Search

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]

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]

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]

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]

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]

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]

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]

Background: Many gamification applications (apps) have been designed to motivate students to learn particular content. Based on the brain activation approach, the present study adapted an app, named Shaking‐On, which requires students to shake their mobile devices to send their answers to multiple‐choice questions to the teacher. Students then learn from their performance. Objectives: To understand how this approach can stimulate participants' emotions when achieving their learning goals, the present study compared Shaking‐On to Kahoot! by checking participants' gameplay anxiety, learning interest, perceived learning value, and learning achievement while learning the Taiwanese language. Methods: The students were divided into two groups to play with one of the two apps, Shaking‐On or Kahoot!, as part of a quasi‐experimental study in which they used the assigned app six times in 6 weeks. Moreover, a questionnaire was distributed to participants and 151 useful responses from the Shaking‐On group, and 148 from the Kahoot! group were returned. Results and Conclusions: After statistical analysis, the results of this study revealed that besides no difference in gameplay anxiety when comparing the two groups of students, there were significant differences in game interest, flow experience, perceived learning value, and learning achievement, further indicating that Shaking‐On with hands‐on shaking outperformed Kahoot!. Lay Description: What is already known about this topic: The adoption of technology in learning pedagogies should enable students to interact with their technological devices in a fun way and there needs to be interested during the learning process.Different designs of e‐learning platforms have different functions for students to interact that promote in them different psychological outcomes, by shaping their learning behaviours and enhancing their motivation and engagement. What this paper adds: The present study adapted an app, named Shaking‐On, which requires students to shake their mobile devices to send their answers to multiple‐choice questions to the teacher, students will then learn from their performance.To understand how this approach can stimulate participants' emotions in achieving learning goals, the present study compared Shaking‐On to Kahoot! by checking participants' gameplay anxiety, learning interest, perceived learning value, and learning achievement when learning the Taiwanese language. Implications for practice and/or policy: The research on the application of CATML to education is increasing, but there has been less research in the field of Taiwanese languages.The studies related to digital game‐based learning, there are few studies that compare games with different operation movements. Therefore, this study can be used as a reference for the application of cognitive and affective theories of multimedia learning to study the field of learning other native and disappearing languages. [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: Collaborative computer simulations are available on some online platforms which support students at distributed locations to synchronously collaborate on the simulations to learn sciences. However, how students collaborate with each other in collaborative simulations is not clear. Objectives: The aim of this study was to investigate whether functional interdependency would influence learning. Methods: Two collaborative learning models with different functional interdependencies were examined (the synchronous model and the distributed accountability model). Multiple data sources obtained from 64 students were collected and analyzed. We discuss the collaborative learning with two levels of factors: the individual‐level factors (i.e., individual perceptions of teamwork quality, visual attention and learning performance before and after a simulation activity) and the pair‐level factors (i.e., discourse data and joint attention). Given that the pair‐level factors in the collaborative learning environment may affect the individual‐level factors, we further discuss the interactions of the two levels of factors in different collaborative learning models with hierarchical linear modeling (HLM) analysis. Results and Conclusions: The analytical results of the individual‐level factors found participants in the distributed accountability model demonstrated more frequent and longer attention to the learning activity. Furthermore, the results indicated that the two simulation learning activities would enhance the participants' learning performance except in Q2. For the pair‐level factors, the results demonstrated that the participants in the distributed accountability model showed more active discourse segments but similar joint attention patterns in the learning activity. The results of the HLM analysis indicated that the students in the distributed accountability model had to collaborate with their partners through more constructive dialogue, and focused on the same areas of interest to enhance their learning performance, as the complexity of the distributed accountability design was implemented in a simulation learning activity. Major takeaways: We found that the increase of functional interdependency cannot guarantee students' learning effect in collaborative learning and may hinder the communication that is needed during collaboration. Researcher may need to consider other collaboration tools to enhance the reciprocal reflection. Lay Description: What is already known about this topic: Collaborative simulations are helpful in making the learning process cohesive.The learning effects of functional interdependence in collaborative learning are under debate. What this paper adds: We examined collaborative learning models with different functional interdependencies.We discuss the collaborative learning with the individual‐, the pair‐level factors and their interactions Implications for practice and/or policy: The importance of decreasing cognitive load induced by simulation with high functional interdependency.It is necessary to increase participants' transactive and constructive engagement in collaborative models. [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]

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]

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: 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]

This study combined 3D printing technology with experiential learning strategies (ELS) to design a hands‐on curriculum for preengineering students. The participants learned interdisciplinary knowledge and abstract scientific concepts through the curriculum. The study implemented a quasi‐experimental design to examine whether the students who learned using the 3D printing technology with ELS demonstrated better learning performances regarding the comprehension of abstract scientific concepts and hands‐on ability. This study selected 184 10th‐grade students from five classes, which were divided into three groups. The experimental process was conducted over a period of 11 weeks (for a total duration of 960 min). It was found that all of the preengineering students improved their comprehension of abstract scientific concepts. The students who learned using the 3D printing technology understood abstract scientific concepts better than those who learned using the traditional hands‐on tools, and the students who learned using the 3D printing technology with ELS demonstrated better hands‐on ability than the other two groups. Using 3D printing technology with ELS resulted in significant positive effects on the participants' handmade processes, in which the students reinforced the connection between knowledge and handmade products, resulting in better comprehension of abstract scientific concepts and hands‐on ability. Lay Description: What is already known about this topic: Applying 3D printing technology to a hands‐on curriculum offers many benefits, such as smoother and easier progress, and a shortened product development cycle and reduced development costs.Preengineering students must understand the impacts of engineering developments and become literate about the technological world around them, but disciplines that are too abstract for students at the high school level can easily lead to myths, and it can affect students' learning outcomes. What this paper adds: Combining 3D printing technology with ELS to design a learning activity.Through the process of this course design, students gained scientific knowledge about energy and produced a hands‐on windmill generator that converted wind energy into electricity. Implications for practice and/or policy: This study used 3D printing technology with ELS to help senior high school students improve their comprehension of abstract scientific concepts and hands‐on ability.By bridging the gap between interdisciplinary knowledge and a hands‐on curriculum, this study provided evidence of engaging in experiences when using 3D printing technology. [ABSTRACT FROM AUTHOR]

According to the wisdom literature, learning from important and meaningful life experiences can foster wisdom. Leading others is one such experience. This paper explores empirically whether and how learning acquired from leadership experience can foster wisdom, which is defined as a real-life process encompassing three core components: cognitive integration, embodiment in actions, and positive effects for oneself and others. This paper consists of two studies. Study 1 investigated the learning acquired from leadership experience and its relationship with wisdom. Eight leaders in higher education in Taiwan participated in five interviews spanning 2 years which explored the lessons learned from their leadership experience. Analysis of the interviews found that leaders acquired rich and multidimensional learning from their leadership experience and that components of wisdom were involved in their learning and their application of the lessons learned. Study 2 examined whether the results of Study 1 could be generalized to a wider population of higher education leaders. An inventory of learning and wisdom compiled from Study 1 was administered to 94 Taiwanese higher education leaders twice within 8 months. Multivariate statistical analysis showed that leaders' responses to items of both acquired learning and components of wisdom increased in 8 months and that these increases were strongly correlated. Results suggest that learning from important and meaningful life experiences can foster wisdom. [ABSTRACT FROM AUTHOR]

Background: Quality of life (QOL) is frequently utilized in clinical medicine and research to assess a patient's health status and treatment effectiveness. Objectives: This study investigates the impact of vocational training on the QOL of visually impaired individuals. Methods: We employed the brief Taiwan version of the World Health Organization QOL Questionnaire (WHOQOL-BREFTW) to assess four domains: physical, psychological, social, and environmental, using a nonequivalent pretest–posttest control group design. The experimental group participated in 6 months of vocational training, including life and career reconstruction. After completing the vocational training, the average QOL score for the experimental group was 3.34 ± 0.18, while the control group had a score of 3.10 ± 0.85. The generalized estimating equation (GEE) results revealed a notable improvement of 10.81 (1.10) in the posttest overall QOL scores compared to the pretest scores in the control group. Conclusion: Vocational training significantly improves the overall QOL for visually impaired individuals. It is noteworthy that the psychological, social relationship, and physical health domains of WHOQOL-BREF TW exhibited the most significant improvements. This emphasizes the following: 1. professional knowledge and technical learning can enhance the abilities of the visually impaired. 2. The improvement in QOL occurs primarily at physical, psychological, and social levels. These levels involve maintaining physical health, reducing dependence on medical care, and enhancing self-care abilities for life reconstruction. 3. Integrating electronics with directional action can help to mitigate the risks associated with outdoor activities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the cognitive functions of Mandarin speakers with poststroke aphasia and to investigate the relationship between nonlinguistic cognitive deficits and the severity of aphasia. Method: Twenty-three adults with aphasia resulting from left-hemispheric stroke and 23 adults matched for age and educational level completed a series of six nonlinguistic cognitive tests measuring nonverbal intelligence, short-term memory, visual selective attention, visual alternating attention, auditory selective attention, and auditory alternating attention. A standardized aphasia assessment (Concise Chinese Aphasia Test [CCAT]) was also conducted to evaluate the severity of aphasia. Data analyses examined cognitive functions by comparing task performance of the two groups and examining the relationship between scores on the cognitive tasks and aphasia severity based on a hierarchical regression analysis. Results: The aphasia group scored significantly lower than the control group on all nonlinguistic cognitive tasks with large effect sizes (d = 0.95 ~ 1.54). Significant associations between different nonlinguistic cognitive tasks and CCAT subtests were observed. Results from the hierarchical regression analysis showed that auditory alternating attention was the only factor that significantly predicted aphasia severity based on CCAT overall scores after age and education level were taken into account. Conclusions: The findings align with prior research observing deficits in nonlinguistic cognition in individuals with aphasia. Implications for clinical practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Patients with bipolar disorder (BD) receive traditional Chinese medicine (TCM) for clinical needs unmet with psychotropic medications. However, the clinical characteristics of practices and outcomes of TCM in BD are not fully understood. This cohort study investigated the clinical characteristics, principal diagnoses, TCM interventions, and TCM prescriptions in patients with BD. Methods: Data for a total of 12,113 patients with BD between 1996 and 2013 were withdrawn from Taiwan's longitudinal health insurance database 2000 (LHID 2000). The chi-square test was used for categorical variables, and the independent t-test was used for continuous variables. A p-value less than 0.05 indicated significance. Results: One thousand three hundred nineteen patients who visited TCM clinics after the diagnosis of BD were in the TCM group, while those who never visited TCM were in the non-TCM group (n = 1053). Compared to the non-TCM group, patients in the TCM group had younger average age, a higher percentage of female individuals, more comorbidities of anxiety and alcohol use disorders, and higher mood stabilizer usage rates. The TCM group exhibited pain-related indications, including joint pain, myalgia, myositis, headache, and sleep disturbances. Corydalis yanhusuo and Shu-Jing-Huo-Xue-Tang were the most useful single herbs and herbal formulae. Conclusions: Physicians need to be aware of the use of TCM in patients with BD. [ABSTRACT FROM AUTHOR]

Aim: The first coronavirus disease 2019 (COVID-19) outbreak in Taiwan occurred in May 2021 and many individuals were infected. All COVID-19 patients were quarantined in designated facilities until they fully recovered to prevent the spread of the disease. Prolonged quarantine could adversely affect these patients. In this study, we focused on investigating changes in the quality of life and mental health of individuals discharged from hospital after recovering from COVID-19. Methods: This study employed a longitudinal design and surveyed individuals discharged from a teaching hospital in northern Taiwan in 2021 within one week of their discharge and again after one month. An online questionnaire comprising the participants' background, respiratory function (COPD Assessment Test), quality of life (WHOQoL-BREF), and emotional problems (DASS-21) was administered to the participants. Results: A total of 56 participants actively took part in both surveys. We observed that participants with abnormal respiratory function had a lower physical and psychological quality of life, especially those with severe symptoms requiring endotracheal intubation during the treatment period of COVID-19. Additionally, approximately 30% of participants experienced anxiety problems throughout this study period. Finally, patients with COVID-19 symptoms exhibited a lower quality of life and higher levels of severe emotional problems. Conclusions: According to our findings, it is necessary to monitor and provide appropriate interventions for individuals who have recovered from COVID-19, especially those who experienced severe symptoms that required endotracheal intubation during COVID-19 treatment. These interventions, such as symptom management and psychological support, can help improve their quality of life and reduce emotional problems. Therefore, after the participants are discharged, hospitals should regularly track the patients' status and provide appropriate support or referrals to help these individuals. Otherwise, future research could include more participants and follow up with them for longer to investigate the longitudinal impact of COVID-19. [ABSTRACT FROM AUTHOR]

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

The paper investigates the effects of phone use (talking, texting, and listening to music) on the street-crossing behaviours of pedestrians and their inattentional blindness in Taiwan. Recent handsets with touchscreens, as well as more advanced features including multimedia, and mobile applications (apps), exacerbate problems relating to cognitive distraction and reduced situation awareness. A controlled field study using video cameras was conducted for observing pedestrians’ crossing behaviours (e.g. crossing time, sudden stops, looking both ways before crossing, and disobeying traffic signals). Pedestrians were classified into two groups: experimental group (talking, texting, and listening to music) and control group (no phone use). Pedestrians’ inattentional blindness was examined by evaluating whether they saw and heard an unusual object (i.e. a clown) nearby. The results indicate that the proportions of unsafe crossing behaviours (e.g. sudden stops, disobeying traffic signals, and not looking both ways before crossing) were higher among distracted individuals and more pronounced among those using instant-messaging apps. These instant-message app users were the least likely to see the clown, and music listeners were the least likely to hear the horn that the clown was honking. Contributing factors to unsafe behaviours include being a student, having a phone screen of 5 inches or larger, and having unlimited 3G Internet access. Texting message via apps was the leading factor on unsafe crossing behaviours of pedestrians and their inattentional blindness. [ABSTRACT FROM PUBLISHER]

This study aims at implementing a simple and effective remedial learning system. Based on fuzzy inference, a remedial learning material selection system is proposed for a digital logic course. Two learning concepts of the course have been used in the proposed system: number systems and combinational logic. We conducted an experiment to validate the success of the proposed system where 88 students who studied a computer-related program at a vocational high school in Taiwan participated in the experiment. The participating students came from three different types of classes. The fuzzy expert system determined the numbers of the remedial material units according to the scores of the pre-test. Based on the results of the fuzzy expert system, each student then received personalized remedial learning materials by randomly selecting problem-based learning units from a learning material repository. After reading the remedial learning materials, the students took the post-test. The experimental results reveal that the students made significant progresses after studying the remedial learning materials. Both of high-achieving students and low-achieving students made significant progresses. Moreover, all of the three types of students made significant progresses. Lay description What is currently known about the subject matter: Remedial learning systems are helpful., Some systems are good for only low-achieving students., The remedial systems are complicated., What their paper adds to this: A fuzzy expert system has been added to produce remedial materials., Automatically select the remedial learning units according to the pre-test., The implications of study findings for practitioners: Our remedial system is good for both high-achieving and low-achieving students., Our remedial system is good for different types of students., Our remedial system is simple and easy-to-implement. [ABSTRACT FROM AUTHOR]

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

Background: The application of palliative care is limited and challenging in intensive care units (ICUs) because of complex factors such as time constraints and unpredictable disease progression. Although research results and international consensus stress the early use of palliative care, utilization remains low, resulting in increased risks of ineffective medical care and poor quality of death. Improving this situation requires a comprehensive understanding of the palliative condition in ICUs. Purpose: This study was designed to investigate the utilization of hospice resources in adult ICUs and to compare this utilization between users and non-users. Methods: This retrospective correlation study recruited cases from the adult ICU database of a medical center in northern Taiwan between June and July 2022. Descriptive statistics, independent t-test and chi-square were used to analyze the data. Results: A total of 1,181 records were analyzed, including 458 (38.8%) females and 723 (61.2%) males. Two hundred and seventeen cases (18.4%) used hospice resources. Although 124 (10.4%) of the 1181 cases were identified as "in urgent need of hospice resources" (i.e., died within 30 days of ICU admission), 25 (20.2%) did not use these resources. Significant differences between the urgent-need cases who did and did not use hospice resources were found in terms of age, disease type, degree of frailty, cardiac arrest, infection, state of consciousness, intubation and tracheostomy status, inotropic and vasopressor medication, renal replacement, ECMO placement, delirium, and Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment Scores. Conclusions/ Implications for Practice: The roughly 20% of ICU patients in urgent needs of palliative care who did not utilize palliative care resources highlight the needs for continued discussion to better assist patients on palliative care decision-making. The findings show multifaceted differences between those who did and did not access palliative care. Future studies should design and test strategies to facilitate the identification of palliative care needs and ensure the effective allocation of palliative care resources in ICUs. [ABSTRACT FROM AUTHOR]

One major drawback of previous research on speech-to-text recognition (STR) is that most findings showing the effectiveness of STR for learning were based upon subjective evidence. Very few studies have used eye-tracking techniques to investigate visual attention of students on STR-generated text. Furthermore, not much attention was paid to learning differences, such as learning ability, learning style preferences and gender, to use STR texts. Therefore, this study carried out one experiment. Firstly, participants' visual attention on STR-generated text was investigated by employing eye-tracking technique. Secondly, how differently effective STR-generated texts can be to influence participants' learning achievement was tested. Thirdly, this study compared visual attention and learning behaviour with the different characteristics of participants, such as learning ability, learning style preferences and gender, to use STR-generated texts. Finally, this study explored students' perceptions regarding usefulness of STR-generated texts for learning. This paper discusses results, research findings and implications along with conclusions and several suggestions for future development and research. [ABSTRACT FROM AUTHOR]

This paper presents a study on implementing the ASR-based CALL (computer-assisted language learning based upon automatic speech recognition) system embedded with both formative and summative feedback approaches and using implicit and explicit strategies to enhance adult and young learners' English pronunciation. Two groups of learners including 18 adults and 16 seventh graders participated in the study. The results indicate that the formative feedback had a positive impact on improving the learners' speaking articulation, and the summative feedback aided the learners' self-reflection and helped them to track their speaking progress. Furthermore, the implicit information such as model pronunciation with full sentences and audio recast benefitted the adult learners, whereas the young learners preferred the explicit learning information such as textual information of individual words for self-correction. In addition, the results of this study also confirm that learners have different perceptions of the media modalities designed with implicit and explicit strategies in the feedback. Feedback with audio modality is more suitable for adults, whereas juxtaposed textual and audio modalities are better for young learners. [ABSTRACT FROM AUTHOR]

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

This paper aims to investigate how a gamified learning approach influences science learning, achievement and motivation, through a context-aware mobile learning environment, and explains the effects on motivation and student learning. A series of gamified learning activities, based on MGLS (Mobile Gamification Learning System), was developed and implemented in an elementary school science curriculum to improve student motivation and to help students engage more actively in their learning activities. The responses to our questionnaire indicate that students valued the outdoor learning activities made possible by the use of a smartphone and its functions. Pre- and post-test results demonstrated that incorporating mobile and gamification technologies into a botanical learning process could achieve a better learning performance and a higher degree of motivation than either non-gamified mobile learning or traditional instruction. Further, they revealed a positive relationship between learning achievement and motivation. The correlation coefficient for ARCS dimensions and post-test shows that the ARCS-A (attention) is greater than ARCS-R, ARCS-C and ARCS-S. This means that the attention (ARCS-A) of this system is an important dimension in this research. The results could provide parents, teachers and educational organizations with the necessary data to make more relevant educational decision. [ABSTRACT FROM AUTHOR]

BACKGROUND: Based on the high prevalence of people with problems in the wrist and hand simultaneously, it is of its importance to clarify whether hand joints exert extra motion to compensate for wrist motion while immobilized. OBJECTIVE: This study aimed to measure the compensatory movement of the thumb and index finger when people perform daily activities with an immobilized wrist. METHODS: Thirty healthy volunteers were recruited in this study. A wrist splint, the Jebsen-Taylor Hand Function Test, and the OptoTrak Certus motion tracking system were used. Seven inter-digit mean joint angles of the index finger and thumb were calculated. Paired sample t-test was used. RESULTS: (1) The compensatory motions were noted in the Metacarpophalangeal and Carpometacarpal joints of the thumb, and the proximal interphalangeal joints of the index finger; (2) The manifestation of compensatory motion was related to type of activity performed except when picking up light and heavy cans. CONCLUSIONS: The compensatory motions appeared while the wrist was immobilized and were found to be disadvantageous to the progression of disease. In the future, studies need to be done to understand how to select products with correct ergonomic design to enable people to reap greater benefits from wearing wrist splints. [ABSTRACT FROM AUTHOR]

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

Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital. Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide. A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries. Study design and methods: The study used a quasi-experimental design. Data was collected in a Baby Friendly hospital. A total of 60 mother-infant dyads were included. The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care. The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits. The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum. Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group. In the experimental group, 90% of the infants completed the first feeding within two hours after birth. At discharge, 93.3% of the mothers in the experimental group and 53.3% in the control group were exclusively breastfeeding. At one month postpartum, 83.3% of the mothers in the experimental group and 36.7% in the control group were still exclusively breastfeeding. Discussion: The intervention program used in the current study is different to previous studies. The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue. Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods. Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan. The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum. Implication for practice: This study provided initial evidence to support the implementation of mother-infant non-separation practices in improving breastfeeding outcomes. Health professionals can be re-educated regarding birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue without increasing nursing workloads while infants' fathers and other family members (eg. mothers-in-law/mothers' mothers) can be encouraged to participate in order to achieve family-centred maternity care. What is already known about the topic? * Early and exclusive breast feeding and ongoing breast feeding is the optimal form of nutrition for newborn babies and promotes positive infant and mother outcomes. * Birth kangaroo mother care plays an important role in providing the optimal atmosphere for a baby's instinctive reflex ability to breastfeed effectively in order to help infant imprinting and suckling. What this paper adds: * The newly developed hospital-based perinatal breastfeeding program has demonstrated effectiveness in promoting exclusive breastfeeding rate at one month postpartum. * Including birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue in a perinatal breastfeeding program may lead to more positive breastfeeding experiences for new mothers. [ABSTRACT FROM AUTHOR]

BACKGROUND: We sought to evaluate the effect of an integrated prospective payment program (IPP) on knowledge of hospice care and willingness to participate in hospice care among family members of patients on prolonged mechanical ventilation (PMV). METHODS: Between November 2013 and April 2014, we used paper-based survey questionnaires from 64 institutions to evaluate knowledge, willingness, and related factors among the main caregivers of patients on PMV regarding hospice care and to determine whether their decisions for the patients were affected by the IPP. RESULTS: The average ages of the respondents and patients on PMV were 51.9 y and 70.8 y respectively; 70.6% of the respondents knew about the Hospice Palliative Care Act (HPCA), and 42.3% of the medical staff had introduced hospice care-related information to patients and caregivers in Taiwan. Among the caregiver respondents, 67.6% agreed to write a letter of intent regarding the choice of hospice care or limited life-sustaining treatment. In total, 66.2% (16.1 = 50.1%) of the respondents agreed to hospice care for their family members (ie, the patients on PMV) when the condition was terminal. The factors of greater HPCA knowledge among the patients on PMV were IPP participation, female sex, and coma status. Factors leading to higher levels of HPCA knowledge included age > 65 y being married, higher income, awareness of the law, and being introduced to hospice care by medical staff. CONCLUSIONS: High levels of hospice care knowledge were unrelated to willingness to participate. HPCA knowledge was greater in the IPP group than in the non-IPP group; however, there was no significant difference in the willingness to agree to hospice care. It is recommended that individuals be encouraged to express their medical decisions. [ABSTRACT FROM AUTHOR]

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

Depression and self‐esteem affects the health and quality of life of older adults who live in nursing homes. This study tested the effectiveness of art therapy activities on reducing the depression and improving the self-esteem of elderly living in long‐term care institutes. This was a quasi‐experimental study. A purposive sampling strategy was used to select 55 subjects who were aged 65 and above with intact mental functions and depression tendencies and currently residing in nursing homes in Kaohsiung, Taiwan. 29 subjects who participated in a selection of 12 artistic activities were assigned to the experimental group and 26 subjects who adhered to their ordinary activities were allocated to the control group. Structured questionnaires of the artistic group were used for data collection. The art therapy programs showed promising effects in improving the depression and self‐esteem of older adults living in nursing homes. Art therapy activities benefit the mental health of older adults. Incorporating artistic activities into social work care may help develop long‐term care into a more diverse, unique, and innovative direction. [ABSTRACT FROM AUTHOR]

Commercial digital drawing pens have incorporated color sensing capabilities to improve the interactive experience of drawing. However, despite these improvements, it remains unclear whether color sensing and picking functions improve drawing learning performance. This study observed third and fourth grade elementary school students, who were in the "dawning realism" stage of artistic development, to determine how using a digital drawing pen with a color sensing function affected their color perception and feature detection abilities. This study analyzed quantitative data on color choice, with some students directly picking colors from the surface of an object and other students choosing colors from the app's default palette. This study also interviewed a focus group of experts who compared between the two aforementioned methods of choosing colors, as used in drawings. The results revealed the following advantages of using a digital drawing pen to directly pick colors off object surfaces: (1) children better utilize and depict the color gradient; (2) children interact with and observe objects and their shapes more thoroughly; (3) children draw objects' shapes and colors more precisely; and (4) children, being in the dawning realism stage, are better able to satisfy their need to perceive the colors and features of objects. [ABSTRACT FROM AUTHOR]

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

Background: In Taiwan, the National Health Insurance Administration initiated the integrated home‐based medical care (iHBMC) program in 2016 to improve accessibility to health care for homebound patients. This study aimed to describe the characteristics of older people receiving iHBMC services in Taiwan as well as the relationship between patient characteristics and survival. Methods: All older adults registered in the iHBMC application dataset were enrolled between March 1, 2016, and December 31, 2018. Data on social determinants of health (income level, residential area), functional status, consciousness status, nasogastric tube or urinary catheter placement, and major diseases were retrieved from the database. Data on the frequency of multidisciplinary team members' visits were collected. The survival rate was investigated using the Kaplan–Meier method. A Cox proportional hazards univariate regression was conducted to analyze factors influencing survival rates. Results: A total of 41,079 patients aged ≥65 years were enrolled in iHBMC services. The results showed that the one‐year survival rates were 72.1%, 67.4%, and 14.7% in the home‐based primary care (HBPC), home‐based primary care plus (HBPC‐Plus), and home‐based palliative care (HBPalC), respectively. Nearly two‐thirds of the HBPC‐Plus patients underwent nasogastric tube placement. The Cox proportional hazards univariate regression analysis showed that a low urbanization level, a low income level, a low functional status, and an impaired consciousness status were significant predictors of poor survival after adjustment for confounding variables. Conclusions: Older adults receiving iHBMC services had a high mortality rate. The high rate of feeding tube use indicated that education and support for both clinical practitioners and family caregivers regarding careful hand feeding are warranted. There was a relationship between low income levels and poor survival in rural areas. Further research on whether social care could impact prognosis should be considered. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a questionnaire which investigates perspectives regarding healthy aging among old patients with chronic illness. This study used qualitative and quantitative methods, including in-depth interviews, focus groups, and surveys between 2014 and 2016. Participants were recruited from the outpatient department of a medical center and a community healthcare center, 23 for interviews and 332 for surveys. The exploratory factor analysis was applied to identify the domains of the questionnaire and reduce the number of scale items. Criterion validity and reliability were evaluated. The final instrument (19 items) comprised the following four domains affected by disease: physical and psychological changes; living environment changes; social relationship changes; and changes in family life. The instrument explained 62.71% of the total variance in healthy aging perspectives. Criterion validity was supported by a significant correlation of the questionnaire with the World Health Organization Quality of Life scale (r, range: 0.14–0.65). The internal consistency of the questionnaire was 0.8 (Cronbach's α, range: 0.71–0.89). The questionnaire is a valid and reliable instrument useful for examining healthy aging perspectives in older adults with chronic diseases. To enhance healthy aging for older persons with chronic disease, policy makers should acknowledge that elderly with chronic diseases not only have healthcare needs but also need attention regarding their psychological health and social and environmental relationships. The healthy aging perspectives questionnaire (HAPQ) can help clinicians to determine how to approach their older patients with chronic diseases to promote healthy aging. [ABSTRACT FROM AUTHOR]

Home-based yoga practice has not been approved as a method for alleviating premenstrual symptoms in Taiwan. This study was a cluster randomized trial. A total of 128 women self-reporting at least one premenstrual symptom were enrolled in the study, of which there were 65 participants in the experimental group and 63 participants in the control group. Women in the yoga group were provided with a yoga DVD program (30 min) to practice for three menstrual months, at least three times a week. All participants were given the Daily Record of Severity of Problems (DRSP) form to measure premenstrual symptoms. After the yoga exercise intervention, the yoga group had statistically significantly fewer and/or less severe premenstrual depressive symptoms, physical symptoms, and anger/irritability. Other disturbances and the impairment of daily routine, hobbies/social activities, and relationships also occurred significantly less often in the yoga group. The study found that yoga is useful to relieve premenstrual symptoms. Moreover, home-based yoga practice is more pertinent in the pandemic era. The strengths and drawbacks of the study are discussed and further study is recommended. [ABSTRACT FROM AUTHOR]

Patients with coronavirus disease 2019 (COVID‐19) has been isolated in hospital‐managed isolation hotels under a policy of the Taiwan government. Centrally isolation patients are more likely to experience psychological symptoms. The purpose of the study was to investigate emotional disturbance during their isolation period and then pinpoint the factors during their isolation period associated with the emotional disturbance. We retrospectively analysed the medical charts of the patients confined to a Banqiao isolation hotel between May 28 and July 3, 2021. The 5‐item brief symptom rating scale (BSRS‐5) was used to evaluate emotional disturbance levels. Descriptive and logistic regression was used for the data analysis. In total, 197 complete medical records were reviewed, and of these 84 (42.6%) showed emotional disturbance. The majority of them reported only minor disturbance (n = 49, 58.3%). After controlling for confounding factors, being satisfied about medical information was the only protective factor associated with emotional disturbance (OR = 0.2, P = 0.018). Being a male patient (OR = 3.0, P = 0.005), worrying about stigmatization (OR = 2.2, P = 0.041) and being unable to contact family members (OR = 2.9, P = 0.018) increased the risk of experiencing emotional disturbance. Patients with clinical symptoms, namely sore throat (OR = 3.4, P = 0.013) and muscle aches (OR = 6.3, P = 0.005), were also found to be more likely to report emotional disturbance. Mental disturbance commonly occurs among patient with COVID‐19 who are isolated in a hospital‐managed hotel. Being a male patient, having symptoms, namely a sore throat and muscle pain, being unable to contact family and/or a failure to receive sufficient medical information were found to be associated with emotional disturbance. In order to help isolated patients, government officials should provide a clear rationale for isolation and recognize the patients' efforts to follow the government's policy, which will help to minimize social stigma. [ABSTRACT FROM AUTHOR]

Objectives: In the past, an inherent dilemma in the education field was the difficulty in stimulating self-regulated learning. Flipped education, i.e., flipped teaching and learning, changed the teaching model, with a strategy of increasing students' active learning during class time through a transformation of teaching and learning methods that enable students to build learning and knowledge on their own. This study investigates the impact of field-based flipped courses on college students taking up self-regulated learning and their learning performance. Methods: This study considers a national university in central Taiwan that adopts 34 field flipped teaching courses and 796 non-degree students from four colleges across all grades as the research objects, and conducts statistical analysis using descriptive statistics, t-test, ANOVA, Pearson's correlation, and regression analysis on questionnaires to evaluate the association among variables. Findings: 1. With respect to the understanding of the uniqueness of field-based flipped teaching before and after the courses, there were differences among students in the Colleges of Education, Humanities, and Management. 2. In terms of students' learning performance in the course pertaining to mastery over core literacy, there were differences between students of the Colleges of Education and Humanities at the beginning of the flipped-learning course. 3. There were differences among the students of Colleges of Education, Humanities, and Science and Technology in the later stage of the flipped-learning course. 4. Differences were found in the pre-test of learning performance at the grade level. 5. Self-regulated learning correlated with learning performance. 6. Field-based flipped teaching correlated with learning performance. 7. Self-regulated learning had a mediating effect on field-based flipped teaching and learning performance. Innovations: There is a little systematic discussion on the emergence and impact of flipped teaching in higher education currently in Taiwan. The authors found correlations among flipped teaching, self-regulated learning, and learning performance from the data, as well as discovered that self-regulated learning had a mediating effect on learning performance in field-based flipped teaching. Value: Making the university, when the curriculum arrangement and the development of the unique curriculum map of higher education in the future, possible to be linked with the local revitalization thinking in addition to the general curriculum, as well as being closely integrated with the local people and matters through field-flipped courses, and sustainably interacting therewith to practice university social responsibility. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID‐19) pandemic. Design and Methods: This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first‐graders before and after school closure. Paired t‐test and the general linear model were applied to data analysis. Results: Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (p =.029) and less delayed sleep‐wake patterns in their children. Practical Implication: Sleep is an indicator that reflects children's behavioral changes in response to the COVID‐19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the efficacy of aromatherapy in relieving the stress of nursing staff working in different departments during COVID-19. A total of 26 nursing staff from Taiwan were recruited for this study. Bergamot essential oil was diffused for over a four-week period in four different hospital departments. We assessed heart rate variability indicators, Nurse Stress Checklist, and Copenhagen Burnout Inventory before and after the intervention. The results of the analysis showed that during a high workload period, aromatherapy had no significant effect on regulating physical stress. Subjective measurements showed a significant impact on work concern and personal fatigue. Moreover, there were large differences among the four departments; the aromatherapy treatment had a weak effect on those with a heavy workload, whereas those with a lighter workload showed a stronger effect. Finally, this study provides practical results about aromatherapy stress reduction applied during the pandemic on first-line medical staff. [ABSTRACT FROM AUTHOR]