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Background On 11 January 2009, Taiwan expanded its smoke-free legislation to all indoor public places and workplaces. This study examined the impact of this policy on secondhand smoke (SHS) exposure in adult non-smokers, across gender and socioeconomic status groups (SES). Methods An annual sample of about 13 000-14 000 non-smokers was drawn from cross-sectional nationwide data of Taiwan Adult Tobacco Behavior Surveys during 2005-2011. Logistic regressions were used to analyse the aggregate data to estimate the association between the 2009 smoke-free legislation and SHS exposures in homes and workplaces. Interaction terms were used to examine the impact of the 2009 smoke-free policy on reducing differences in SHS exposure across gender, education and income groups. Results The 2009 policy reduced the odds of SHS exposure in homes in 2009 (OR=0.76, 95% CI 0.68 to 0.84) and in workplaces (year 2009: OR=0.49, 95% CI 0.39 to 0.62; year 2010: OR=0.79, 95% CI 0.66 to 0.95). The model with interaction terms showed that men were more likely than women to be exposed to workplace SHS (OR=2.02, 95% CI 1.80 to 2.27) but were less likely to be exposed to home SHS (OR=0.79, 95% CI 0.73 to 0.86). SHS exposure in homes was significantly related to lower socioeconomic status, but the 2009 smoke-free policy reduced the difference in SHS exposure across education levels. Conclusions The 2009 smoke-free policy reduced the SHS exposure for non-smokers. However, this impact on home SHS did not persist after 2009, and the effect of protection was unequal across gender and SES groups. Thus, further enforcement of smoking restrictions would be needed to reduce the risk of SHS exposure and improve protection against SHS risk among parts of the population with lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Perfluoroalkyl substances (PFASs), as coating materials, possess oil-resistant and waterproof properties. However, their persistency and toxicity have caused concerns. This study developed a method for determining five types of 20 PFASs with ultra-performance liquid chromatography/tandem mass spectrometry, and measured seven categories of 32 commercial samples of oil-resistant food packaging in Taiwan. The assay was validated according to the specification of Taiwan Food and Drug Administration (TFDA). Samples of 100 cm² were cut into pieces and were ultra-sonicated in 20-mL methanol at 50 °C for 45 minutes. The extracts were concentrated to 1 mL for instrumental analysis. Most matrix effect factors and extraction efficiencies of the analytes were 50%e80% and 52%e99%, respectively. Most limits of detection and limits of quantification were between 0.07e11.3 ng/dm² and 0.17e18.3 ng/dm², respectively. Most recoveries ranged from 70% to 117% at three tested levels, and the precisions (%RSD) were lower than 19%. Microwave popcorn paper contained more types and higher levels of PFASs than other packaging, with perfluoroalkyl acids at 8.3e1960 ng/dm² and fluorotelomer alcohols (FTOHs) at 9.7e7188 ng/dm². High concentrations of FTOHs were also observed in one oil-proof paper bag at 454¡2595 ng/dm² and in one French fries paper bag at 22.4e167 ng/dm². [ABSTRACT FROM AUTHOR]

Aims: Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy. Methods: We adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale. Results: A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age. Conclusion: Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management. Summary statement: What is already known about this topic? Psychological insulin resistance is a common psychological barrier to initiation and persistence with insulin therapy.Psychological insulin resistance causes poor glycaemic control and diabetes‐related complications.Psychological insulin resistance may negatively impact self‐management in patients with type II diabetes mellitus. What is the contribution of this paper? Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy.Patients with poor self‐management had statistically significantly higher levels of overall psychological insulin resistance, fear of injections and self‐testing, expectations regarding positive insulin‐related outcomes, and stigmatization by insulin injections, compared to those with appropriate self‐management. What are the implications of this paper? Knowing in advance the factors associated with diabetes self‐management will allow healthcare professionals prevent psychological insulin resistance in patients with type II diabetes mellitus treated with insulin therapy.Healthcare professionals can design and provide patient‐centred diabetes education based on education level to enhance self‐management. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Purpose: The demand for long-term home care services has been increasing in Taiwan due to the significant growth of the older population. In order to understand the crucial roles that language and communication play in providing better long-term home care services in Taiwan, this study aims to adopt a gerontological sociolinguistic perspective to investigate how professional care workers communicate with older people in this context. Design/methodology/approach: Interviews were conducted with 58 long-term home care workers to identify their communication accommodation strategies for older people, considering their health conditions (dementia), personalities (grumpiness), living status (loneliness) and general principles of long-term home care communication. Findings: The study's findings provide practical insights for long-term home care workers to enhance their communication skills while interacting with older people. Research limitations/implications: The results could contribute to improving the quality of care services provided to older people and address their specific communication needs. Originality/value: To the best of the author's knowledge, this paper is the first attempt to identify contextually specific communication accommodations to older people in existing literature of gerontological sociolinguistics that addresses language, communication and older age. The salience of the findings in this study can be further enhanced if they were applied in the development of training programs for future Taiwanese long-term home care workers. [ABSTRACT FROM AUTHOR]

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]

This paper aims to address the research questions of whether individual's oral health status is associated with subjective well-being, as well as if there is possible moderating role of self-rated oral health among two groups of Chinese older adults (≥55 years old) in Honolulu, Hawaiʻi and Taichung, Taiwan. Using survey data collected in 2018 (N = 430, Honolulu) and in 2017 (N = 645, Taichung), ordinary least square regressions were applied. Results showed that, for both samples, oral health status was negatively and significantly associated with subjective well-being, and both associations were moderated by self-rated oral health. In addition, the moderating effects were more salient for the Honolulu sample, who enjoyed higher levels of self-rated oral health and life satisfaction. These results suggest the significant associations of both oral health status and self-rated oral health on individual health and well-being for Chinese older adults residing in different cultural contexts. [ABSTRACT FROM AUTHOR]

Aim: This quasi‐experimental study aimed to explore effects of walking exercise on disease activity, sleep quality, and quality of life among individuals with systemic lupus erythematosus. Methods: After recruiting people with systemic lupus erythematosus from a hospital in Taiwan between October 2020 and June 2021, participants were free to opt to receive one walking exercise programme plus standard care for 3 months or to membership of a control group receiving routine care. Primary outcomes included Systemic Lupus Erythematosus Disease Activity Score, the Pittsburgh Sleep Quality Scale, and a quality‐of‐life scale for patients with systemic lupus erythematosus, namely, LupusQoL. These scales were administered first, at baseline and later, within 1 week following completion of the intervention. Between‐group effects were compared using generalized estimating equations with adjustment for baseline variables. Results: The experimental and control groups each included 40 participants. Multivariate analysis indicated that adding the walking exercise programme into routine care elevated sleep quality and LupusQoL (the latter in the subscales of physical health, planning, and intimate relationships), except for disease activity. Conclusion: Findings of this study supported the addition of walking exercise as part of routine care for people with systemic lupus erythematosus and may be a reference in the provision of adequate care for these patients. Summary statements: What is already known about this topic? Systemic lupus erythematosus is a lifelong autoimmune disease that affects any organs throughout the body, thus insidiously causing negative impacts on the affected patients.Today, use of exercise programmes such as walking exercise has been studied as a remedy for many medical conditions, but its effectiveness in minimizing the symptoms of distress among people with systemic lupus erythematosus is unknown. What this study adds? Participants with systemic lupus erythematosus who opt to receive the walking exercise programme for 3 months in addition to routine care experience improved sleep quality and quality of life compared with those receiving routine care alone. The implications of this paper: In accordance with the belief that "an ounce of prevention is worth a pound of cure," early implementation of an exercise programme should be considered in addition to routine care for patients with systemic lupus erythematosus.Evidence from this research could provide empirically informed and robust data for healthcare policymakers and in turn might help to reduce the incidence of morbidity among patients with systemic lupus erythematosus. [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: Cigarette smoking is a serious global health issue. Limited studies previously analyzed health literacy components in patients undergoing smoking cessation interventions. This study focuses on individuals enrolled in smoking cessation services and investigates the distribution of health literacy in three domains (health care, disease prevention, and health promotion) and four abilities (access, understand, appraise, and apply health information). The study also explores the correlation between background factors (age, BMI, etc.) and health literacy, as well as the differences in health literacy levels among different background variables (gender, etc.). Methods: 228 individuals completed the health literacy questionnaire. Descriptive statistical analysis, Pearson Correlation, and a Chi-Squared Test were employed to investigate the various health literacy levels and background variables. Results: 68% had excellent or sufficient health literacy. A total of 32% were considered problematic or to have inadequate health literacy. Of the three domains of health literacy, participants performed better in the healthcare domain. More than one-third were problematic in accessing and appraising information. Conclusions: this paper, being the pilot study in providing an analysis of health literacy components in individuals undergoing smoking cessation, could serve as a useful reference for devising interventions for different population groups in trying to maximize successful cessation rates. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to explore the effectiveness of a mobile app to support oral mucositis care to improve the nutritional status and reduce the occurrence of oral mucositis of patients with head and neck cancer undergoing concurrent chemoradiotherapy. Background: Concurrent chemoradiotherapy is the optimal treatment for head and neck cancer, but oral mucositis and malnutrition are common complications. Design Quasi‐experimental study using a pre‐post design was used in this work. Method: Participants were recruited from a major regional hospital in Taiwan from July 2018 to July 2020. There were 32 participants in each group: the mobile app group (Intervention Group) or routine care (Control Group). The primary outcome measure was Patient‐Generated Subjective Global Assessment (PG‐SGA). We also collected data on grade of oral mucositis, painNnumeric Rating Scale (NRS), weight loss, haemoglobin (Hb), albumin and quality of life (QoL). Result: The PG‐SGA score was significantly lower in the intervention than the control group at all three time points. Hb and albumin decreased less significantly in the intervention than the control group after 2 months. The oral mucositis grade was significantly less severe in the intervention than the control group at all three time points; for the NRS, at T2 and T3. Conclusion: Using the mobile app effectively improved nutritional status, alleviated the side effects, and improved the QoL of head and neck cancer patients with concurrent chemoradiotherapy. Summary statement: What is already known about this topic? Oral mucositis leads to malnutrition and hinders treatment in cancer patients.An oral health care mobile application ('app') is an easy‐to‐access health care resource What this paper adds? A mobile app improved oral mucositis, pain sensation score, nutrition status and QoL for patients with head and neck cancer undergoing concurrent chemoradiotherapy.A mobile app could increase the accessibility of a large amount of care information to patients. The implications of this paper: A mobile app could be used to establish an efficient communication platform; to provide feedback for patient self‐management to alleviate the feeling of suffering, and could enhance patients' competency to manage their oral mucositis. [ABSTRACT FROM AUTHOR]

Aim: To explore the significance of culture, professional support in the community, social interactions and intrapersonal determinants of adults' preferences for life‐sustaining treatments and palliative care. Methods: A cross‐sectional design with a Social Ecological Model was used. Between 1 October 2012 and 31 December 2012, 474 adults aged ≥20 years living in a city of Southern Taiwan completed the survey. Data were analysed using hierarchical multiple regression. Results: The life‐sustaining measures model was significant with 15.3% (p < 0.0001) of the variance in the Modified Emmanuel Medical Directives being explained by variables of death of self and healthcare services' support. The palliative care model was significant with 18% (p < 0.0001) of the variance in the Modified Hospice Attitude Scale being explained by variables of palliative care knowledge, death of self and social interactions. However, cultural value adherence did not predict adults' preferences for life‐sustaining measures and community resources support did not predict palliative care preference. Conclusions: Findings enhance our understanding of the significance of different societal levels on adults' preferences for end‐of‐life care. Palliative care knowledge, fear of death, healthcare services' support and social interactions are essential factors that need to be taken into consideration when it comes to discussion about life‐sustaining treatments and palliative care. Summary statement: What is already known about this topic? End‐of‐life (EOL) preferences can be shaped not just by knowledge, values and individuals' attitudes but rather a host of social influences.Few studies with theoretical frameworks or models in the literature are available to provide a comprehensive understanding of factors contributing to responses at the EOL. What this paper adds? The findings advance the knowledge of the influence of social interactions, healthcare services' support, palliative care understanding and fear of death on adults' preferences for life‐sustaining treatments and palliative care.The identified relationships in the context of life‐sustaining treatments and palliative care provide practical guidelines, which can help to inform appropriate supportive interventions for EOL care planning. The implications of this paper: Healthcare services that provide a mediating structure where a person belongs should focus on enhancing community resources regarding EOL healthcare planning, knowledge about palliative care and reinforcing life and death education.The social support network and emotional ties with a person's significant others should also be taken into consideration to facilitate EOL healthcare planning and to promote good quality of life at EOL. [ABSTRACT FROM AUTHOR]

Background: Implementing English medium instruction (EMI) has become a proliferating measure in higher education to embrace globalization. Nevertheless, university students reported various challenges in taking EMI courses. Objectives: This study investigated the effect of the computer‐mediated terminology pretraining on university students' EMI success, regarding their efficacy in taking EMI courses, self‐directed learning (SDL), and EMI performance. Methods: Participants were 86 university students enrolled in two EMI educational psychology courses. Students in the experimental group were assigned computer‐mediated terminology pretraining tasks for 13 consecutive weeks, while those in the control group did not receive the pretraining assignment. Both groups were taught using the problem‐based learning (PBL) pedagogy with a computer‐mediated structured whiteboard. Results and Conclusion: The study findings showed that the computer‐mediated terminology pretraining enhanced learners' response efficacy. Both groups increased their SDL under the PBL pedagogy. Besides, multigroup comparison results demonstrated that efficacy in EMI positively predicted SDL, which was related to better EMI performance in the experimental group but not in the control group. Notably, students conducting computer‐mediated terminology pretraining remitted the influence of English ability on their EMI performance. Major Takeaways from the Study: Implications for instruction were made to use the combined strategy of the computer‐mediated terminology pretraining and PBL in EMI courses to facilitate university students' efficacy in taking EMI courses, self‐directed learning behaviours, and EMI performance. Lay Description: What is already known about this topic?: Implementing English medium instruction (EMI) courses has become a prevalent measure for higher education to embrace globalization.Some students hold positive attitude toward taking EMI courses, while others hold negative attitude toward taking EMI courses.Correlational research showed that individual differences, such as English proficiency, self‐efficacy in EMI, and academic language skills, are associated with EMI success. What this paper adds: This study adds to the literature in EMI success to investigate how computer‐mediated terminology pretraining under problem‐based learning (PBL) pedagogy will affect learners' efficacy in EMI, self‐directed learning (SDL), and EMI performance.The computer‐mediated terminology pretraining enhances learners' efficacy that their efforts or responses in taking the EMI course are effective.Students' efficacy in taking EMI courses promotes their self‐directed learning; moreover, self‐directed learning behaviours in EMI is associated with better EMI performance for students with computer‐mediated terminology pretraining but not for those in the control group due to the influence of English ability.The computer‐mediated terminology pretraining can compensate the effect of individual differences in English ability on EMI performance. Implications for practice and/or policy: Instructors can assign the computer‐mediated terminology pretraining before the face‐to‐face EMI session to prepare learners with the basic understanding of the professional concepts for the complex PBL activities.Effective pedagogical support, such as combined strategy use of computer‐mediated terminology pretraining and PBL, can enhance learners' efficacy in EMI and help them plan and prioritize their learning progress to achieve better EMI performance. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non‐ventilated intensive care unit patients. Methods: A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6‐sulfatoxymelatonin levels, relaxation responses measured using the Richards–Campbell Sleep Questionnaire, liquid chromatography‐mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. Results: Overall, 28.03% of participants showed virtually no 6‐sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6‐sulfatoxymelatonin and vital signs. Conclusions: The effects of using earplugs alone on sleep quality, urinary 6‐sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality. Summary statement: What is already known about this topic? Excessive noise exposure causes numerous adverse health outcomes, which not only contributes to noise‐induced stress and hearing loss but also affect patients' sleep.Wearing earplugs might be a practical nonpharmacological strategy used by nurses to improve ICU patients' quality of sleep. What this paper adds? Wearing earplugs alone did not affect patients' urinary 6‐sulfatoxymelatonin level in the ICU.Wearing earplugs alone did not increase patients' subjective sleep quality in the ICU. The implications of this paper: The findings of the present study on the effects of using earplugs alone on sleep quality, urinary MT6s level and vital signs in ICU patients extend the literature, particularly with respect to the limited research on using earplugs alone.Prolonged effect of earplug intervention on sleep quality is unknown. A longer intervention may help elicit any difference in sleep quality. [ABSTRACT FROM AUTHOR]

The paper takes a descriptive-analytical method to examine the emerging relationship between Taiwan and exiled Tibetans. It identifies four key issues to underscore the historical ties, current challenges and prospects of Taiwan and exiled Tibetan relations. The study finds that Tibetan Buddhism has played an important role in strengthening relations, especially people-to-people connections, even though higher-level exchanges and engagement were often obstructed by factors such as the Chinese hegemony and the Kuomintang's contestation of sovereignty over Tibet. Therefore, the study argues that to establish a cohesive relationship, both sides should focus on non-political factors, such as religion, education and the promotion of democratic values. [ABSTRACT FROM AUTHOR]

Background: Weight control is a widespread phenomenon among young adults, especially in women. Aim: This study aimed to determine the prediction factors of weight control intention in a young Chinese sample. Methods: A cross‐sectional study was conducted with 963 (276 male and 687 female; mean age 21.8 ± 4.4 years) adult students from a university in Taiwan. The data were collected from October 2016 to January 2017. Body mass index (BMI), the Chinese version of the Weight Self‐Stigma Questionnaire, the Body Areas Satisfaction Scale and the Media Influence Questionnaire were used as data collection instruments. Results: The participants with weight control intention had higher BMI, weight self‐stigma and media influence scores and lower body satisfaction scores than those without the intention. Female sex, BMI, weight self‐stigma, body satisfaction and media influence were significant predictors of weight control intention for all participants. Conclusion: Before conducting weight loss programmes, the perception of weight self‐stigma and the influence of social media on body image should be confirmed, particularly in women with intention to lose weight. SUMMARY STATEMENT: What is already known about this topic? Weight loss is a popular issue in the health field, owing to the effect of obesity on multiple aspects of life.Females have a higher intention than males to control their weight.People with obesity are more likely to internalize weight stigma from public attitudes and influences and are more dissatisfied than others with their body appearance. What this paper adds? Females have a higher perception of weight self‐stigma and are more dissatisfied than males with their body and the influence of social media on body image.The Chinese young adults with weight control intention had a higher body mass index, weight self‐stigma, body dissatisfaction and media influence than adults without weight control intention.Weight self‐stigma, body dissatisfaction, influence of mass media and body mass index may play synergistic roles in triggering weight control intention in Chinese young adults, particularly in women. The implications of this paper Nurses should pay attention to young adult females with normal BMI and intention to lose weight.Nurses and other healthcare professionals who conduct weight loss programmes should confirm with young adults, particularly with women, their perception of weight self‐stigma, body dissatisfaction and social media influence.Healthy and non‐prejudiced advice should be included in weight loss consultation. [ABSTRACT FROM AUTHOR]

Project-based learning is among the most common learning approaches aimed at conveying professional standards and best practices to students in programming courses. However, team projects commonly impose problems related to responsibility sharing, such as low effort or inequality in contributions. This paper presents a collaborative programming assessment system featuring a code quality assessment function with specific metrics to measure individual contributions. Student engagement data is used to detect nonconformities in collaboration using a learning analytical approach. Latent profile analysis was used to detect four theoretical team profiles differentiated by team effort (2 levels) and within-team collaboration (2 levels). We demonstrated the efficacy of assessing code to evaluate team dynamics and student behaviour, wherein efforts to resolve coding style failures can be used as a proxy by which to estimate the taskwork awareness of team members. Submission data from 146 students in 41 web-programming projects revealed four behavioural patterns that could potentially hinder the effective functioning of programming teams: free-riding, social loafing, the bystander effect, and lone wolves. We also demonstrated the applicability of automated programming assessment systems to the monitoring of learning progress, thereby facilitating timely interventions to correct difficulties at the team level. [ABSTRACT FROM AUTHOR]

Purpose During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. Method: A cross‐sectional design was used, and convenience sampling was performed. Eighty‐six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF‐12 questionnaire were used for data collection. Results: The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health‐related QOL. Health literacy also was a predictor of mental health‐related QOL. Conclusion: The results provide the factors associated health literacy as well as health‐related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life. SUMMARY STATEMENT: What is already known about this topic? Individuals with lower health literacy generally had fewer communications with medical personnel regarding their own risk of disease.Individuals with higher health literacy tend to have better social‐related QOL. What this paper adds? Survivors with early‐stage breast cancer tended to be younger (aged 60 years or less) had normal body mass index, continued working, had no other illnesses and better physical health.Survivors with normal body mass index who had not received chemotherapy had better mental health.Health literacy was the main predictor and accounted for 20% of the variance in physical health and for 18.8% of the variance in mental health. Implications of this paper: Nurses should understand the importance of health literacy, which is a key factor to improve QOL for survivors with breast cancer.Nurses should develop individualized care plans for survivors based on different levels of health literacy to improve the efficiency of the nurse–patient dialogue. [ABSTRACT FROM AUTHOR]

Moral thinking and communication are critical competencies for confronting social dilemmas in a challenging world. We examined these moral competencies in 70 college students and graduates from Taiwan, the United Kingdom, and the United States. Participants were assessed through semi-structured written interviews, Facebook group discussions, and a questionnaire. In this paper, we describe the similarities and differences across cultural groupings in (1) the social issues of greatest importance to the participants; (2) the factors influencing their approaches to thinking about social issues and communicating with others; and (3) the characteristics of their moral functioning in terms of moral awareness, moral judgment, moral discourse, and moral decision-making. [ABSTRACT FROM AUTHOR]

INTRODUCTION The global tobacco epidemic poses a notable challenge to global health due to its association with various tobacco-related diseases. Although tobacco smoking is associated with depression, the exact mechanism by which tobacco smoking increases the risk of depression is unclear. This study explored the potential effects of tobacco smoking on depression. METHODS We used data in the analysis from the Taiwan Biobank of 27916 individuals recruited from 2015 to 2020. To investigate the associations between tobacco use and depression, the results of the depression-measuring subscale of the Patient Health Questionnaire-4 as well as data on participants' tobacco consumption and other relevant covariates, were analyzed. RESULTS Participants who smoked were more likely to report depression than those who did not smoke (AOR=1.50; 95% CI: 1.21-1.86). Furthermore, depression was significantly higher in women who smoked than in their male counterparts (females: AOR=1.68; 95% CI: 1.27-2.23, and males: AOR=1.32; 95% CI: 0.96- 1.80). Women aged <55 years and who smoked were more likely to report depression, whereas this trend was not observed in those aged ≥55 years (<55 years: AOR=1.75; 95% CI: 1.23-2.48), and ≥55 years: AOR=1.58; 95% CI: 0.97- 2.56). CONCLUSIONS Tobacco smoking is a significant factor associated with depression, particularly in younger women. The increasing prevalence of tobacco use for years among younger women in Taiwan might contribute to shifts in the associations between depression and tobacco use in women. [ABSTRACT FROM AUTHOR]

Background: Digital game‐based learning (DGBL) has been shown to be an effective strategy for promoting learning motivation. However, a lack of attention has been paid to investigating the effects of individual differences on elementary students' reading motivation and in‐gaming achievements in DGBL. Objectives: This study developed an educational mobile game to facilitate learners' reading activities, and investigated how prior knowledge and gaming experience affected learners' reading motivation, gaming motivation, perceptions and in‐game achievements. Methods: A total of 53 third to fifth grade elementary school students participated in this study, and were divided into the high prior knowledge (HPK)/low prior knowledge (LPK) and the high gaming experience (HGE)/low gaming experience (LGE) groups. Results and Conclusions: The HPK learners had higher reading motivation, perceptions, gaming and social achievements than the LPK learners, whereas they had similar gaming motivation and reading achievements. In addition, the HGE learners had lower reading motivation, reading and gaming achievements than the LGE learners, whereas they had similar gaming motivation, perceptions and social achievements. Moreover, correlational results showed that similarities and differences were observed between the HPK/LPK and HGE/LGE learners. Implications: The findings of this study suggest that learners' prior knowledge and gaming experience play influential roles in reading motivation, gaming motivation, perceptions and in‐game achievements. A framework is proposed for researchers or game designers to develop personalized DGBL systems to accommodate the HPK/LPK and HGE/LGE learners' individual needs or preferences in DGBL. Lay Description: What is already known about this topic: Reading motivation is a critical factor influencing reading performance.Students have difficulties developing reading skills due to a lack of reading motivation, and therefore need additional support.DGBL has been shown to be an effective strategy for promoting learning motivation.Relevant empirical research investigating the impact of individual differences on reading in DGBL is scarce. What this paper adds: A mobile game‐based reading app was developed to facilitate elementary students' reading activities.This study provides understandings of the impact of prior knowledge and gaming experience on reading motivation, gaming motivation, perceptions and in‐game achievements in DGBL.The HPK learners had higher reading motivation, perceptions, gaming and social achievements than the LPK learners, whereas they had similar gaming motivation and reading achievements.The HGE learners had lower reading motivation, reading and gaming achievements than the LGE learners, whereas they had similar gaming motivation, perceptions and social achievements. Implications for practice and/or policy: Educators should consider adopting DGBL to facilitate students' reading activities.Prior knowledge and gaming experience play influential roles in reading motivation, gaming motivation, perceptions and in‐game achievements.Learners' prior knowledge and gaming experience should be taken into account when designing learning activities in DGBL.A personalized DGBL system should be developed to accommodate the needs and preferences of the HPK/LPK and HGE/LGE learners. [ABSTRACT FROM AUTHOR]

Taoism and Confucianism both exited simultaneously as philosophies of living in dynastic China. Although there has been an increasing popularity in scientometric studies, religion and health (R&H) literature lacks a holistic evaluation investigating articles relevant to Taoism and Confucianism. All publications produced in Taoism and Confucianism literature and indexed in Web of Science (WoS) databases between 1975 and 2018 were included in this study. Database search on health and Taoism literature retrieved 199 documents from WoS databases. Main research areas were Psychology, Religion and Behavioral Sciences (24.121, 21.608 and 20.603, respectively). The USA ranked first with 38 papers followed China, Taiwan and the UK (n = 35, 20 and 6 documents, respectively). Hong Kong Polytechnic University from China was the most contributor institution in health and Taoism literature. A total of 448 documents were published in health and Confucianism literature between 1975 and 2018, and original articles covered 93.08% of all literature. China was leading country with 126 articles followed by the USA, South Korea and Taiwan (n = 97, 35 and 35 items, respectively). The most productive institutions were City University of Hong Kong (China), Karolinska Institute (Sweden) and University of Hong Kong (China). Researchers from developing and least developed countries should be encouraged to carry out novel scientometric studies in R&H literature. [ABSTRACT FROM AUTHOR]

Aims: This study was to explore the student nurses' bullying, social support and their health status during clinical practicum programmes and the predictors of health status among student nurses during clinical practicum programmes. Methods: A cross‐sectional design with structured questionnaires was used, recruiting 200 student nurses in a 5‐year junior college programme in south Taiwan. Results: The significant predictors of nursing students' health status during clinical practicum programmes were 'whether experiencing bullying situations during clinical practicum' and 'low social support'. Conclusion: In order to prevent bullying during clinical practicum, encouraging nursing students to report all the clinical practicum bullying incidents, providing counselling to nursing students and arranging clinical practicum bullying prevention courses to students were important. Moreover, providing instructors and nursing staff with teaching, communication and feedback skills might help nursing students prevent bullying incidents during clinical practicum programmes. A longitudinal study design was suggested for the future study in order to assess the cause–effect relationship of the bullying and social support on health among students during clinical practicum SUMMARY STATEMENT: What is already known about this topic? Nurses' exposure to workplace bullying will result in their health problems. What this paper adds? Student nurses' exposure to bullying during clinical practicum and low social support might impact on their health status. The implications of this paper: Establishing supportive practicum environments is important to help nursing students prevent bullying incidents during clinical practicum programmes.Nurse educators might include the results of this study into the contents of the educational programmes to increase students' knowledge on student nurses' bullying and its risks. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore nurses' demographic data, assertiveness, psychosocial work condition, and workplace bullying, and find the predictors of workplace bullying. Methods: This study adopted a cross‐sectional design. A stratified sample comprising 241 nurses from a regi onal teaching hospitals in Taiwan was selected from the 10th to the 23rd September, 2018. Data were analysed by using the SPSS Statistics 17.0. Descriptive statistics (frequency, percentage, mean, and standard deviation), one‐way Anova, t test, Pearson's correlation, and multiple linear regressions were used. Results: The results showed that the participants with "past bullying experience," "lower self‐assertiveness," "higher work psychological demands," "lower workplace justice," "lower labour participation," and "lower overall social support" are more likely to experience workplace bullying. Conclusions: Hospital managers should pay attention to the problem of nursing workplace bullying. First of all, hospital managers should encourage curriculum on nursing workplace bullying and incorporate nursing workplace bullying prevention training courses in curriculum planning. SUMMARY STATEMENT: What is already known about this topic? Workplace bullying can cause physical and psychological disorders in nurses and affect patients' safety.Understanding the affecting factors related to workplace bullying may be beneficial for decreasing the incidence of workplace bullying in nurses. What this paper adds? Past bullying experience, self‐assertiveness, work psychological demands, workplace justice, labour participation, and overall social support were predictors of workplace bullying. The implications of this paper: The establishment of a friendly workplace environment is important, such as, building up justice policies and involving nurses' opinions whilst setting up all policies.Nurse managers may provide educational programs to nurses in order to improve their knowledge and skills to deal with workplace bullying. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate the effectiveness of individualized exercise counselling in changing exercise behaviour and relieving pregnancy‐related distress symptoms in pregnant women. Methods: A quasi‐experimental design and convenience sampling technique were used. Participants were recruited from the prenatal outpatient departments of medical centre hospitals in Taipei, Taiwan. The experimental group (n = 52) received face‐to‐face exercise counselling followed by 8 weeks of exercise sessions in their homes. The control group (n = 49) received no exercise counselling. Pregnancy‐related distress symptoms were assessed before and after 8 weeks in both groups. Results: The after‐counselling scores of total (t = 2.46, P < 0.05) and physical (t = 3.18, P < 0.01) distress symptoms were significantly lower than the before‐counselling scores in the experimental group. The total, physical and psychological distress scores significantly differed between groups and before and after counselling. The adjusted R2 values for total, physical and psychological distress symptoms ranged from 0.59 to 0.70. Participants' exercise habits increased from prepregnancy (19.2%) to after counselling (71.2%). Conclusion: Exercise counselling may effectively increase exercise habits and reduce pregnancy‐related distress symptoms among pregnant women. Women with higher pretest symptom distress scores also had higher posttest symptom distress scores. Based on our outcomes, health care providers should routinely provide exercise counselling to pregnant women. SUMMARY STATEMENT: What is already known about this topic? Previous studies have found that exercise can be very beneficial for pregnant women by relieving pregnancy‐related distress.Women also commonly reported that advice regarding exercise during pregnancy is generally vague (not individualized), constantly changing and often limited to a continuation of their previous routine or simply increased walking.Studies on the effectiveness of individual face‐to‐face exercise counselling for pregnant women for relieving their pregnancy‐related distress symptoms are limited. What this paper adds? Individual face‐to‐face exercise counselling can reduce pregnancy‐related symptoms in pregnant women.The pretest score was a significant factor that influenced the degree of relief from symptom distress. The implications of this paper: This study could help health care providers to provide pregnant women with exercise counselling as part of their routine prenatal care to relieve pregnancy‐related distress. [ABSTRACT FROM AUTHOR]

Aim: Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full‐term normal childbirth in southern Taiwan. Methods: Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State‐ Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. Results: Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. Conclusion: Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions. SUMMARY STATEMENT: What is already known about this topic? Recurrent miscarriage is considered a major life event and, for some, a failure to fulfil a core responsibility for the family lineage.Research about the differences between genders in both the type and degree of emotional response to a miscarriage is limited. What this paper adds? Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than women without recurrent miscarriage.The key predictors of depressive symptoms among women of childbearing age were anxiety, stress, social support and history of recurrent miscarriage, accounting for 62.9% of the variance. The implications of this paper: This study highlights the need to increase healthcare professionals' awareness of the importance of evaluating stress, anxiety and depressive symptoms in women with recurrent miscarriage.It is recommended that future studies develop and test supportive care protocols for couples experiencing recurrent miscarriage. [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]

The outbreak of COVID-19 in early 2020 created dangerous public health conditions which pressured governments and health systems to respond in a rapid and effective manner. However, this type of rapid response required many governments to bypass standing; bureaucratic structures of health sector administration and political governance to quickly take; essential measures against a rapidly evolving public health threat. Each government's particular; configuration of governmental and health system decision-making created specific structural and functional challenges to these necessary centrally developed and coordinated strategies. Most East Asian governments (except Japan) succeeded relatively quickly in centralizing essential disease control and treatment initiatives in a timely manner. In contrast, a number of European countries, especially those with predominantly tax-based financing and politically managed health delivery systems, had greater difficulty in escaping bureaucratic governance and management constraints. Drawing on data about these governments' early stage COVID-19 control experiences, this article suggests that structural changes will be necessary if low-performing governments are to better respond to a pandemic. This paper also summarizes other relatively successful strategies. By adopting such strategies, nations can help overcome structural bureaucratic and administrative obstacles in responding to further waves of COVID-19 or similar future pandemic events. [ABSTRACT FROM AUTHOR]

Background: Performance goal orientations are influential motivational factors for predicting learning performance. However, a lack of attention has been paid to investigating the effects of performance goal orientations on learning performance and in‐game performance in the context of digital game‐based learning. Objectives: This study implemented a game‐based English vocabulary learning system and investigated how performance goal orientations affected learners' learning performance and in‐game performance. Methods: A total of 59 non‐English major university students participated in this study, divided into performance‐approach learners (PAPL) and performance‐avoidance learners (PAVL) based on their performance goal orientations. The English vocabulary listening test and log data were collected for conducting quantitative analyses. Results and conclusions: The results showed that the PAPL outperformed the PAVL in learning performance, whereas the two groups demonstrated similar gain scores and overall in‐game performance. Moreover, the results showed that the PAVL's learning performance was strongly associated with all aspects of in‐game performance in the learning activities. Conversely, the PAPL's learning performance was only associated with two aspects of in‐game performance in the competition activities. Implications: The findings of this study suggest that performance goal orientations play significant roles in both learning performance and in‐game performance, which could benefit the PAVL's in‐game performance, which is a substantial factor in promoting their learning performance via DGBL. Lay Description: What is already known about this topic: Digital game‐based learning (DGBL) has been widely adopted in various subject areas.DGBL is an effective learning approach for language learning.Performance goal orientations are influential motivational factors in predicting learning performance.Relevant empirical research on performance goal orientations in DGBL is scarce and inconclusive. What this paper adds: A game‐based English vocabulary learning system was developed based on the considerations of different characteristics of performance goal orientations.This study provides understandings of the impact of performance goal orientations on both learning performance and in‐game performance in DGBL.Performance‐approach learners outperformed performance‐avoidance learners, whereas the two groups demonstrated similar gain scores and overall in‐game performance.Performance‐avoidance learners' in‐game performance is a substantial factor in promoting their learning performance via DGBL. Implications for practice and/or policy: Educators should consider adopting game‐based assessment to reduce the gap between learners with different performance goal orientations.DGBL can be a potential approach to supporting different performance goal orientations, but it is particularly beneficial to learners with performance‐avoidance goals.Learners with different performance goal orientations need different types of learning activities to achieve better performance.A personalized DGBL system should be developed to accommodate the needs and preferences of learners with performance‐approach and performance‐avoidance goals. [ABSTRACT FROM AUTHOR]

Patient participation in healthcare activities is key to producing successful patient‐centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi‐structured interview was applied to focus groups for nurses, and to face‐to‐face interviews for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities (authoritative culture, participation behaviors, and obstacles to participation), and two differences (sources of acquiring patient‐related health information, and responsible party). Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman's language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation.Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. What the paper adds to existing knowledge: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression.Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one‐point increase in meaning in life score was associated with 0.47‐point decrease in depression score and 0.13‐point decrease in suicidal ideation score, respectively. What are the implications for practice: Logotherapy is a meaning‐centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression.Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. Introduction: Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim: To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method: A cross‐sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results: The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p <.03), and meaning in life had a direct negative association with depression (β = −0.51, p <.01) and indirect association with suicidal ideation through depression; this indirect association was −0.21 (p <.01). Discussion: Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice: Logotherapy is a meaning‐centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation. [ABSTRACT FROM AUTHOR]

No quantitative study has explored the influence of attention on learning English as a foreign language (EFL). This study investigated whether computer-detected attention is associated with EFL reading and listening and reading and listening anxiety. Traditional paper-based English tests used as entrance examinations and tests of general trait anxiety, reading, listening, reading test state anxiety, and listening test state anxiety were administered in 252 Taiwan EFL college students who were divided into High Attention (Conners' Continuous Performance Test, CPT < 50) and Low Attention (CPT ≥ 50) groups. No differences were found between the two groups for traditional paper-based English tests, trait anxieties, general English reading anxiety scales, and general English listening anxiety scales. The Low Attention group had higher test state anxiety and lower listening test scores than the High Attention group, but not in reading. State anxiety during listening tests for EFL students with computer-detected low attention tendency was elevated and their EFL listening performance was affected, but those differences were not found in reading. [ABSTRACT FROM AUTHOR]

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

This experimental study investigated long-term effectiveness of two educational methods on knowledge, attitude, and practice (KAP) about palliative care consultation services (PCCS) among nurses, recruited from a medical center located in Northern Taiwan in 2015, using a stratified cluster sampling method, with 88 participants in multimedia (experimental) and 92 in traditional paper education (control) group. Data were collected using KAP-PCCS questionnaire before education, immediately after, and 3rd and 6th month after education. Results showed that both K-PCCSI and P-PCCSI significantly increased immediately after, and at the 3rd month after education for the experimental group; the K-PCCSI remained significantly higher for the experimental group at the 6th month. The highest increase in scores for both K-PCCSI and P-PCCSI was observed at the 3rd month. There was no significant change in A-PCCS in both groups after follow-up periods, when compared before education. Therefore, using multimedia every 3 months to continue strengthening their knowledge may increase the referrals of terminal patients to PCCS. [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]

The present study introduced Ren'py software as a digital storytelling (DST) tool to explore the effective use of digital game design learning in promoting critical thinking among high school students. A sample of 46 high school students enrolled in "Thinking Utopia," an elective course in critical thinking for civics education, was put into groups of 3 to 4 for learning activities towards their collaborative designs of DST games. The course stretched across 9 weeks. Students' performance in critical thinking tests was also closely examined using paired‐sample t‐test analysis, which found no significant improvements; however, their interview responses were carefully studied using qualitative analysis and revealed that many of them agreed that the proposed collaborative activities for game script writing and for their collaborative designs of original hurdle questions have stimulated their critical thinking ability and contributed to the development of their other skills such as communication, problem‐solving and media literacy. Lay Description: What is already known about this topic: • Critical thinking is a key 21st century skill for students to arrive at an impartial judgement on controversial issues. • Digital storytelling and its practical value as an emerging technology may contribute to students' ability in critical thinking. • Collaboration and teamwork for design‐based learning may help students achieve deep learning. What this paper adds: • A model course plan on civics education featuring collaborative learning through digital game‐based design. • Further discussions on students' ability in critical thinking and their learning experience in a course involving collaborative design of digital storytelling games. Implications for practice and/or policy: • Collaborative learning through digital storytelling game‐based design may not promote critical thinking among high school students if they failed to initiate active discussions among themselves. • Collaborative learning through digital storytelling game‐based design among high school students may benefit other aspects of their learning, such as their skills in communication, problem‐solving, media literacy and test taking. [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]

Online search involves multitasking and may demand better working‐memory capacities (WMC) and additional cognitive aids. Given the constraints of human cognition, we tested the effectiveness of note‐taking strategies on university students' online search performance. Also examined were the profile configurations of WMC tests in silence and in irrelevant speech as well as its interaction effects with note‐taking strategies on online search performance. Among the participants of 60 university students, we found a four‐group WMC profile composition that differed significantly across WMC scores in both silence and irrelevant speech. Results showed that WMC profiles, note‐taking groups and their interaction effect were significant factors on online search performance. Both Free Note and Matrix Note were beneficial for the students in low silent WMC profile groups. Study results have both theoretical and practical implications, advancing our understanding of the interrelationship of WMC under different conditions and informing instructional practice of online search performance. Lay Description: What is already known about this topicWorking memory capacity is fundamental to multitasking ability.Online search is a typical multitasking behavior that requires constant switching between different information sources.Students who take note perform better than those who do not while reading materials with seductive but irrelevant information.What this paper addsStudents working memory capacity is examined under silent and irrelevant speech conditions.Students exhibited different profile patterns in their working memory capacity under silent and irrelevant speech conditions.Taking note, either in matrix form or free form, can significantly improve students' online search performance for those with high WMC ONLY in irrelevant speech or for those with low WMC in both silent and irrelevant speech conditions.Implications for practiceNote‐taking as auxiliary support may facilitate students' integration and evaluation of the online information across multiple sources during their online search.Instructions on how to self‐construct matrix note are needed to help students develop advanced note‐taking skills for their learning involving online search. [ABSTRACT FROM AUTHOR]

This research develops a web‐based model, entitled the "intuitive claim, peer‐assessment, discussion, and elaborate claim argumentation training" (IPadE) model, and embeds with a Web‐based Interactive Argumentation System to enhance undergraduate students' socioscientific argumentation abilities. This research adopts a quasi‐experimental research design; the sample comprised 131 undergraduate students from two classes (69 in the experimental group and 62 in the control group). The socioscientific issue discussed were related to global health. This study collected and analysed quantitative and qualitative data, including the pretest and posttest of students' knowledge test scores and argumentation abilities questionnaire. The results generally confirmed the effectiveness of the IPadE model. First, in a comparison of the content knowledge and argumentation skills, the experimental group have statistically significantly improved than the control group. Second, regarding the number of reasoning modes proposed, the experimental group could propose multiple reasoning modes and reasoning levels on rebuttals increased after training. Lay Description: What is already known about this topic: In the traditional classroom setting, it is difficult to obtain a fair expression of opinions because dominant students lead the debate. With internet and communication technology (ICT) rapid development, that has been emerging as a useful supplement to traditional methods. Web‐based interactive learning environments have recently become a popular and effective tool in the education field worldwide.Argumentation skills are the critical reasoning abilities that a modern citizen should possess. Regrettably, the researchers have consistently demonstrated that adolescents' and young adults' insufficient competencies regarding argumentation, constructing weaknesses of two‐sided arguments, and difficulty justifying evidence in support of their claims (Brem & Rips, 2000; Driver, Newton, & Osborne, 2000; Kuhn, 1991, 2003; Naylor, Keogh, & Downing, 2007; Voss & Means, 1991). Students' inadequate knowledge of science and judgment capacity can cripple their competency to make satisfactory decisions and be responsible citizens in society (Fowler, Zeidler, & Sadler, 2009).The integration of argumentation activities into science‐related curriculum is currently upheld as a core factor for a successful science program. In addition, HIV/AIDS is a prominent global health problem in Taiwan. Research based on global health‐related content knowledge and argumentation is rarely.Most of the literature has focused on the learning of elementary and middle school students (Fowler et al., 2009; Jimènez‐Aleixandre, Rodriguez, & Duschl, 2000; Keselman, Kaufman, Kramer, & Patel, 2007; Lin & Mintzes, 2010; Wu & Tsai, 2007; Zohar & Nemet, 2002) and has rarely investigated pre‐service and in‐service teachers and undergraduate students. (Osborne, Erduran, & Simon, 2004; Chang & Chiu, 2008). What this paper adds: Research based on global health‐related content knowledge and argumentation is rarely. We develop the IPadE argumentation model with Web‐based Interactive Argumentation System to enhance argumentation abilities of undergraduate students toward globe health problem.We develop three research instruments, including HIV/AIDS knowledge test (HKT), Open‐ended SSI argumentation ability questionnaire (SAAQ), and Argumentation ability checklist (AAC).We added the metacognitive supports interface designs "context viewer" function of WIAS; on the left is the initial argumentation context of the user, in the middle is the Lakatos' argumentation model, and on the right is the peer assessment score. Students can view their own initial argumentation context and reflect upon it after interacting with their peers and group discussion to obtain a sounder argumentation in the argumentation stage (Figure 5). Implications for practice: Development of HIV/AIDS knowledge: The results confirm that experimental group students in the semester program using the IPadE model with WIAS performed better and significantly improved HIV/AIDS knowledge.Development of argumentation skills: The results confirm that undergraduate students using the IPadE model with WIAS performed significantly better than those in the control group.Changes in students' use of arguments modes: The majority of the reasons proposed by participants were science‐and‐technology‐oriented arguments, followed by law‐oriented and social‐oriented arguments in the PH. Additionally, the students' use of the major argument modes were proposed as law‐oriented in the NH and rebuttal; however, the number of students in the experimental group that could propose multiple argument modes in the PH, NH, and rebuttal increased after training.Design of online discussion boards: The students used the discussions to assess peer learning by looking at peers' viewpoints and ideas. Comparison of face‐to‐face classroom, the WIAS can provided students with opportunities at anytime and anywhere through asynchronous discussions board to record their thoughts then make peer learning. This study suggest that a well‐designed web‐based argumentation system is a critical part of the higher education experience when the goal is to improve students' argumentation ability. [ABSTRACT FROM AUTHOR]

The purpose of this research was to compare the effectiveness of physical and virtual tangrams on preschool children's learning engagement and achievement. Children listened to an e‐storybook narration and solved puzzles individually. The experimental group (N = 31) completed puzzles embedded in the e‐storybook using virtual tangrams, while the control group (N = 30) completed the same puzzles using physical tangrams on outlines drawn on a paper. Results indicated that the experimental group had significantly higher overall engagement than the control group. The experimental group had significantly higher learning achievement (time taken to complete outlines) when using virtual tangrams. It is hoped that the study will be beneficial to classrooms concerning how to use tangrams in teaching and learning and to instructional designers on how to design an e‐storybook for young readers. [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]

Background Obesity is prevalent and increasing but understudied across Pacific Islanders. Tuvalu is a South Pacific country with a high obesity rate and faces multiple threats of food insecurity. Home garden serves as a sustainable food source and can be a possible intervention for the obesity pandemic in Tuvalu. This study investigated Tuvaluans' home garden use and obesity, and explored factors associated with increased use of home gardens. Methods We conducted a nationwide, cross-sectional study in Tuvalu during 2022. Structured questionnaires were administered during the in-person interviews, and trained interviewers measured the height and weight of each participant. The association between home garden use, obesity and severe obesity were tested with univariate and multivariable logistic regression. We also applied overlapping weights to balance the distribution of baseline demographic factors. Results The average body mass index was 34.87 kilogrammes (kg) / square metre (m2) among the study population of 1024 adults (630 from Funafuti and 394 from other islands in Tuvalu). Overall, people having home gardens was associated lower odds for severe obesity compared to those without a home garden in overlap weighting models (odds ratio (OR)=0.946, 95% CI=0.897-0.997, P=0.039) and the association was stronger in Funafuti (OR=0.927, 95% CI =0.866-0.991, P=0.027) than in the outlying islands (OR = 0.967, 95% CI = 0.889-1.052, P = 0.435). Furthermore, increased age was positively associated with having a home garden in Funafuti, and smoking showed an inverse association. Conclusions Having a home garden is associated with lower odds of severe obesity in Tuvalu, and the association is stronger in Funafuti. Smokers are less likely to have home gardens, and increased age is positively associated with having home gardens. These findings promote more home garden utilisation and provide evidence for targeted interventions in Tuvalu. [ABSTRACT FROM AUTHOR]

This study combined virtual reality (VR) technology, the 6E (Engage, Explore, Explain, Engineer, Enrich, and Evaluate) model, and STEM (Science, Technology, Engineering, and Mathematics) education to develop a hands‐on activity aimed at helping students to achieve "learning by doing." The participants were 162 tenth‐grade students, divided into the Experimental Group (hands‐on activity using VR technology) and the Control Group (hands‐on activity via lectures). Using sequential analysis, this study investigated how the hands‐on activity influenced the students' behavioral patterns in learning. The results showed that all of the students' learning performances and hands‐on abilities were enhanced. Moreover, the students who used VR technology achieved both significantly better learning performances and hands‐on abilities, indicating that VR might be able to help the students understand abstract scientific concepts and build mental models, which they used to internalize and organize knowledge structures. Furthermore, this study discovered that the students who learned using VR technology formed a cyclical learning pattern, starting with a group discussion (G), moving on to solving problems (S) and developing a product (D), and then going back to another group discussion. However, the students who learned via lectures produced a linear learning pattern in the order of G→S→D. Lay Description: What is already known about this topic: The VR provides students with the visualization of abstract concepts and novel points of view that is impossible to display in a real environment.STEM knowledge can be integrated into hands‐on activities to foster students' core competencies through engineering design and producing procedures. What this paper adds: Used VR technology, 6E model, and STEM education to design a hands‐on learning activity.In the activity, students learned how to solve problems, modify their product, and enhance their quadcopter's operational performance, which was a specific representation of "learning by doing." Implications for practise and/or policy: This study combined VR, the 6E model, and STEM education to develop a hands‐on activity to improve students' abstract scientific concepts, interdisciplinary knowledge, and hands‐on ability.The differences of the learning behaviour patterns during the hands‐on process between the VR technology and lectures were also found. [ABSTRACT FROM AUTHOR]

This paper extends investigation of religiosity and longevity to Taiwan using a 1989 survey: N = 3849, aged 60+, with 18 years of follow-up. Religious activity is measured as worship and performance of rituals. A Gompertz regression, adjusted and non-adjusted for covariates and mediating factors, shows the hazard of dying is lower for the religiously active versus the non-active. Transformed into life table functions, a 60-year-old religiously active Taiwanese female lives more than 1 year longer than her non-religious counterpart, ceteris paribus. Mainland Chinese migrants are examined carefully because of unique religious and health characteristics. They live longer, but the religiosity gap is similar. [ABSTRACT FROM AUTHOR]

This study investigated how students designed English academic oral presentations via a blended language learning environment. Data were collected from focus group interviews, observations of students, and instructor perspectives to explore how students develop academic presentation skills. In addition, a total of 36 oral presentations were assessed by a rubric and frequency counts of presentation language and features. By adopting an ecological approach, we identified the interactions between different factors that influenced learning. Interview findings and observations suggested students welcomed the immediacy of the technology and demonstrated signs of autonomous learning by self‐selecting the chat application Line for group collaboration. Participants preferred both online and face‐to‐face collaboration, as students discovered the limits of online communication. Results indicated that group oral presentations improved, with stronger introductions, linking devices, and visual elements. However, students had problems constructing conclusions and trouble linking the main ideas to the content. Lay Description: What is already known about this topic? Group oral presentation projects train students in 21st century competencies such as multimedia skills, critical thinking, problem solving, and collaboration.Cloud computing collaborative environments have the potential to help students develop language and communication skills.Users are aware of some of the affordances of mobile devices for language learning. What this paper adds? A description of the design and development of a blended language learning environment (BLLE) for English undergraduate oral presentations.Identified improvements in oral presentation introductions, cohesion, and visual elements from using this BLLE.Provides deep, qualitative insights on student perspectives for collaborative, mobile‐based learning from an ecological approach. Implications for practice and/or policy Oral presentation skills can be developed in a BLLE providing the instructor involves students in the design process.Instructors need to discover the right blend for language learners between online and face‐to‐face collaboration to facilitate project development.Collaboration, instruction, effective learning technology, and convenience are the four main factors that interact and influence how students develop and perform group oral presentations in a BLLE. [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: Both the high-risk human papillomavirus (HR-HPV) infection and tobacco exposure are significantly associated with cervical neoplasm risk. Immune cells play important roles in carcinogenesis. However, it is still unclear whether immune cells have a mediating effect on the HR-HPV infection and tobacco exposure with cervical neoplasm development. Aim: The aim of this study was to determine how the increased white blood cell (WBC) count affects the relationship between HR-HPV DNA load and tobacco exposure in the development of cervical neoplasia. Methods: A hospital-based case–control study design was conducted with a total of 108 cases of Taiwanese women with ≥ cervical intraepithelial neoplasia (CIN) I confirmed by biopsy, and 222 healthy Taiwanese female subjects with negative findings on a Pap smear were assigned to the control group. The study evaluated HR-HPV status and immune cell counts (WBCs, natural killer (NK) cells) and tobacco exposure by a self-construct questionnaire. Results: Both HR-HPV DNA load and tobacco exposure significantly independently increased cervical neoplasm risk (AORs: 1.28 and 1.42, respectively). Similar significant results were found for WBCs and NK cells, with respective AORs of 1.20 and 1.00. Moreover, increased WBCs (β = 0.04, 95% CI corrected: 0.01–0.07) and tobacco exposure (β = 0.02, 95% CI corrected: 0.01–0.04) mediated the relationship between the high-risk HPV DNA load and cervical neoplasm risk. Conclusions: Elevated WBC count acts as both predictor and mediator in cervical neoplasm development linked to HR-HPV DNA load. Monitoring and maintaining WBC levels within the normal range could be a preventive strategy for cervical neoplasm development. [ABSTRACT FROM AUTHOR]

Objective. The Fugl-Meyer assessment for upper extremity (FMA-UE) is a measure for assessing upper extremity motor function in patients with stroke. However, the considerable administration time of the assessment decreases its feasibility. This study aimed to develop an accumulative assessment system of upper extremity motor function (AAS-UE) based on the FMA-UE to improve administrative efficiency while retaining sufficient psychometric properties. Methods. The study used secondary data from 3 previous studies having FMA-UE datasets, including 2 follow-up studies for subacute stroke individuals and 1 test-retest study for individuals with chronic stroke. The AAS-UE adopted deep learning algorithms to use patients' prior information (ie, the FMA-UE scores in previous assessments, time interval of adjacent assessments, and chronicity of stroke) to select a short and personalized item set for the following assessment items and reproduce their FMA-UE scores. Results. Our data included a total of 682 patients after stroke. The AAS-UE administered 10 different items for each patient. The AAS-UE demonstrated good concurrent validity (r =0.97-0.99 with the FMA-UE), high test-retest reliability (intra-class correlation coefficient=0.96), low random measurement error (percentage of minimal detectable change=15.6%), good group-level responsiveness (standardized response mean=0.65-1.07), and good individual-level responsiveness (30.5%-53.2% of patients showed significant improvement). These psychometric properties were comparable to those of the FMA-UE. Conclusion. The AAS-UE uses an innovative assessment method, which makes good use of patients' prior information to achieve administrative efficiency with good psychometric properties. Impact. This study demonstrates a new assessment method to improve administrative efficiency while retaining psychometric properties, especially individual-level responsiveness and random measurement error, by making good use of patients' basic information and medical records. [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]

Subjective well-being presents a societal challenge for vulnerable older adults. This study aims to investigate the mediating role of place attachment in the relationship between attitudes toward aging and subjective well-being among community-dwelling older adults in Taiwan. Two waves of investigations were conducted to examine the interplay between attitudes toward aging, subjective well-being, and place attachment among older adults. In Wave I, 1190 participants were enrolled, revealing predominantly younger cohorts with substantial educational levels. The subsequent Wave II involved 483 participants, maintaining continuity in characteristics. Subjective well-being remained moderate across waves, with prevalent positive attitudes toward aging. Place attachment scores indicated moderate to high associations. After controlling for demographics, structural equation modeling (SEM) in both waves revealed significant positive associations: attitudes toward aging influenced well-being, attitudes toward aging were positively associated with place attachment, and place attachment was positively related to well-being. Mediation testing confirmed the mediating role of place attachment in the relationship between attitudes toward aging and well-being. These findings underscore the important role of place attachment. It is evident that improving attitudes toward aging is an effective intervention which can lead to a better sense of well-being by enhancing place attachment to empower civil society. [ABSTRACT FROM AUTHOR]