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

Aims: To assess the effectiveness of an unsupervised home‐based pulmonary rehabilitation with self‐management program in patients with chronic obstructive pulmonary disease (COPD). Background: A few recent studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. Design: This study used a quasi‐experimental design. Methods: Seventy‐two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. Results: The Medical Research Council dyspnea scale and COPD Self‐Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. Conclusion: A short‐term unsupervised home‐based pulmonary rehabilitation with self‐ management program had significant benefits for patients with COPD. The long‐term effects need to be confirmed. Summary statement: What is already known about this topic? The literature emphasizes the importance of alternative supervision of home‐based pulmonary rehabilitation rather than center‐based pulmonary rehabilitation for patients who find this inconvenient to access.Few studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with chronic obstructive pulmonary disease (COPD). What this paper adds? This study demonstrates that a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program can improve dyspnea during physical activity, self‐care efficacy in certain activities and quality of life after discharge in patients with COPD. The implications of this paper: The findings of this study can be used as the basis for providing a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program for patients with COPD after discharge.We recommend that patients with COPD undergo unsupervised home‐based pulmonary rehabilitation with self‐management for 3 months after discharge, especially if regular hospital visits for this are not convenient.The effect of longer‐term unsupervised home‐based pulmonary rehabilitation can be further studied in the future. [ABSTRACT FROM AUTHOR]

Aim: Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of coronavirus disease 2019 (COVID‐19) infection among frontline nurses. This study aimed to explore the relationships among teamwork, work environment and resources, work–life balance, stress perception and burnout among nurses working at a dedicated infectious disease control hospital. Methods: The participants were 389 nurses at a dedicated infectious disease control hospital in Taipei City, Taiwan. This study adopted survey design with a questionnaire using the Safety Attitude Questionnaire. Results: The work–life balance among nurses at the dedicated hospital significantly mediated the effects of teamwork and work environment and resources on burnout. In addition, stress perception had interaction effects on work–life balance and burnout. Conclusion: This study's results provide important recommendations for managing teamwork, work environment and resources, work–life balance, stress perception and burnout prevention in nurses to help them better prepare and cope with emergencies. Findings can serve as a reference for developing relevant hospital management policies. Summary statement: What is known about the topic? Organizational changes, information scarcity and shortages of personal protective equipment were the primary factors driving uncertainty when the pandemic began.Work environments can significantly affect burnout, job satisfaction and perceived stress among nurses.Teamwork is an important factor affecting nurse burnout. What this paper adds? Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of COVID‐19 infection among frontline nurses.Healthcare systems should emphasize the issues of teamwork, work environment and resources and work–life balance among nurses to help them prepare for and cope with emergencies.Nurse supervisors should constantly monitor for burnout among subordinates and eliminate their stressors. The implications of this paper: When teaching nursing management skills during an epidemic, it is essential to focus on strengthening the nursing supervisors' communication role, particularly during an outbreak.To reduce nurse burnout, key leadership and culture aspects in the work environment include prioritizing infection control measures, providing social support, encouraging strong multidisciplinary teamwork, ensuring adequate resources are available and receiving support from hospital superiors and the government. By addressing these factors, healthcare organizations can create a positive work environment that supports nurses' well‐being and promotes better patient outcomes.To manage nurses in the postpandemic era, healthcare organizations can implement routine training programs, new models of cross‐teamwork, emergency response plans, effective systematic monitoring and mental health intervention programs. These strategies can help promote collaboration, support nurses' mental health and ensure preparedness for future crises. Healthcare organizations can create a more effective healthcare system by adopting these measures. [ABSTRACT FROM AUTHOR]

This study examines whether the Internet-based questionnaire is psychometrically equivalent to the paper-based questionnaire. A random sample of 2,400 teachers in Taiwan was divided into experimental and control groups. The experimental group was invited to complete the electronic form of the Chinese version of Center for Epidemiologic Studies Depression Scale (CES-D) placed on the Internet, whereas the control group was invited to complete the paper-based CES-D, which they received by mail. The multisample invariance approach, derived from structural equation modeling (SEM), was applied to analyze the collected data. The analytical results show that the two groups have equivalent factor structures in the CES-D. That is, the items in CES-D function equivalently in the two groups. Then the equality of latent mean test was performed. The latent means of “depressed mood,” “positive affect,” and “interpersonal problems” in CES-D are not significantly different between these two groups. However, the difference in the “somatic symptoms” latent means between these two groups is statistically significant at α = 0.01. But the Cohen's d statistics indicates that such differences in latent means do not apparently lead to a meaningful effect size in practice. Both CES-D questionnaires exhibit equal validity, reliability, and factor structures and exhibit a little difference in latent means. Therefore, the Internet-based questionnaire represents a promising alternative to the paper-based questionnaire. [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]

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

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]

Background: Taiwan's higher education institutions prioritize interdisciplinary knowledge and cultural competence in cultural design, emphasizing the value of immersion in the local environment to develop cultural competence. However, challenges arise from the disappearance of traditional local lifestyles and limitations of traditional outdoor lectures such as group size and learning environment. Mobile augmented reality technology serves as a personal learning tool to overcome these challenges, enabling learners to uncover hidden knowledge in scenic locations and improving learning efficiency. Objective: The study utilized learning analytics to investigate the impact of using mobile augmented reality on enhancing learners' cultural competence. Methods: The study used both qualitative and quasi‐experimental quantitative research to evaluate the effects of mobile augmented reality on cultural competence. A total of 78 third‐year university students participated in the study, with 37 of them using mobile augmented reality to learn about culture. The researchers utilized both the Mann–Whitney U test and interviews to compare the effectiveness of mobile augmented reality with that of a 'real' tour guide in field courses. Results: The experimental results indicate that learners were able to continuously seek and find information about local culture through field exploration with mobile augmented reality, resulting in similar effects to those of attending a live lecture. Conclusions: It showed that incorporating mobile AR into field visits can create gamified and active learning scenarios that enhance immersion and drive active learning in local culture. The results in greater cultural knowledge and understanding, leading to the development of cultural competence in students. Lay Description: What is already known about this topic: There is a heightened emphasis on cultivating and demonstrating cultural competence across various fields due to the significantly grow of cultural and creative industries.Relying solely on traditional classroom teaching for learning about local culture may result in a diminished impact, as a comprehensive understanding of culture necessitates a keen sense of life.To address the limitations of traditional classroom lectures, educators continuously strive to enhance teaching methodologies by developing innovative approaches, such as experiential learning and community‐based learning, which involve hands‐on activities and real‐world engagement to foster increased learning motivation and improved effectiveness.Augmented reality (AR), a technology that overlays virtual images onto real scenes in real time, has gained extensive usage in diverse fields such as medicine, national defence, education, and entertainment, offering interactive gaming experiences and providing an opportunity to experience the culture and past lives of locals in the field, enhancing learners' understanding of cultural history and creating immersive encounters during visits.Particularly in digital learning, the integration of AR enables learners to engage with additional content through mobile devices, fostering an immersive and gamified learning experience. What this paper adds: The use of the AR app for learning about the local culture yielded comparable outcomes to traditional guided tours.Participants actively engaged in self‐directed learning and demonstrated a sense of initiative while utilizing AR.The flexibility and autonomy provided by field learning, which extended beyond the course period, allowed participants to revisit the field and explore at their own pace using AR.Demonstrates that participants took control and responsibility for their own learning, leading to an enhancement in learner autonomy.Participants who utilized the Roaming Jingliao AR system to explore cultural scenarios exhibited enhanced knowledge and attitudes regarding cultural competence, specifically in areas such as cultural understanding, rice food cultural knowledge, Songjiang folk arts, and skills and practices, which can be attributed to the immersive and autonomous nature of AR‐based knowledge learning in outdoor guided courses, minimizing the influence of external environmental factors and facilitating a deeper understanding of the content compared to traditional guided tours. Implications for practice and/or policy: The findings of this study highlight the importance of considering the limitations associated with a relatively small sample size when conducting research within a university curriculum. To enhance the validity and reliability of future studies, practitioners and policymakers should prioritize the inclusion of larger and more diverse samples, enabling a more comprehensive understanding of the impact of AR technology on cultural learning and informing evidence‐based practices and policies.The study's focus on a specific group of participants and their contextual background highlights the need for future research to include participants from diverse educational settings and cultural backgrounds, ensuring that the findings are more applicable and relevant to a broader population. Practitioners and policymakers should consider the importance of inclusivity and diversity when designing and implementing cultural learning interventions using AR technology.The recognition of technological limitations highlights the importance of considering the specific AR system used in cultural learning interventions. Practitioners and policymakers should be cautious when adopting AR technologies and recognize that different AR systems or platforms may yield different outcomes. Future research should focus on evaluating the effectiveness of various AR systems and platforms to inform decision‐making regarding the selection and implementation of AR technologies for cultural learning initiatives. [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]

Accessible Summary: What is known on the subject?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems.Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders.The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. What the paper adds to existing knowledge?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. What are the implications for practice?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. Introduction: Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question: Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method: The study employed a cross‐sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results: Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion: Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices: Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders. [ABSTRACT FROM AUTHOR]

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

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]

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: 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]

This semester-long study attempted to investigate 122 (M: 21; F: 101) Taiwanese undergraduates' responses to bibliotherapy and two textbooks in an Advanced English Reading classroom. Data collection included an anonymous 6-point Likert scaled questionnaire with a space for free comments and the students' reflection papers to show their perceptions. The results of the study showed that bibliotherapy effectively helped the students (a) understand the importance of self-knowledge, life growth, emotion management, positive thinking, and behavior awareness, (b) understand the importance of (literature) reading, (literature) reading course, and the benefits of (literature) reading, and (c) enhance self-understanding, positive thinking, mental growth, and (positive) behavioral change. Moreover, the study found that the two textbooks could effectively boost the students' bibliotherapeutic energy, including their positive thinking ability, mental growth, and mature behavior. [ABSTRACT FROM AUTHOR]

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

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

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

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]

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

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]

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

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

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]

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

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]

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

Suppose learners use their free time to go online to review course materials, and they do so by taking optional tests that consist of multiple‐choice questions (MCQs). What will happen if, for every practice question, there is always a choice (out of four possible choices) that is marked as "the (current) hot choice?" Will this make any difference in learning effects? To answer this question, an educational experiment was conducted. It was found that "hot designations" helped the experimental group perform significantly better in both the immediate post‐test exam and a delayed post‐test exam and that learners with higher levels of initial knowledge benefited more from this review strategy. From the results of a follow‐up questionnaire and one‐on‐one interviews, it was found that the proposed review strategy promoted a more thorough thinking style in subjects of the experimental group. Lay Description: What is already known about the subject matter: There are good reasons why multiple‐choice questions (MCQs) are a popular choice for tests.E‐learning such as game‐based/mobile learning often uses MCQs for formative assessment.The main "problem" with MCQs is that MCQ tests tend to encourage rote learning.It is desirable to use MCQ tests to promote meaningful learning.What this paper adds to the subject matter: An HMCQ is an MCQ with one of its four choices being marked as "the (current) hot choice."The proposed review strategy requires learners to use their free time to do online tests.Learners taking HMCQ tests better retained knowledge than learners taking MCQ tests.Learners with higher levels of initial knowledge benefited most from the HMCQ review strategy.Implications of study findings for practitioners: It should be worthwhile to use HMCQ tests to help learners review course materials.The effect of "hot" designations (in MCQs) on learning still needs to be clearly delineated.Are there other approaches that also go well with "hot" designations (in MCQs)? [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]

This paper explores the measurement of subjective well-being (SWB) in Taiwan through survey data as a result of 13 self-reported SWB questions. We illustrate the findings using multivariate data analysis approaches. First, by taking the first two principal component scores extracted from all SWB measurements, the biplot presents a relatively 'even' society for SWBs, in which the plot depicts all data-points radiating from the center. Second, we employ factor analysis to juxtapose these 13 SWB measurements into three factors: health-related, prosperity-related, and social-related. Third and finally, this paper applies the seemingly unrelated regression model to verify the determinants of SWB. The SWB measurements are mostly increasing in higher education and (disposable) income, while falling with unemployment. Volunteering, donating more money to charities, having more leisure time, spending more hours on sports, and being involved in more arts-related activities all enhance an individual's well-being. Gender and age may matter, but they are indecisive in the direction for various SWBs. [ABSTRACT FROM AUTHOR]

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue.Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries.Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90).Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined. [ABSTRACT FROM AUTHOR]

Priority setting is a critical process for national healthcare systems that need to allocate limited resources across unlimited healthcare demands. In recent decades, health policymakers have identified the need to combine technical dimensions of priority setting with political dimensions relating to community values. A range of methods for engaging the public in priority setting has been developed, yet there is no consensus around the most effective methodology. A 2014 paper proposed the integration of two methods currently used for soliciting public preferences around health care services: i) an individual survey instrument, Discrete Choice Experiments (DCEs) and ii) Citizen Juries (CJs), a group-based model that incorporates education and deliberative dialogue. This pilot study is among the first to empirically test this integrated method to assess its value across two domains: does the CJ process alter participant preferences and are the consensus values of the CJ captured by the individualistic DCE? The two-part, mixed methods study was administered in Taipei, Taiwan in August of 2016. Twenty-seven participants completed a DCE as a baseline pre-test, ranking a set of attributes in terms of importance for future resource allocation under Taiwan's National Health Insurance System. Twenty of the participants next took part in the integrated CJ-DCE method, which consisted of education and facilitated dialogue through a CJ, followed by retaking the DCE survey. Participant preferences changed after undergoing the CJ process and these new, group-based preferences were reflected in the second DCE, meaning participants did not revert to their original individualistic preferences. The results of this study demonstrate that the integrated CJ-DCE method adds value in allowing an ethically communitarian set of values to be developed and captured via an individualistic methodology. Further testing is needed to investigate the reliability of our findings and how it may be implemented to maximize public acceptance. • Universal healthcare systems often incorporate public values into priority setting. • This study tested the integration of a Citizen Jury and Discrete Choice Experiment. • The Citizen Jury process impacted participants' expressed values. • The Discrete Choice Experiment reflected the communitarian Citizen Jury values. • This integration merits further testing to improve the measurement of public values. [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]

Blogs are one of the most widely used Internet applications; however, there is a lack of attention paid to understanding blog adoption with respect to individual reading/writing habits. This paper, therefore, investigates how individual reading and writing habits contribute to blog adoption. A survey was conducted in order to understand the relationship between an individual's reading and writing habits, in terms of reading/writing attitude and reading/writing behavioural patterns, and the adoption of blogs. A total of 210 blog users participated in the study. Hypotheses were tested and data were analysed using multiple regression analysis and logistic regression analysis. The results revealed that reading and writing habits are a significant predictor of blog adoption. Furthermore, based on Rogers' diffusion of innovation theory, this study also investigated whether people's habitual characteristics (i.e. heavy and light) have some sort of relationship with the stage of blog adoption (i.e. earlier and later). A subsequent analysis showed that people with a heavier reading habit group tended to adopt at an earlier stage, while this consequence was absent in those with heavier writing habits groups. [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]

For the past 4 years, undergraduate students from the Faculty of Health, University of Newcastle, Newcastle, Australia, have undertaken a two week cultural study tour in Thailand, being exposed to a broad range of cultural interactions, health settings in rural and remote areas, and health-treatment approaches, including traditional and complementary therapies. Student evaluations and reflections were collected after the 2010 and 2011 study tours. This paper reports on findings following thematic analysis of the data, which identified central themes, including connectivity to others, 'awakenings', 'embodiment', and looking to the future. Findings included a recognition by students of a growth in awareness and change in perspective, which they felt would impact on their future approach in caring for patients from culturally- and linguistically-diverse backgrounds. We conclude that the study tour provided an effective way of sensitizing students to cultural differences and promoting cross-cultural awareness. [ABSTRACT FROM AUTHOR]

Purpose: Little research has been reported concerning insufficient physical activity in Taiwanese adolescents with asthma. The aims of this paper are to compare the amount of physical activity between asthmatic and non-asthmatic adolescents in Taiwan, as well as to investigate the influential factors associated with insufficient physical activity in asthmatic adolescents. Methods: Self-reporting structured questionnaires (socio-economic status, scale of family support for physical activity, amount of physical activity) and peak expiratory flow were assessed from 286 adolescents with asthma and 588 non-asthmatic adolescents in a cross-sectional design. Insufficient amount of physical activity was based on less than 300 minutes per week of moderate and vigorous physical activity. Results: Adolescents with asthma have a greater amount of physical activity and a higher level of family support than those who are non-asthmatic. In Taiwan, adolescents with asthma, girls relative to boys, obesity relative to average weight, and low family support relative to high family support were found to be associated with insufficient physical activity. Conclusion: Physical activity in adolescents with asthma is insufficient especially in girls, in asthmatics with obesity, and in those with low family support. We suggest that physical activity programs should be applied to Taiwan adolescents with asthma in order to match the criteria of 300 minutes per week of moderate and vigorous physical activity, especially for girls, the obese and those with a low level of family support. [ABSTRACT FROM AUTHOR]

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

As knowledge management systems within organisations, professional virtual communities (PVCs) are popular knowledge-seeking tools, which bring together geographically dispersed members from outside of the organisations. An increasing number of employees use PVCs for knowledge seeking, knowledge exchange and problem solving at work. Why do members choose to receive knowledge from other community members in PVCs needs to be understood. This paper extends Ajzen's [1991. The theory of planned behaviour.Organizational Behavior and Human Decision Processes, 50 (2), 179–211] theory of planned behaviour to elicit external beliefs in terms of personal motivation, as well as technological and social factors, and to examine the relative importance of these factors. According to this study's online survey of 323 members in three PVCs, the results show that the significance of beliefs, such as system quality, compatibility, trust, knowledge growth and knowledge quality, in creating positive attitudes towards knowledge seeking. Community identification is shown as a salient belief for the subjective norms of knowledge seeking. System quality and resource availability are revealed as important determinants for perceived behavioural control of knowledge seeking. Knowledge-seeking intention is based on the attitude towards knowledge seeking and the subjective norm of knowledge seeking, whereas knowledge-seeking behaviour is solely determined by knowledge-seeking intention. Implications for research and practice are discussed. [ABSTRACT FROM PUBLISHER]

The audiences of performing arts events are changing, together with wider economic and cultural changes. A questionnaire survey of three folklore performances was conducted in 2008, and yielded a response of 1,470 theater audience members in Taiwan. Traditional folklore performances are usually seen as appealing by old male viewers. However, the findings showed that the audiences of the performances comprised fewer men and a considerable number of women. With the successful transformation of the art organization in relationship marketing, young and collegiate respondents were shown to be frequent and loyal viewers of this folklore performance. The school channel in this study was found to be an effective way to disseminate performance-related information to the young audiences. In addition, age was found to be the predictor for building relations of the emotional bond. This paper contended that building relationships required emotional bonds with the art organization. For long-term true relationships, it was suggested to be driven by the goal of directed emotional quality perceived by the audiences. The discussion on the future studies and limitations were concluded. [ABSTRACT FROM AUTHOR]

Aim Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. Methods Data of the I- Lan Longitudinal Aging Study ( ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. Results Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m2 for men and 5.9 kg/m2 for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. Conclusions The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36-45. [ABSTRACT FROM AUTHOR]

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

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

Because the senior population comes from various backgrounds, how to meet their needs and to cater to their different levels poses a great challenge for aging-education instructors when designing effective projects. The goal of this paper was to present the implementation of an innovative and effective project in aging education titled The K-shape Learning Project for Senior Citizens. The project was implemented in Taitung University and lasted for five months with 140 seniors in five sessions in total. An action research approach was adopted for the course implementation and content modification throughout this project. Meanwhile, data was collected through questionnaires and interviews. The findings then emphasized four elements for other aging education professionals' references: the philosophy and goal of the project, the implementation process of the project, the perception and response of participants, and the reflection of the educators. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper is a report of a study conducted to investigate differences between nurse practitioners' perceptions of the importance of required competencies and their self-evaluated existing competencies, and the main factors influencing these differences. Background. The difference between nurse practitioners' perceptions of required competencies and their existing competencies has never been investigated. Therefore, it is still uncertain whether these two competencies differ. Design. A nationwide survey study was authorised by the Department of Health (DOH) in Taiwan. Methods. For this nationwide survey study, the Questionnaire of Competencies in the Nurse Practitioner's Role was mailed to all nurse practitioners who qualified for the first annual national NP licence exam in Taiwan. Of 582 questionnaires distributed, 374 valid questionnaires were returned for a response rate of 64·2%. Results. The scores for required competencies were all higher than existing competencies. The competencies with largest differences were (in increasing order) clinical research, direct care, and leadership and reform. The competencies with smallest differences were (in ascending order) medical assistance, communication and coordination, and ethical decision-making. Differences in the total score between required and existing competencies were significantly influenced by nurse practitioners' age, seniority as nurse practitioner, whether the nurse practitioners' institution had a nurse practitioner advancement system, and the number of patients under their care. Conclusions. Nurse practitioners' perceptions of the importance of their expected role competencies were significantly greater in most cases than their actual competencies. Relevance to clinical practice. These findings could serve as a reference to improve cultivation of the NP system in Taiwan, to strengthen professional competencies in NP training programs. [ABSTRACT FROM AUTHOR]

Various writing assistance tools have been developed through efforts in the areas of natural language processing with different degrees of success of curriculum integration depending on their functional rigor and pedagogical designs. In this paper, we developed a system, WriteAhead, that provides six types of suggestions when non-native graduate students of English from different disciplines are composing journal abstracts, and assessed its effectiveness. The method involved automatically building domain-specific corpora of abstracts from the Web via domain names and related keywords as query expansions, and automatically extracting vocabulary and n-grams from the corpora in order to offer writing suggestions. At runtime, learners' input in the writing area of the system actively triggered a set of corresponding writing suggestions. This abstract writing assistant system facilitates interactions between learners and the system for writing abstracts in an effective and contextualized way, by providing suggestions such as collocations or transitional words. For assessment of WriteAhead, we compared the writing performance of two groups of students with or without using the system, and adopted student perception data. Findings show that the experiment group wrote better, and most students were satisfied with the system concerning most suggestion types, as they can effectively compose quality abstracts through provided language supports from WriteAhead. [ABSTRACT FROM AUTHOR]

BackgroundThis study examined the prevalence of major depressive disorder (MDD), and the correlations and co-morbid conditions associated with MDD, in the adult Taiwanese population, which a previous estimate in the 1980s had found to be at the lower end of the spectrum worldwide. Possible explanations for the reported low prevalence of MDD were evaluated.MethodAs part of a survey of common psychiatric disorders in a nationally representative sample of individuals aged ⩾18 years who were non-institutionalized civilians in Taiwan, a face-to-face interview using the paper version of the World Mental Health Survey of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI) was conducted between 2003 and 2005. Functional impairment and help-seeking behaviors were compared between Taiwanese subjects with MDD and their counterparts in the USA.ResultsAmong the 10 135 respondents, the lifetime prevalence of MDD was 1.20% [standard error (s.e.)=0.2%]. Individuals who were divorced or widowed, aged ⩽40 years, and female were at increased risk, whereas rural residents were at lower risk for MDD. The proportion of MDD cases co-morbid with other psychiatric disorders in this study was much lower than in the US study. Only one-third of Taiwanese individuals with MDD sought help despite having twice the number of lost workdays compared with the US sample.ConclusionsDespite the low prevalence of MDD in Taiwanese adults, the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection of and intervention in major depression in this population. [ABSTRACT FROM PUBLISHER]

liu c.-c., chen y.-c., yeh y.-p. & hsieh y.-s. (2011) Effects of maternal confidence and competence on maternal parenting stress in newborn care. Journal of Advanced Nursing 68(4), 908-918. Abstract Aim. This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. Background. Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. Methods. A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants <4 months old. Data were collected between August 2007 and January 2008 using a self-report questionnaire on mothers' and infants' demographic variables, maternal confidence, maternal competence and self-perceived maternal parenting stress. Results. After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. Conclusion. To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics. [ABSTRACT FROM AUTHOR]