to participate in the study. It was proven that providing AI image e-book guidance before surgery significantly changed the behavior of patients and promoted relief of urinary catheter discomfort through self-efficacy to reduce urinary catheter pain after surgery (p < 0.001). It was found that providing AI image e-book guidance can shorten the time for health education and provide patients with repeated medical education and familiarity with health guidance, which can help to address the important clinical service demand issue and the shortage of nursing staff. [ABSTRACT FROM AUTHOR]

Background: Previous research has examined the use of augmented reality (AR) and virtual reality (VR) in English language teaching. However, to the best of our knowledge, none of the earlier studies that investigated integrating AR and VR "wearables" into teaching and learning English based on the attention, relevance, confidence, and satisfaction (ARCS) motivation model compared the differences in learning motivation and performance between traditional teaching methods and those using AR‐ and VR‐based using wearables. Objectives: To create a thematic learning environment based on learners' lived experiences and provide them with an immersive English course that extends textbook knowledge using a technology‐assisted real‐life learning context. Method: This study used a quasi‐experimental research design. A total of 119 participants were spilt into three learning groups based on teaching tools: traditional methods and AR‐ and VR‐based wearable devices. The performance of each group was evaluated through three stages using appropriate educational tools for traditional, AR‐, and VR‐based classrooms, followed by semistructured interviews. Multiple regression analysis was conducted to investigate the inference learning performance (remembering and analysing) of the four ARCS dimensions with the three teaching methods. Results: The results showed that confidence and relevance were positively correlated with learning performance in the VR‐based wearable group. In the context of the ARCS model, learners' confidence predicted learning performance and the remembering subdimension when VR‐based learning materials were used. Implications: These results suggest that, compared to traditional teaching methods, VR‐based wearables make it easier to create a highly immersive learning environment and are more likely to help learners find the correct words, improve their accuracy, and increase their confidence and sense of accomplishment in the entire learning process. Lay Description: Augmented reality (AR) and virtual reality (VR) allow learners to apply memorized subject knowledge to real‐life scenarios.The attention, relevance, confidence, and satisfaction (ARCS) motivation model enhances learning. What this paper adds: The study proposed the integration of AR and VR with "wearables" for teaching English.The study investigated the differences between how the teaching materials designed to incorporate different technological devices with the four ARCS dimensions predict their learning performance (remembering and analysing). Implications for practice and/or policy: The ARCS motivation model‐based design allows learners using VR‐based wearables to learn English through multiple interactions in real‐time.Integrating daily life experiences with course materials can attract learners' attention in the early stages of teaching.VR‐based learning creates a virtual learning environment relevant to the learners, allows them to learn English thematically in an immersive environment, and allows them to interact with the system. [ABSTRACT FROM AUTHOR]

Scholars have suggested that flipped learning can be enhanced by designing effective in‐class learning activities to improve students' higher order thinking skills. Problem posing has been recognized as such a learning strategy that has great potential for improving students' higher order thinking skills. However, it has been reported as a challenging task for most students. Research evidence has indicated the potential of engaging students in group learning with step‐by‐step hints when conducting problem‐posing activities. Therefore, this study proposed a multilevel concept mapping‐based problem‐posing strategy to assist students in completing the problem‐posing tasks in flipped learning. To understand the effectiveness of the proposed strategy, a flipped learning system was developed and adopted in the science class of an elementary school. Seventy‐five fifth graders from three classes were divided into experimental group A, experimental Group B and a control group. Students in Group A used the concept map‐guided problem‐posing strategy for flipped learning (CMPP‐FL), students in Group B used the problem‐posing strategy‐based flipped learning, while students in the control group used the conventional flipped learning strategy. The results showed that the CMPP‐FL was effective in terms of improving students' learning performance, especially for students with higher levels of critical thinking tendency. Lay Description: What is already known about this topic: Flipped learning enabled teachers to have more class time to engage students in applying knowledge.Scholars have suggested that the value of flipped learning can be enhanced by designing effective in‐class learning activities to improve students' higher order thinkingProblem‐posing has been recognized as such a learning strategy that has great potential for improving students' higher order thinking. What this paper adds: This study proposed a multilevel concept mapping‐based problem‐posing strategy to assist students in completing the problem‐posing tasks in flipped learning.A flipped learning system was developed and adopted in the science class of an elementary school.It was also found that the results showed that the concept map‐guided problem‐posing strategy was effective in terms of improving students' flipped learning performance, especially for those with higher levels of critical thinking tendency. Implications for practice and/or policy: Employing concept maps as a guidance for problem posing is a promising approach.It is worth investigating the impacts of the concept map‐guided problem posing approach on the students with different personal characteristics, such as knowledge levels or motivational levels.It is worth applying the approach to other courses in the future to further explore its effectiveness. [ABSTRACT FROM AUTHOR]

Robotics education has received an increasing attention in recent years as a means to build students' motivation, team collaboration skills, and other valuable 21st century competencies. Yet there is a lack of experimental studies to investigate and identify strategies to facilitate robotics education. This study adopted a 2 × 2 quasi‐experimental design to investigate two strategies: the incorporation of augmented reality (AR) and the introduction of competition in robotics activities. Students' robotics task performance, team collaboration processes, 21st century learning competencies and learning motivation were measured as dependent variables. The results indicated that AR significantly improved students' motivation, team processes, and 21st century competencies. Moreover, the effects of AR were more pronounced with the competition groups. Implications are drawn to provide guidelines on the use of AR and competition in robotics education. Lay Description: What is currently known about the subject matter?Robots in education have been recognized as an effective approach to enhance learning competencies.The benefits of AR in learning gains and motivation. What their paper adds to this?To design robotics curricula that can be used in middle schools.To understand what middle school students can learn from the robotics curricula. The implications of study findings for practitionersHow to utilize AR in robotics education.What are the structure and pace of robotics curricula for middle school students? [ABSTRACT FROM AUTHOR]

Previous studies on the interactive response system (IRS) have generally adopted the lecture method to facilitate teaching and learning, while few have made efforts to investigate the learning effects of instructional methods and IRS activities on learning and teaching. The purpose of the present study was therefore to explore whether the use of the IRS with two different teaching methods would affect students' learning performance. A quasi-experimental design was employed, with the teacher conducting the course using the learner as leader strategy in the experimental group (E.G.) and the teacher leader strategy in the control group (C.G.). The experiment was conducted over a period of 15 weeks (a semester), and questionnaires were administered at the beginning, in the middle and after the experiment to elicit the learners' views on the IRS application. The results support previous research which found that using the IRS improved learners' engagement and interaction. They also provide further evidence that the use of the IRS with both teaching strategies not only had a short-term learning effect but could also be a tool for sustaining students' learning motivation and self-directed learning for long-term learning purposes. Besides, the use of the learner as leader strategy contributed to enhancing discussion in groups, especially for the leading groups. The use of the IRS with the learner as leader strategy benefited those who acted as leaders in taking the initiative to learn the course content, and also engaged the students who acted as learners in concentrating on the course because it was their classmates who were leading. Lay Description What is already known about this topic The interactive response system (IRS) facilitates course interaction, and increases course attendance and learning performance, Most studies have integrated the IRS with lectures to facilitate teaching and learning, What this paper adds The paper explored the effectiveness of using the IRS with two teaching methods on students' learning for a semester., The use of the learner as leader strategy with IRS benefited the learners who acted as leaders in taking the initiative to learn the course content, and engaged the students who acted as learners in concentrating on the course., Implications for practice and/or policy Students are benefited in taking the initiative to learn the contents through hosting the IRS activity., Teachers could adopt both lectures and learner as leader strategy with IRS to sustain students' learning motivation and self-directed learning for long-term learning purposes. [ABSTRACT FROM AUTHOR]

Because the microworld can create a learning environment that allows learners to interact with the real world, the view of the microworld has been widely used in education and training. In this study, the simulated transactional interactive concurrent system (STICS) was used to provide an environment that simulates the stock market trading of the Taiwan Stock Exchange; the goal is to explore the effectiveness of using STICS in enhancing the financial literacy of students. This study adopts a quasi‐experimental design approach and divides students into two groups. The intervention group was made up of 42 students who learned financial knowledge aided by STICS, with a comparison group consisting of 43 students who learned with traditional lecturing and dictating methods. The study found that learners who used the STICS as an aid to learn financial knowledge had significantly better learning effectiveness than those who did not use STICS, in terms of motivation, attitude, and achievement. The intervention group also made significant improvements in average scores in learning motivation and achievement after 8 weeks of experimental teaching and learning. Lay Description: What is already known about this topic This study employs the microworld perspective as a learning scaffold which simulates the real financial environment through computer assistant learning.By means of the computer assistant learning pattern of STICS, it not only enhances the financial literature of learners, but also increases the happiness and fun in the learning process. What this paper adds This allows learners can free from the barrier of insufficient investment funds by using STICS computer assistant learning.The STICS computer assistant learning system have the potential of promoting interactivity between learners and instructors, and improving the students' financial achievements. Implications for practice and/or policy The benefits of the STICS computer assistant learning are not only to enable students to deepen their understanding of the content of the textbook, but also to experience practical trading environment, such as profitability, risk, delivery and payment, long‐buying and short‐selling, etc.From this study, it is known that improving students' financial literacy not only contributes to personal wealth, but also avoids the recurrence of financial turmoil.In the future, we should devote ourselves to teach students how to apply knowledge to the real environment in an immersive learning, without being out of reality. [ABSTRACT FROM AUTHOR]

This study developed a web‐based multimedia assessment system (WMA system) and applied it to science laboratory instruction. The goal was to improve students' knowledge acquisition under science laboratory instruction. The developed system enabled learners to perform self‐assessments by responding to multimedia technology test items online. The system recorded each learner's complete answer history and provided the students with personalized learning resources. This study adopted a quasi‐experimental research design. The learning content was an "experiment on separating mixtures." Students participating in the research were divided into a typical science laboratory instruction group (TI group; n = 25) and a group that received instruction through the WMA system (WMA group; n = 26). Before instruction, all the students completed the conceptual knowledge and experimental knowledge pretests. During instruction, the TI group watched the teacher's demonstration experiment, and the students then performed the experiment in a real laboratory. In the WMA group, after learning through the WMA system, the students also performed the experiment in a real laboratory. After instruction, all the students completed the conceptual knowledge and experimental knowledge posttests. The findings indicated that the students in the WMA group showed significantly higher improvements in their scientific conceptual knowledge and experimental knowledge. Lay Description: What is already known about this topic: Although science laboratory instruction is important to science education, the role of science laboratory instruction in science education has been increasingly questioned.Many teachers still follow outmoded science laboratory instruction methods in their teaching, which makes students treat scientific experiments as "following recipes to cook."Multimedia technology is effective in assisting science laboratory instruction because proper scientific experiment course and computer‐simulated activities allow students to solve scientific problems dynamically.What this paper adds: This research proposed an effective approach to perform science laboratory instruction based on digital self‐assessment and combines it with the teaching activities in a real laboratory.The web‐based multimedia assessment system (WMA system) are developed to administer multimedia technology test items and assist students in performing self‐assessment in science laboratory instruction.Integrating WMA system into science laboratory instruction is effective in improving students' conceptual knowledge and experimental knowledge.Implications for practice: Conducting scientific experiments online using a self‐assessment approach allows students to examine their own understanding of scientific experimental procedure and receive personalized learning feedback.The online self‐assessment approach could be applied in "flipped learning" of science laboratory instruction to allow learners to do assessment‐centred personalized online learning about scientific concepts and knowledge related to scientific experiment before performing a real scientific experiment. [ABSTRACT FROM AUTHOR]

Background: Establishing a nurturing bond with the unborn child is essential for expectant mothers throughout pregnancy. While the influence of family support and pregnancy adaptation on maternal-fetal bonding is evident, these factors remain unexplored in the early stages of pregnancy. This study aims to elucidate the dynamic interaction between family support, pregnancy adaptation, and maternal-fetal bonding during the first trimester, explicitly investigating the mediating role of pregnancy adaptation. Method: A cross-sectional design was conducted to recruit expectant mothers between 8 and 12 weeks of gestation without significant complications. Results: Family support and pregnancy adaptation emerged as significant predictors of maternal-fetal bonding, and pregnancy adaptation mediated the relationship between family support and maternal-fetal bonding in the first trimester. Conclusions: The study confirms the critical role of family support and pregnancy adaptation in facilitating maternal-fetal bonding during early pregnancy, with pregnancy adaptation fully mediating this relationship. Healthcare providers are encouraged to involve family members in early interventions, focusing on assessing family support and engaging them in education and activities to strengthen the emotional bond between the mother and her unborn child. [ABSTRACT FROM AUTHOR]

Introduction: Many tactile graphics designed for individuals with visual impairments consider single factors. According to the results of our previous study, there may be interactions among scale, representation, and complexity factors. We conducted this integrative study with these three factors. Additionally, for the representation factor, we introduced a new level that mixed the two common levels (line drawing, (LD), and texture picture, (TP)), into a textured-line drawing, (TLD). Methods: We included 18 participants with congenital blindness. They were asked to identify and name tactile graphics. The design of tactile graphics involved three factors, each at different levels, including scale (large, medium, and small), representation (TP, LD, and TLD), and complexity (easy and complex). We recorded the identification time and accuracy and conducted three-way analysis of variance to investigate interactions. Results: The identification time for small-scale graphics was shorter than that for large-scale graphics. The accuracy for small-scale graphics was higher than medium-scale graphics. Under the TLD mode, the accuracy for small and medium-scale graphics was higher than that for large-scale graphics. For medium-scale graphics, TLD performed better than LD. Discussion: Because the sizes of small-scale graphics were similar to those of actual objects, they were easy to identify. If the TLD mode is used for medium-scale graphics, the components in the operation area can be completely presented, which is helpful for identification. However, if large-scale graphics are used under the TLD mode, the operation area is relatively small and difficult to identify. Implications for Practitioners: It is recommended to present objects at 1:1 under the small-scale. Under the medium-scale, the operation area can be presented by closed plains, while non-operation areas can be presented using lines. Under the large-scale, it is recommended to reduce the size of the graphics to an extent where both hands can be used to explore. [ABSTRACT FROM AUTHOR]

This study aimed to examine the group differences in participation level between children with and without global delays and to explore the associations between mastery motivation, executive function, and participation in young children with and without global developmental delays (GDD). Methods: we recruited 26 children with GDD aged 2 to 5 years and 26 children with sex- and mental age-matched developing typically (TD). The participants were assessed child development using the standardized developmental test, and their mothers were asked to fill in questionnaires, including the revised Dimension of Mastery Questionnaire (DMQ 18) with preschool version to assess mastery motivation, the Behavior Rating Inventory of Executive Function with preschool version (BRIEF-P) to assess executive function, and the Young Children's Participation and Environment Measure (YC-PEM) used to obtain participation levels. Results and conclusions: young children with GDD showed significantly lower participation levels at home, daycare, and community than TD group. We found that for young children, child mastery pleasure, health condition, and total persistence were significant predictors of child participation. Therefore, coaching parents to observe and facilitate their children's motivation and executive function, as well as child developmental abilities, is important in order to enhance children's participation in daily activities. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the usefulness of augmented reality (AR) in teaching. An experiment was conducted to examine children's learning performances, which included the number of errors they made, their ability to remember the content of what they had read and their satisfaction with the three types of teaching materials, including a picture book, physical interactions and an AR graphic book. The three teaching materials were aimed to respectively demonstrate the characteristics of six bacteria with 2D graphics, 3D physical objects, and 3D virtual objects. Seventy-two fifth-grade children were randomly selected to participate in the study, and they were divided into three groups, each of which used the assigned teaching material to learn the name of the six different bacteria in intervals of 1, 2 and 3 min. Results showed that the AR graphic book offers a practical and hands-on way for children to explore and learn about the bacteria. Follow-up interviews indicated that the children liked the AR graphic book the most, and they preferred it to the other materials. Lay Description What is currently known about Augmented Reality and learning? Augmented reality (AR) provides a new perspective for learning by allowing learners to visualize complex spatial relationships and abstract concepts., What the paper adds to the subject matter? AR improves learning performances to a similar extent as the most used teaching materials (both picture books and physical interactions) do., AR not only facilitates learning but also increases learning motivations better than conventional teaching materials do. The implications of study findings for practitioners. If children feel bored about reading textbooks, give them AR (because AR effectively enhances learning and children are more motivated when using AR)., AR teaching material is a good alternative to conventional picture book and physical interactions. [ABSTRACT FROM AUTHOR]

Learning a foreign language requires interaction with language input while involved in a task. Given that problem‐based learning (PBL) offers hands‐on application in realistic contexts, and that virtual reality (VR) enables learners to interact with multiple modalities of information, this study examines how the integration of VR technology into PBL contexts affects students' motivation for, problem‐solving during, and vocabulary acquisition in learning English as a foreign language (EFL). A total of 84 engineering majors who enrolled in a course of English for specific purposes were randomly assigned to either an experimental group or a control group. Students in the experimental group participated in a VR‐assisted PBL context, in which they were to view a PBL scenario using VR technology and then to create VR videos about solving the given problems. Those in the control group participated in a PBL context without the use of VR technology for viewing and solving the identical scenario. After the intervention, all the students wrote a problem‐solving analysis, took a vocabulary knowledge test, completed a learning motivation questionnaire, and participated in individual interviews. The results showed that the students in the experimental group significantly outperformed those in the control group in terms of vocabulary acquisition, and were more motivated to learn English related to their future careers, whereas there was no significant difference in the problem‐solving performance of the two groups. Implications of these findings highlight the value of engaging EFL learners in immersive environments for contextualized learning through the integrated use of VR and PBL. Lay Description: What is already known about this topic?: Virtual reality (VR) technology has been shown to enhance students' knowledge and skills in STEM fields.Problem‐based learning (PBL) has been widely used in medical education but not so much in foreign language education.English as a foreign language (EFL) students usually have very limited access to the target language beyond the classroom, thus lack a motivating reason for them to learn English after graduation. What this paper adds?: The VR‐assisted PBL approach proposed in this study was found to significantly enhance the EFL students' specialized vocabulary knowledge.The VR‐assisted PBL approach was found to motivate and sustain the EFL students' interest in career English.Exposing the EFL students to PBL contexts was capable of developing their problem‐solving performance, regardless of VR integration. Implications for practice and/or policy: The proposed approach has the potential to facilitate student learning in EFL education, particularly English for occupational purposes.EFL educators may apply the VR‐assisted PBL approach to narrow the gap between language classrooms and workplace contexts by immersing students in authentic contexts that were relevant to their occupational knowledge and workplace English. [ABSTRACT FROM AUTHOR]

Background: Team-Based Learning (TBL) is a potentially effective method of instruction that has been applied only infrequently in nursing education in Taiwan. Purpose: This study was developed to examine the effects of incorporating the TBL strategy into the course "Advanced Medical Nursing English". Methods: A quasi-experimental, single group, and pre-post test design was adopted. Nursing students who took the "Advanced Medical Nursing English" elective course used the TBL strategy for 8-weeks. Students were assigned to heterogenic groups of 12 students each based on their scores on an English pre-test. The collected data included the scores on individual and group readiness tests, a self-directed learning questionnaire, learning satisfaction, and an English posttest. Self-completed reflection papers and focused group interviews were used for qualitative appraisal. Results: A total of 72 students were enrolled. Nearly all (93.1%) were female and 21-22 years of age. The results of a paired samples t-test applied to examine the effects of the TBL strategy on learning outcomes showed that English posttest and self-directed learning ability scores had both improved significantly (all p < .05). The results of ANOVA tests showed that students with lower pre-test scores improved more than those with higher pre-test scores. The results of a sample t-test with a test value of 4.0 applied to examine learning satisfaction found a non-significant change (p > .05), indicating no change in perceived satisfaction. The qualitative analysis identified four themes regarding perceptions of the TBL strategy, including "friendships in learning", "harmonious atmosphere and participations", "inertial shock and adjustments", and " excessive learning load". Conclusion: TBL was shown to be an effective learning strategy for RN-BSN students in a Medical Nursing English Course, particularly those with relatively low pre-test scores. Future studies should focus attention on reading assignments to avoid overburdening students. The results of this study may serve as a reference for medical nursing English education. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sleep and mental health are very important in the aviation industry. Reports show that gender is one of the risk factors of insomnia, and most Asian flight attendants are female. Therefore, it is necessary to understand insomnia, and the correction to mental health among female flight attendants. OBJECTIVE: To investigate the prevalence of insomnia in female flight attendants and its association with mental health. METHODS: We used a cross-sectional design. We recruited 412 female flight attendants with more than 3 months of working experience. We collected the socio-demographic and work-related data, measured insomnia and mental health by the Athens Insomnia and Brief Symptom Rating Scales. Descriptive statistics, single-factor analysis of variance, Pearson's correlation analysis, and structural equation modeling were performed to analyze the relationships. RESULTS: There are 45.4% of female flight attendants having insomnia, and 24.8% had suspicious insomnia. The most considerable and serious insomnia problem was falling asleep (15.3%, 4.9%). Factors related to insomnia include smoking, drinking, family load (e.g., housekeeping and caring for family), economic stress and late-night/early morning workdays during last month. Also, insomnia had a direct association with mental health (T = 17.11, p < 0.001). CONCLUSION: We found that insomnia is negatively correlated with the above factors and mental health. We recommend that airline industries can run their sleep-education programs and provide relevant mental-health-promotion programs for flight attendants. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Suicide is a global mental health issue. Taking care of suicidal individuals is a substantial challenge. Most studies emphasize the suicidal individual. Few studies have emphasized the family caregivers of suicidal individuals., No study has explored the relationship between family caregivers' caring stress with suicidal attitudes and suicide care ability., What this paper adds to existing knowledge? The main results indicated that the older family caregivers tended to have a more negative attitude towards suicidal individuals. Female family caregivers' stress was higher than that of male family caregivers., A mild level of caring stress would help family caregivers have a more positive attitude towards suicidal individuals. Furthermore, a positive attitude would help family caregivers improve their caring ability., What are the implications for practice? Mental health nurses could help family caregivers, especially female family caregivers, reduce their holistic caring burden by looking for support resources and enhancing their coping strategies., Mental health nurses could help family caregivers promote positive attitudes towards suicidal relatives by understanding suicidal individuals' suffering., Abstract Introduction Suicide is a global mental health issue. Family caregivers play a key role in preventing suicide attempts. Aims The aim of this study was to examine the relationship among stress due to the family caregiver's role, suicidal attitude of the family caregiver and suicide care ability among family caregivers. Additionally, instruments of caring stress, attitudes towards suicidal relatives and caring abilities used in the study were tested to measure construct validity. Methods A cross-sectional correlational study was conducted with 164 family caregivers of people who are suicidal. The following three questionnaires were used: the Caring Stress Scale, the Suicidal Attitudes Scale and the Suicidal Caring Ability Scale. Structural equation modelling was performed using SPSS AMOS 19.0 to examine the path relationships among variables. Results Bivariate analyses showed that age was negatively correlated with suicidal attitude. In the final path model, caring stress had a positive effect on suicidal attitudes. Suicidal attitude and suicide care ability were highly positively correlated. Gender had a direct effect on caring stress, which indicated that female family caregivers experienced more stress from their role. Implications for practice: Mental health nurses could help family caregivers become aware of the emotional pain that suicidal people experience and then promote their positive attitudes towards their suicidal relatives. Furthermore, family caregivers could increase their ability to care for their suicidal relatives, which could reduce the numbers of suicides. [ABSTRACT FROM AUTHOR]

Introduction: This paper presents an epidemiologic study of appendicitis in Taiwan over a twelve-year period. An analysis of the incidence in the low-income population (LIP) is included to explore the effects of lower socioeconomic status on appendicitis. Methods: We analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database (NHIRD) from 2000 to 2011. All cases diagnosed as appendicitis were enrolled. Results: The overall incidences of appendicitis, primary appendectomy, and perforated appendicitis were 107.76, 101.58, and 27.20 per 100,000 per year, respectively. The highest incidence of appendicitis was found in persons aged 15 to 29 years; males had higher rates of appendicitis than females at all ages except for 70 years and older. Appendicitis rates were 11.76 % higher in the summer than in the winter months. A multilevel analysis with hierarchical linear modeling (HLM) revealed that male patients, younger patients (aged ≤14 years), and elderly patients (aged ≥60 years) had a higher risk of perforated appendicitis; among adults, the incidence increased with age. Moreover, the risk of perforation was higher in patients with one or more comorbidities. LIP patients comprised 1.25 % of the total number of patients with appendicitis from 2000 to 2011. The overall incidence of appendicitis was 34.99 % higher in the LIP than in the normal population (NP), and the incidence of perforated appendicitis was 40.40 % higher in the LIP than in the NP. After multivariate adjustment, the adjusted hospital costs and length of hospital stay (LOS) for the LIP patients were higher than those for the NP patients. Conclusions: Appendicitis and appendectomy in Taiwan had similar overall incidences, seasonality patterns, and declining trends compared to numerous previous studies. Compared to NP patients, LIP patients had a higher risk of appendicitis, longer LOS and higher hospital costs as a result of appendectomy. [ABSTRACT FROM AUTHOR]

Background: Low physical activity is common in systemic lupus erythematosus populations. Aim: To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. Methods: A randomized, controlled, single‐blind trial was conducted from March 2015 to August 2016. Seventy‐six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow‐ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. Results: The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. Conclusions: Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier. SUMMARY STATEMENT: What is already known about this topic? Patients with systemic lupus erythematosus (SLE) have inactive lifestyles, and few of them exercise regularly.Patients with SLE have poor aerobic fitness and muscle strength.Fatigue, poor sleep, and low quality of life are common in patients with SLE. What this paper adds? The five A's physical activity counselling model is feasible and can enhance SLE patients' physical activity levels.Vitality and mental health improvement are associated with an increase in physical activity. The implications of this paper: Health care professionals could provide physical activity counselling to SLE patients during every clinical visit.Health care professionals could encourage patients with SLE to use a pedometer as a monitor to record their daily steps. [ABSTRACT FROM AUTHOR]

Aim: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. Methods: In this cross‐sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face‐to‐face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility‐related knowledge. Results: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. Conclusion: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins. SUMMARY STATEMENT: What is known about this topic? Women with cancer diagnosed during the reproductive age are interested in a subsequent pregnancy.Less than half of childbearing‐age women with cancer have a comprehensive discussion about the potential impact of cancer therapy on fertility with the oncology physician.Reproductive‐age women with breast cancer have gaps in their knowledge of fertility planning as breast cancer survivors. What this paper adds? One in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy.Most women with breast cancer lack sufficient general and cancer‐specific knowledge about infertility.Factors associated with knowledge of infertility are fertility intention and education level. The implications of this paper: Results offer oncological nurses an understanding of fertility needs and infertility‐related knowledge in childbearing‐age women with breast cancer.Clinical nurses should continue to assess fertility willingness and knowledge of infertility in women with cancer both before and after cancer treatments.Comprehensive education about fertility and infertility in Taiwan is suggested. [ABSTRACT FROM AUTHOR]

This study examines the efficacy of a novel college sustainability course in promoting relevant environmental knowledge and interest in careers related to environmental aspects within the Taiwanese educational context. The core content of the course covers the essential concepts of sustainability and introduces students to environmental issues and their interrelation with the nexus of food, energy, and water, as well as related economic and social issues. This action competencefocused course was designed to allow students to develop their understanding of sustainability through a combination of engaging lectures, novel group activities, case studies, exercises, and team projects. The sample consisted of 44 Taiwanese undergraduate and graduate students majoring in the science, technology, engineering, and mathematics (STEM) disciplines. Participants' interest in STEM careers and perceived knowledge were measured by a pre-test and post-test administered before and after the program, respectively. Analyses of variance, correlation analyses, and crosslagged panel regression analyses were conducted to test four hypotheses. Results of repeatedmeasure analysis of covariance indicated that knowledge increased significantly from pre-test to post-test, but not career interest. Results of a cross-lagged panel regression analysis also indicated that pre-test knowledge was a significant positive predictor of post-test career interest. By creating an engaging class atmosphere and promoting experiential self-learning activities, this course was highly effective in enhancing students' knowledge of key sustainability aspects. Implications for interest development theory and sustainability pedagogy are also discussed. [ABSTRACT FROM AUTHOR]

Background: Fatigue is associated with multidimensional factors in heart failure patients. Investigating longitudinal changes in fatigue and its association in patients undergoing cardiac surgery is needed to create interventions for improving fatigue during recovery. Aims: This study examined the trajectory of fatigue and its associated factors over time in patients undergoing cardiac surgery. Methods: This longitudinal study enrolled 125 patients undergoing cardiac surgery in northern Taiwan. Patients completed questionnaires before surgery, at discharge, and at 1, 3 and 6 months post‐discharge. Fatigue was measured using the General Fatigue Scale. Generalised estimating equation models were fitted to identify variables associated with fatigue over time. This study complied with the STROBE checklist. Results: The sample (mean age = 60.70 ± 10.42) was mostly male (68%). High fatigue was found in 73.6% of patients before cardiac surgery and significantly decreased over the six months after discharge. NYHA III/IV, lower haemoglobin level, more symptom distress, poor sleep quality, higher anxiety and depression and lower social and family support were significantly associated with an increase in fatigue levels over time. Compared with before discharge, decreases in sleep quality at 1, 3 and 6 months were significantly associated with an increase in fatigue levels (p <.001). The increases in social support (B = 0.20, p =.016) and family support (B = 0.37, p =.002) at 6 months were significantly associated with an increase in the fatigue scores. Conclusion: Fatigue was common and associated with symptoms, sleep quality, emotion and social support in patients undergoing cardiac surgery. In addition to symptom management, improving sleep quality and social support are important to manage fatigue for the long‐term care of patients undergoing cardiac surgery. Relevance to clinical practice: Patient education on symptom management, sleep hygiene and family support is suggested to improve fatigue in patients recovering from cardiac surgery. [ABSTRACT FROM AUTHOR]

Some studies show that the Twitter's growth is leveling off and that its marketing has become ineffective. The purpose of this paper is to analyse what is needed for microblogs’ perpetuation. Factors such as message quality, source credibility, perceived usefulness, perceived interactivity, perceived playfulness, confirmation, and satisfaction were tested for their impact on continuance intention. A post-acceptance model of microblog continuance was proposed based on information system continuance model. We found that continuance intention to use microblogs is greatly affected by satisfaction, which in turn is affected by perceived interactivity and perceived usefulness, but satisfaction is not affected by confirmation or perceived playfulness. Although confirmation has no direct effect on satisfaction, it affects perceived interactivity and perceived usefulness, which in turn affect satisfaction. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study is to compare the efficacy of an 8‐week pelvic floor muscle training program with surface electromyography feedback, performed in different body positions (supine, sitting, and standing), in women with stress urinary incontinence. Design This is a prospective observational study performed January 2014 to May 2016. Methods: The training program was performed by 110 women with stress urinary incontinence, each completing 4 individual training sessions. The main outcome was the electromyography activity of the pelvic floor muscles and of the synergistic abdominal muscles. Outcome measures were evaluated at 4 time points, namely at baseline and at 2, 4, and 8 weeks of training. Results: A notable effect of training was identified at week 2, which was sustained through to week 8. Training yielded a significant improvement in increased sustained voluntary contraction of the pelvic floor muscles in all 3 positions. The efficacy of training was influenced by the duration of training, age, body mass index, and history of vaginal delivery. Conclusion: Training of the pelvic floor muscles, with positive reinforcement by surface electromyography feedback of the pelvic floor muscles and of the synergistic abdominal muscles, was effective for the treatment of stress urinary incontinence in women and should be considered as a feasible option by healthcare providers. SUMMARY STATEMENT: What is already known about this topic? In women with stress urinary incontinence, the sudden loss of urine negatively affects their quality of life.Conservative treatment remains the mainstay for managing this condition, for which pelvic floor muscle training is regarded an effective treatment.Biofeedback provides positive reinforcement during pelvic floor muscle training and can be achieved via several methods including electromyography, manometry, or ultrasonography. What this paper adds? An 8‐week training program, using surface electromyography as feedback, was effective in reducing female stress urinary incontinence; the effect was notable after 2, 4, and 8 weeks of training.The program was effective when performed in supine, standing, and sitting positions, with the greatest improvement obtained in the supine position.The duration of training, age, body mass index, and history of vaginal delivery were significant factors influencing training outcome. The implications of this paper: Health care professions should be adept at evaluating the severity of stress urinary incontinence symptoms to provide the best treatment.Nurses should acknowledge the benefits of the pelvic floor muscle training with bio‐assisted surface electromyography feedback and encourage patients with stress urinary incontinence to consider the program.Factors that might influence the efficacy of the training, namely age, body mass index, and history of vaginal delivery, should be considered during treatment counselling and treatment. [ABSTRACT FROM AUTHOR]

Background.: Knowledge regarding the relationship between writing kinetics and the difference among writing tasks is limited. Purpose.: This study examined the differences in handwriting performance when doing tasks with different levels of challenge from both temporal and kinetic perspectives among children in four different age groups. Method.: The cross-sectional design introduced a force-acquisition pen to detect differences of pen grip and writing kinetics among 170 school-age children doing writing tasks at different difficulty levels. Data were obtained on the force information of the digits and pen tip and the kinetic parameters to examine the coordination-and-control mechanism between the digits and pen. Statistical analyzes were carried out to indicate the differences in writing performance among groups and tasks. Findings.: Statistical differences in the pen-grip forces, force fluctuation, and force ratio between grip and pen-tip forces were found when performing different writing tasks and among different age groups. Implications.: The study provides an alternative method to explore how writing performance among school-age children can vary according to the difficulty of the writing tasks. [ABSTRACT FROM AUTHOR]

Fluoride is present naturally in water and has been used worldwide for the prevention of caries. Several studies conducted in high water fluoride or endemic fluorosis areas reported that fluoride adversely affected children's cognitive function, but some studies had negative findings. This study aimed to assess the relationship between urinary fluoride, dental fluorosis, and intelligence among schoolchildren living in communities with non-fluoridated drinking water. This cross-sectional study was conducted on 562 children aged 6–12 years in Taichung, Taiwan. Each child's urinary fluoride level was determined by a fluoride-ion-selective electrode, and the dental fluorosis condition was evaluated according to the criteria of Dean's Index. The Raven's Colored Progressive Matrices-Parallel and Standard Progressive Matrices-Parallel were used to assess children's intelligence. The results showed that the mean (±standard deviation) urinary fluoride concentrations were 0.40 ± 0.27 mg/L (0.43 ± 0.23 mg/g creatinine) among participants. The prevalence of dental fluorosis was 23.67%. After extensive evaluation of potential confounders, dental fluorosis and urinary fluoride were not associated with intelligence quotient (IQ) scores or grades in the regression models. In conclusion, dental fluorosis and urinary fluoride levels were not significantly related to the IQ of schoolchildren living in areas with low drinking water fluoride. [ABSTRACT FROM AUTHOR]

This study aims to examine the effectiveness of chair yoga therapy on improving functional status and daily life activity scores in older female adults with knee osteoarthritis living in the community. A quasi-experimental design was adopted. In total, 85 female participants with knee osteoarthritis were assigned to the chair yoga therapy intervention group (n = 43) or the comparison (n = 42) group. A 12-week chair yoga exercise program was provided to the intervention group two times per week from January to April 2020. The primary outcomes, which include changes in physical functional ability, body mass index, and biophysiological indicators, were evaluated for all participants in the pre- and post-measures time periods. The analysis shows that the participants had a significantly higher level of functional fitness and daily life activity scores after the chair yoga intervention. This finding indicates that the chair yoga program was effective in improving the functional fitness and daily life activity scores of community-dwelling elderly females with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Aims: To compare nurses' non‐optimal eating behaviours across different shifts, to examine whether non‐day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non‐optimal macronutrient intake. Design: This is a 4‐day intensive longitudinal study. Methods: A convenience sample of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4‐days of 24‐h dietary recalls. One‐way ANOVA and Kruskal–Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non‐optimal eating behaviours and (2) associations between non‐optimal eating and high energy contribution of non‐optimal macronutrients. Results: Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non‐day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat. Conclusions: Nurses were more likely to have non‐optimal eating behaviours on non‐day shifts, which may contribute to an increased intake of saturated fat; thus, increasing their risk of chronic diseases. Strategies to improve non‐day shift nurses' non‐optimal eating behaviours may be beneficial to their health. Impact Shiftwork is known to affect nurses' eating behaviours; however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non‐day shift nurses' non‐optimal eating behaviours. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore and compare stress, coping, professional identity and work locus of control of new graduate nurses among Shanghai, Hong Kong and Taipei. Background: The transition from a student to a staff nurse role is recognized as a stressful experience and can be a rough journey. Many newly graduated nurses find it challenging to cope with their new roles in their first few months. Methods: A cross‐sectional research was used in the study. This study was completed in Shanghai, Hong Kong and Taipei with newly graduated nurses working in hospitals. A total of 591 graduate nurses who had worked within 1 year in hospitals were recruited using convenient sampling. Data were collected using a structured questionnaire, including demographics, the occupational stress scale, the Chinese trait coping style questionnaire, the nurse professional identity scale and the work locus of control scale (Chinese version). Results: The newly graduated nurses in Shanghai had significantly lower (p < 0.05) work stress score (2.65 ± 0.67) compared with their counterparts in Hong Kong (2.99 ± 0.69) and Taipei (2.94 ± 0.60). Newly graduated nurses in Shanghai tended to choose positive coping to deal with stressful situations, whereas those in Hong Kong would be more likely to adopt negative attitudes (p < 0.05). The newly graduated nurses in Taipei had the lowest level of professional identity (3.25 ± 0.55, p < 0.05), and their work control tended to be external (46.13 ± 6.20). In contrast, those in Shanghai (52.75 ± 6.04) and Hong Kong (59.41 ± 7.29) tended to be controlled internally. Conclusions: The study findings revealed the differences among newly graduated nurses in Shanghai, Hong Kong and Taipei with their level of stress, coping, professional identity and work locus of control. Proper leadership, mentoring for newly graduated nurses, and emphasis on first aid nursing training, emotional management and management of stress in newly graduated nurse transition programmes were suggested. Implications for Nursing Management: By comparing the results in the three regions, we recommend that nursing managers promote the right leadership style. In addition to coaching, nursing managers can assign additional mentors to newly graduated nurses to help them supplement their clinical knowledge and skills with psychological support. These mentors can come from senior nurses or nursing managers working on less demanding tasks. In addition to the existing post transfer training programmes, new graduate nurses should also focus on emergency nursing training, emotional management training and stress management training. [ABSTRACT FROM AUTHOR]

Background: Hypertension is prevalent in older women and is associated with increased cognitive impairment. Exercise has demonstrated beneficial effects on cognitive function, but the impact of exercise on older hypertensive women remains unclear. We investigated the effects of an aerobic walking program on memory, subjective cognitive complaints, and brain-derived neurotrophic factor in older hypertensive women. Methods: A quasi-experimental study with a pretest–posttest design was conducted. Older hypertensive women were randomly assigned to the aerobic walking group or a control group with routine care. The intervention group received a 24-week aerobic walking program. Data were collected at baseline and 24 weeks after enrollment. Participants' characteristics, memory, subjective cognitive complaints, and plasma brain-derived neurotrophic factor were analyzed. Results: The aerobic walking group (n = 30) reported improvements in total recall, delayed recall, and subjective cognitive impairment after 24 weeks of aerobic walking. Compared to the control group (n = 28), the aerobic walking group showed significantly greater improvement in delayed recall at 24 weeks. However, aerobic walking had no significant effect on subjective cognitive complaints or brain-derived neurotrophic factor. Conclusion: The aerobic walking training significantly improved memory performance among older women with hypertension. A longer randomized controlled trial with a larger sample is necessary to confirm and further explore the effects of this intervention. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. Background: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. Design: The study used a one‐sample descriptive‐correlation design. Methods: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product–moment correlation were performed for data analysis (See STROBE). Results: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. Conclusions: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person‐centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. Relevance to Clinical Practice: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs. [ABSTRACT FROM AUTHOR]

Promoting dementia‐friendly communities is an important strategy for improving quality of life for people with dementia and dementia‐family caregivers. The process of building dementia‐friendly communities should include all people living in the community. The objective of this study was to compare perceived dementia friendliness in the community among people with dementia, family caregivers, service providers, and the general public. In Taiwan, we surveyed 60 people with dementia, 140 family caregivers, and 200 members of the general public face to face, with 200 service providers surveyed by mail. Participants completed the Perceived Community Dementia Friendliness measure, consisting of seven subscales: care services, community members, community environment, community interactions, transportation, hospitals, and stores and organisations. This measure has acceptable convergent validity, construct validity, and internal consistency reliability for use in Taiwan. Differences in perceived dementia friendliness were examined by chi‐square tests/analysis of variance. Among the seven subscales, hospitals were rated with good dementia friendliness by 70% of people with dementia (n = 42); however, care services were rated poor by 23.3% of people with dementia (n = 14). Hospitals were also rated with good dementia friendliness by 39.2% of family caregivers (n = 54). Care services were rated as having good dementia friendliness by 43.5% of service providers (n = 87) and 47% of the general public (n = 86). Furthermore, community interactions were rated as good by small percentages of family caregivers (11.4%, n = 16), service providers (22.2%, n = 44), and the general public (30.9%, n = 58). Family caregivers, service providers, and the general public rated hospitals with the highest mean dementia‐friendliness score and community interactions with the lowest. Perceived community‐dementia friendliness among participants with dementia differed from that of participants without. People with dementia prioritised improving care services, while people without dementia rated facilitating community interactions as more vital. These differences provide vital insights into understanding the policies and administration of dementia‐friendly communities. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of a musical fitness programme (MFP) intervention in improving neuropsychiatric symptoms, depression, upper‐limb muscle strength and cognition of older adults with cognitive impairment in long‐term care (LTC) facilities. Background: Because of population ageing, the number of older adults with cognitive impairment has been increasing. The effectiveness of medications in treating cognitive impairment is limited; therefore, the global trend has been for non‐pharmacological treatments. However, intervention studies of MFPs on older LTC residents with cognitive impairment are scant. Design: This study adopted a quasi‐experimental design in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist. In total, 84 older adults with cognitive impairment were recruited from seven LTC facilities. The MFP was implemented from July–November 2019. Methods: The intervention group received the MFP, which was 50 min per session, twice a week for 12 weeks, whereas the comparison group received usual care. Neuropsychiatric inventory nursing home version, the Cornell scale for depression in dementia Chinese version, 30‐s arm curl test and Mini‐Mental State Examination were the outcome measures. Data were analysed using Chi‐square test, t test and repeated measure analysis of variance. Results: After the intervention, the scores of neuropsychiatric inventory and the Cornell depression exhibited significant differences over time between two groups (F = 3.6, p =.029; F = 5.96, p =.003, respectively). Nevertheless, 30‐s arm curl test and Mini‐Mental State Examination demonstrated non‐significant between‐group differences. Conclusion: The MFP can effectively reduce neuropsychiatric symptoms and depression in older adults with cognitive impairment in LTC facilities. To ensure a more robust evidence base, more research is warranted. Relevance to clinical practice: The MFP is a non‐pharmacological treatment that can be implemented to promote psychological well‐being among older adults with cognitive impairment in LTC facilities, and to indirectly reduce nursing staff burden. To assist nursing staff in providing this intervention, on‐the‐job training is needed. [ABSTRACT FROM AUTHOR]

Aims: To develop a clinical medical material management App for nurses, in order to reduce their workload and improve the efficacy of medical material management. Design: The single-group pre- and post-test experimental design was adopted. Methods: The subjects were nurses in the intensive care units of a regional hospital in Hsinchu City enrolled by purposive sampling. Single-group pre-tests and post-tests were conducted. The research period was from November 2019 to March 2020. The workload, stress, and information acceptance of 57 nurses before and after the intervention of the Medical Equipment App were collected. The research tools included a structured questionnaire, which includes open questions that cover the aspects of workload, stress, and information acceptance intention of nurses, as well as a demographic questionnaire, which collects the basic personal data, including gender, age, years of service, educational level, nursing ability level, use ability of IT products, and unit type. The results were analyzed and compared using SPSS, APP Inventor, and data mining modeling to determine the effects of the App. Results: After employing the Shift Check App, the average workload of nurses was effectively reduced, in particular, the workload reduction of the N1 level nursing ability was greater than that of N2. In addition to satisfaction, the scores of information acceptance intention in all aspects, including behavioral intention, technology use intention, and contributing factors, all increased. Conclusion: The use of information technology products to assist medical material management in clinical practice has a significant effect on the load reduction of nurses and improvement of satisfaction. Clinical relevance: The App developed in this study can improve nurses' work satisfaction, quality of care and workload reduction. [ABSTRACT FROM AUTHOR]

This study investigates three aspirated voiceless stop consonants and their unaspirated counterparts produced in Taiwan's Southern Min dialect by 10 laryngeal speakers (LA), 10 speakers with pneumatic artificial larynxes (PA), and 10 oesophageal speakers (ES). Listeners' perceptions of the accuracy of the three groups in producing these six stop consonants were also examined. Each of the voiceless stop consonants /p, pʰ, t, tʰ, k, kʰ/, followed by the vowel /a/, was represented by a Southern Min character and appeared three times on a list in random order. Each character had a consonant-vowel syllable structure, and all were read with Tone 1 (high and level). Voice onset time (VOT) was measured for each stop consonant. A separate group of 20 listeners was then asked to identify the consonants produced by the LA, PA, and ES speakers. The VOT values of aspirated voiceless stop consonants from PA and ES were shorter than those from LA. Although PA and ES had aspiration contrast in their VOT values, perceived accuracy was low for PA (/pʰ/: 16.3%; /tʰ/: 13.5%; /kʰ/: 22.8%) and ES (/pʰ/: 33.7%; /tʰ/: 25.9%; /kʰ/: 31.9%). The mean percentages of correctly identified /pʰ, tʰ, kʰ/ produced by PA were at chance level. In terms of VOT values, it is recommended that, when producing aspirated voiceless stop consonants, PA and ES elongate the duration between the release of the oral constriction and the onset of their vibratory sound source. Moreover, it is also recommended that further investigation into other phonetic properties that support stop contrast is needed. [ABSTRACT FROM AUTHOR]

Liver cancer is the most common cause of mortality in men and women. The aim of this study was to evaluate the methanolic extract of aerial parts of Leonurus sibiricus L (LS) for its anticancer activity on HCC cell lines. Human HCC cell lines, Huh-7 and HSC-T6 were used for cytotoxicity assay, determination of ROS and gene expression analysis (p53, Bcl-2, Bax, caspase-3, caspase-8, and caspase-9). Western blotting was used to assess ERK, AKT, and Caspase-3 activation. HPLC-MS analysis was also performed to determine the phytochemicals present in LS-M extract. LS-M extract has increased the expression of proapoptotic genes, including p53, Bax, and caspase-9 and down-regulated the activation of ERK and Akt. The caspase-3 activity as well as the ROS generation were significantly increased in a dose-dependent manner compared to control. The carotenoids, lutein and beta carotene present in LS-M extract exhibited anticancer activity. In overall, the methanolic extract of LS induces apoptosis in Huh-7 as well as in HSC-T6 cells possibly involving a ROS-mediated mitochondrial signaling pathway. Graphical abstract - The methanolic extract of LS induces apoptosis in Huh-7 as well as in HSC-T6 cells possibly involving a ROS-mediated mitochondrial signaling pathway [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effects of a simulation-based education programme on critical care nurses' knowledge, confidence, competence and clinical performance in providing delirium care. Design: Single-blinded randomized controlled trial. Methods: Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups. Results: Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group. Conclusion: The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses. Impact: Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the long-term effectiveness of the Care & Organize Our Lifestyle (COOL) programme, a self-regulation theory-based mHealth programme, on improving disease knowledge and physical activity in youth with congenital heart disease (CHD). Design: A three-arm parallel-group randomized controlled trial. Methods: A total 143 participants with simple and moderate CHD aged 15-24 years were recruited from June 2016 to February 2018. The 12-month programme compared two active intervention groups to a standard-care control group (n = 47). Participants in one active intervention group (n = 49) were provided with COOL Passport, a mobile healthcare application. Those in the other group (n = 47) were provided with access to the Health Promotion Cloud system and use of game-based interactive platforms along with COOL Passport. Outcomes were the Leuven Knowledge Questionnaire for Congenital Heart Disease and the International Physical Activity Questionnaire--Taiwan Show-Card Version. Results: After 12 months, 103 participants remained; the overall attrition rate was 28%. No significant differences were observed between the groups in any domain of disease knowledge after 6 months or 1 year. Neither active group exhibited significantly greater physical activity intensity than the standard-care control group in any month during the 1 year. Conclusion: The mHealth-tailored intervention of the COOL programme did not improve disease knowledge or physical activity in young adults with CHD. Impact: The application of the COOL Passport and Health Promotion Cloud system and use of game-based interactive platforms must be modified and verified in future studies and may have clinical potential. [ABSTRACT FROM AUTHOR]

Aim and objectives: The study aimed to investigate the associations of suicide risk, self‐efficacy and mental health help‐seeking among the lesbian, gay, bisexual and transgender (LGBT). Background: The LGBT individuals were found to have higher risk of suicide. However, mental health promotion and suicide prevention strategies were lacking in this population. Design: A cross‐sectional survey with two‐group comparison. Methods: The LGBT group was recruited through snowballing method, which was then age‐matched with the comparison group as the reference. The questionnaire contained demographics, self‐rated health, suicide risk assessment and help‐seeking indicators including formal (e.g. medical or psychiatric services) and informal (e.g. family or friends) help sought. Chi‐square tests, t‐tests, two‐way ANOVA and multivariable regression were performed to test the differences between two groups. The methods followed STROBE criteria. Results: The LGBT group had a significantly higher prevalence of lifetime/recent suicide ideation, prior suicide attempts and mental distress or depressive symptoms. Their self‐rated health and health‐related self‐efficacy were poorer than those of the comparison group and were associated with increased suicide risk levels. Among the 27.1% of LGBT who intended to seek help for depression, one in five visited psychiatric services. The LGBT were 2–4 times more likely than the comparison group to disclose their distress or seek informal help. However, psychiatric and medical service contacts were relatively low for suicide high‐risk individuals in the LGBT group. Conclusions: The LGBT individuals had a lower level of self‐efficacy and higher suicidal risks than the general public. Healthcare professionals and the public should be aware of their informal help‐seeking signals such as disclosure of suicide ideation to friends/relatives and connect them to proper mental health resources for further assessment. Relevance to clinical practice: The LGBT with suicide risks require early detection and proper referrals by first‐line nurses to promote suicide prevention in this population. [ABSTRACT FROM AUTHOR]

To explore the trends in actions and factors influencing families of children with hearing loss, regarding early treatment following the implementation of a newborn hearing screening (NHS) in Taiwan. A retrospective study was conducted by extracting data from the treatment histories of families with children who had hearing loss and who were contacted and assessed by the non-profit organisation (NPO). Children born between 2012 and 2018 were included. The time lapse between initial NHS and early treatment sought by each family was documented and the factors predicting the timing of those actions were identified. Data of 2095 families of children with hearing loss and who received treatment from an NPO for the annual birth cohort of 2012 through 2018 were included. The median age at treatments initiation improved through the years. Parental educational level and the child's degree of hearing loss were significant indicators of the child's initial age at treatment intervention, age when hearing aids were fitted, and days taken to contact the organisation. The NHS in Taiwan promoted earlier treatment for children with hearing loss. Furthermore, patient instructions and education may be important to enable parents to take actions for early intervention. [ABSTRACT FROM AUTHOR]

Background: Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. It has been shown that stress can be either a trigger or aggravating factor for ill-health in general, but studies have seldom differentiated the impact of general health status on perceived stress. This study examined factors associated with perceived stress of clinical practice among nursing students with a particular focus on the effect of general health status on stress. Methods: This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan. Results: Health status scores varied from 28 to 139, with an average of 68.40 (SD = 25.75). Health status was reported to be 'good' (scores 28–55) in 35.5% of participants, moderate (scores 56–83) in 24.6%, and poor (Scores ≧ 84) in 39.9% of participants. Perceived stress scores ranged from 0 to 95 points with an average score of 36.65 (SD ± 15.95). The classification and regression tree (CART) analysis showed health status as the most important factor linked to perceived stress with a Normalized Importance value of 100%. Those who reported general health status (measured through General Health Questionnaire (GHQ)-28) score of ≤34.5 perceived mild stress and those with a score of > 34.5–< 84.5 perceived moderate stress. A score of 84.5 was found to be the point of transition to perceptions of severe stress. When health status score was greater than 84.5, perceived stress was at a severe or extremely severe level. Conclusions: Our findings indicated health status as a potential measure to identify students who were most vulnerable to perceived stress. Given the cross-sectional design of this study and the bidirectional relationship between health and stress, more studies are needed to fully establish the predictive link between general health status and vulnerability to stress. [ABSTRACT FROM AUTHOR]

Phenomenon: There is now broad acceptance that the development of cross-cultural competence (CCC) supports the delivery of appropriate care to diverse groups and is an essential component in medical education worldwide. CCC training in East Asian contexts has been constrained by the fact that "cultural diversity" training globally has focused primarily on the needs of racial and ethnic communities, to the relative neglect of other groups. The present study explores Taiwanese students' perceptions of CCC provision to identify gaps in local medical education and thus facilitate a more systematic delivery of CCC. Approach: Using an adapted and translated version of the Cross-Cultural Care Survey developed by Harvard Medical School, we collected 1567 student responses from four geographically-distributed Taiwanese medical schools between 2015 and 2017. In addition to student responses, we also collected 122 clinical teacher responses from two of the four medical schools that were surveyed to cross-examine the students' self-perceived competence. The data were analyzed with SPSS and ANOVA was employed with student data to compare the differences among different stages. The analysis focuses on CCC in 4 stages of training: general education, basic pre-clinical and integrated clinical sciences, clerkship, and internship. Findings: The findings show that students felt unprepared to deal with health disparities and the needs of diverse groups and there was no evidence of an increased sense of preparedness in the development of relevant skills in the analyses of the pre-clinical to clinical stages of the curriculum. Similarly, teachers also perceived students across the different stages of training to be unprepared in dealing with the health disparities and needs of diverse groups. However, although findings from teachers' responses parallel those from students, teachers tend to perceive students to be even more unprepared than they perceive themselves to be. The training for CCC appeared inadequate from both set of data and students perceive CCC training to be less explicitly evident in the medical program as it advances from the foundation stage to the pre-clinical stage. Insights: The study raises some crucial issues in terms of diversity and CCC training in medical education programs. The fact that increased awareness of health disparities and the needs of diverse groups fails to be aligned with a sense of preparedness and skillfulness confirms that CCC has not been explicitly and sufficiently addressed in the medical curriculum, particularly in the pre-clinical stage when the focus is on acquiring scientific and technical knowledge. This study shows how a questionnaire designed by and for an American medical institution situated in a highly diverse society can be adapted so that its findings serve as a baseline for medical education programs in Taiwan, and perhaps in other countries that are beginning to acknowledge hitherto "hidden" diversity. This study also has implications which indicate that CCC is crucial in the delivery of appropriate care by members of the medical profession to diverse patients. [ABSTRACT FROM AUTHOR]

Objective: To identify distinct subgroups of patients newly diagnosed with lung cancer (LC) over time and to explore the predictors of distinct trajectories of symptom and fatigue distress in LC patients. Methods: A total of 120 patients newly diagnosed with LC were recruited in this longitudinal prospective study. Our survey investigated patients' symptoms in 6 months. Latent growth curve analysis (LGCA) was conducted to identify patients with distinct trajectories of symptom and fatigue distress. The characteristics of the patients among groups were compared for statistical differences by the chi‐square test or ANOVA. Results: The results of LGCA revealed that the linear three‐trajectory model had the best model fit for symptom and fatigue distress. Patients' symptom and fatigue distress improved with time, except for patients with increasing trajectories. Patients' trajectories of symptom and fatigue distress were affected by pain, lower functional status, total symptom score and depression. Moreover, patients with increasing trajectories of symptom and fatigue distress experienced more pain, physiological symptoms and depression from 1 to 6 months. Conclusions: Pain and functional status were the major factors that deteriorated the recovery of trajectory in symptom distress and fatigue distress among patients with increasing trajectories. [ABSTRACT FROM AUTHOR]

This cross-sectional study assessed prenatal pertussis vaccination acceptance in Taiwan. A sample of pregnant women from five private clinics in Taiwan was recruited. Demographics, experience of prenatal vaccinations, key considerations, knowledge, and attitude about pertussis and its vaccination were measured. Among 505 participants, the vaccination rate, including planned vaccination, was 29.7%. Factors associated with acceptance included clinic location, primary caregiver of the newborn, newborns with siblings, previous influenza vaccination history, knowledge and attitude toward pertussis and its vaccination. Public health agencies should provide free vaccinations, clarify misinformation, and publicize prevention information, to improve prenatal pertussis vaccination acceptance. [ABSTRACT FROM AUTHOR]

Long-term stress experienced by caregivers is often overlooked, as is their pre-planning for senior life, but helping middle-aged and older caregivers to prepare for senior life is the foundation for active aging. The purpose of this study is to elucidate middle-aged and older caregivers' attitudes toward aging, proactive coping, and the need to learn life safety and to identify the factors influencing their need for life safety instruction. In this study, a questionnaire survey was administered to middle-aged and older caregivers with 1 year of experience or more in caring for older adults. In total, 500 questionnaires were distributed using a snowball sampling method, of which 415 valid questionnaires were recovered. The research tools included a personal information questionnaire, attitude toward aging scale, proactive coping scale, and need for life safety instruction scale. The results of this study were that: 1. Middle-aged and older caregivers had a low psychological evaluation of aging and a weak response to aging. 2. Respondents demonstrated a strong need to learn life safety. 3. Average monthly salary, aging awareness, aging behavior, attitude toward proactive coping, and proactive coping ability were strong predictors of the need to learn life safety. The principal conclusion was that the need for life safety instruction increased concurrently with unemployment, a decrease in aging awareness and behavior, an improvement in attitude toward proactive coping, and a decrease in proactive coping ability. Therefore, life safety education can be provided to the aforementioned group to satisfy their learning needs adequately. [ABSTRACT FROM AUTHOR]

This study was to compare biopsychosocial consequences among three groups of women with gestational hyperglycemia. We conducted a repeated-measures study at five time points among 132 women with gestational hyperglycemia. Women's physiological indicators and their psychosocial indicators were measured. There were 22.7% of participants had gestational diabetes mellitus (GDM), 11.4% had gestational impaired glucose tolerance (G-IGT), and 65.9% had mild gestational hyperglycemia (MGH). Women with GDM had higher fasting blood glucose and systolic/diastolic blood pressure than women with MGH. Women with GDM had higher diastolic blood pressure compared to women with G-IGT. Significant differences were found between the five time points regarding women's fasting blood glucose, diastolic blood pressure, depression, and health status. Health care providers should conduct early screening for predictors of metabolic syndrome in women with any degree of gestational hyperglycemia. Nursing interventions could be offered as early as the perinatal period to promote women's health. [ABSTRACT FROM AUTHOR]

Aims and objectives: The primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level. Background: As many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health‐related quality of life. Design: This study adopted a cross‐sectional correlational research design. The STROBE checklist for cross‐sectional studies was used as a reference for reporting the study. Methods: A consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires. Results: Study subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (ß = −0.38), comorbidity index (ß = −0.024) and age (ß = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level. Conclusions: Survivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue. Relevance to clinical practice: The study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Natural disasters and aging societies are increasingly prevalent globally. To improve environmental injustice and contribute to social good, the Tzu Chi Recycling Program engages older adult volunteers in recycling usable materials into eco-friendly blankets for disaster survivors. Drawing on life span and ecological systems theories, this study examined the longitudinal effects of this program on older adults' mental and physical health. Using a quasi-experimental longitudinal design, data were collected from older adults at recycling stations (intervention group, n = 36) and community centers (control group, n = 36) in rural areas in Southern Taiwan. Findings from two-way repeated measures analysis of variance show that the program significantly improved older adults' self-compassion, compassion for others, depression, hostility, happiness, and hypertension. Older adults built resilience and contributed to environmental sustainability and social good, which suggest a new avenue for social work practitioners and policy-makers to address social and environmental challenges. [ABSTRACT FROM AUTHOR]

Objective: To quantify differences in patient expectations of healthscape (e.g., interior environment) across Western medicine (WM) and Traditional Chinese Medicine (TCM) paradigms. Data sources/study setting: Primary survey data comprise 469 Taiwanese consumers. National insurance coverage of both TCM and WM is an ideal setting to test for differences in healthscape expectations. Study design: Respondents report their recent experience as either exclusive users of TCM, exclusive WM, neither, or dual usage (both TCM and WM), and are randomly assigned to one of two surveys (identical except one refers to WM contexts, the other TCM) to rate the importance of 28 healthscape factors derived from previous studies. Data collection/extraction methods: Multivariate analysis of variance is used to test the research hypotheses. Principal findings: Dual users accept some differences across paradigms. In contrast, exclusive WM users apply their existing WM expectations to TCM contexts, raising the possibility of dissatisfaction and low adoption. Conclusions: A person's experience with TCM is related to acceptance of healthscape differences. Medical service providers of TCM, and by extension complementary and alternative medicine, should devise strategies to ease initial visitation by exclusive WM users. Healthscape designs need not be modeled closely on a WM standard, as dual users accept differences. [ABSTRACT FROM AUTHOR]

This study aims to examine the prevalence of multiple types of child victimization and the effects of multiple types of victimization on children's mental health and behavior in Taiwan. The study also examines the child-protection rate and its correlates among children experiencing various types of victimization. This study collected data with a self-report questionnaire from a national proportionately stratified sample of 6,233 fourth-grade students covering every city and county in Taiwan in 2014. After calculating the 1-year prevalence of child victimization, the study found that bullying was the most prevalent (71%), followed by physical neglect (66%), psychological violence (43%), inter-parental violence (28%), community violence (22%), physical abuse (21%), and sexual violence (9%). As the number of victimization types increased, children were more likely to report greater posttraumatic symptoms, psychiatric symptoms, suicide ideation, self-harm thoughts, and violent behaviors. Gender, neonatal status, parental marital status, and other family risks were significantly associated with elevated incidences of the victimization types. Only 20.6% of the children who had experienced all seven types of victimization had received child protective services. A child was more likely to receive child protective services if he or she had experienced sexual violence, community violence, inter-parental violence exposure, higher family risks, higher suicidal ideation, or living in a single-parent or separated family. In conclusion, this study demonstrates the cumulative effects and the harmful effects that children's experience of multiple types of victimization can have on the children's mental health and behavior. The present findings also raise alarms regarding the severity of under-serving in child-victimization cases. These results underscore the importance of assessing, identifying, and helping children with multiple victimization experiences. [ABSTRACT FROM AUTHOR]