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The major challenge of high-temperature shape memory alloys (SMAs) is the collocation of phase transition temperatures (TTs: Ms, Mf, As, Af) with the mechanical properties required for application. Previous research has shown that the addition of Hf and Zr into NiTi shape memory alloys (SMAs) increases TTs. Modulating the ratio of Hf and Zr can control the phase transformation temperature, and applying thermal treatments can also achieve the same goal. However, the influence of thermal treatments and precipitates on mechanical properties has not been widely discussed in previous studies. In this study, we prepared two different kinds of shape memory alloys and analyzed their phase transformation temperatures after homogenization. Homogenization successfully eliminated dendrites and inter-dendrites in the as-cast states, resulting in a reduction in the phase transformation temperatures. XRD patterns indicated the presence of B2 peaks in the as-homogenized states, demonstrating a decrease in phase transformation temperatures. Mechanical properties, such as elongation and hardness, were improved due to the uniform microstructures achieved after homogenization. Moreover, we discovered that different additions of Hf and Zr resulted in distinct properties. Alloys with lower Hf and Zr had lower phase transformation temperatures, followed by higher fracture stress and elongation.

To examine the associations of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam, a country experiencing rapid economic growth.A cross-sectional study was conducted in a high school in northern Vietnam from July to September 2019. Symptoms of depression and anxiety were respectively assessed using the Center for Epidemiological Studies Depression Scale and the Vietnamese Anxiety Scale. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Internet use and demographic characteristics were obtained using structured questionnaires. A multiple logistic regression was performed.In total, 678 participants with an average age of 16.1 (standard deviation 0.9) years were included. Nearly one-third of the adolescents (30.7%) exhibited excessive internet use (4 h/day), 19.6% experienced depressive symptoms, 14.5% presented anxiety symptoms, and 58.8% reported poor sleep quality. Compared to non-excessive internet users, excessive internet users (4 h/day) experienced significantly higher levels of depressive symptoms (p = .001), anxiety (p = .008), and poorer sleep quality (p.001). Students who were female and with fair/poor self-rated health experienced higher depression, anxiety, and poor sleep quality (p.05). After adjusting for demographic and health-related factors, students with excessive internet use were 58% more likely to experience poor sleep quality (odds ratio, 1.58, 95% confidence interval [1.06, 2.35]).Excessive internet use in Vietnamese high school students was significantly associated with poor sleep quality, but not with depression or anxiety.

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

This study aimed to evaluate the psychometric properties of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Indonesian postpartum women. We conducted a cross-sectional study including 237 postpartum women in Yogyakarta City, Indonesia. Participants completed the BSES-SF, Edinburgh Postnatal Depression Scale (EPDS), and Hospital Anxiety and Depression Scale (HADS). Construct validity, internal reliability, and divergent validity were examined using confirmatory factor analysis, Cronbach’s alpha, and Pearson’s correlations. We identified a unidimensional structure through confirmatory factor analysis with an excellent internal consistency by Cronbach’s alpha of .90. Divergent validity was evidenced by low correlation of the BSES-SF with the depressive symptoms (EPDS, r = −.21; HADS-D, r = −.17, p

A recent increase in screen time during early childhood has adversely affected the sleep and psychosocial health of children; however, limited information is available regarding effective interventions to reduce the screen time among them. This study aimed to investigate the effect of a parental educational program on screen use, sleep quality, and psychosocial adaptation among preschoolers.A clustered randomized controlled study with a parallel-group design was conducted. Preschoolers with a screen time of ≥2 h/day and their parents were recruited. In total, 14 kindergartens containing 129 parent-child dyads were randomly allocated to either the experimental group (receiving parental education, N = 63 dyads) or the control group (daily activities, N = 66 dyads). Data were collected before and after the intervention. A screen time questionnaire, the Children's Sleep Habits Questionnaire, and the Pediatric Symptom checklist-17 were provided to the participants. A linear mixed-model analysis was performed to examine the efficacy of the intervention.After the intervention, the screen time of children in the experimental group was significantly reduced (effect size: 0.83, p .001), and they presented improved sleep quality (effect size: 0.57, p = .01) and attention score (effect size: 0.77, p = .02) for psychosocial adaptation.Parental education is an effective intervention for reducing screen time and improving sleep quality and attention among preschoolers.Healthcare professionals should consider implementing parental educational programs to reduce screen time, and thus improve the sleep quality and psychosocial health of preschoolers.

PurposeThe sharing economy is an emerging trend that takes advantage of underused assets and generates enormous amount of economic value. However, little research has been done to understand the factors that drive people to share assets.Design/methodology/approachThis study develops two models, one based on the theory of planned behavior (TPB) and another based on social capital theory (SCT), to explain why individuals want to share their assets with others. An Internet survey is conducted to collect data and test the proposed models. Most of respondents were members of Airbnb or Uber – accommodation sharing and taxi services.FindingsThe results show that the TPB model has greater explanatory power than the SCT model. The individual's motivations, attitude, perceived behavioral control, facilitating technological conditions and identification with the community increase their intention to share assets.Originality/valueThis study distinguishes asset suppliers from consumers to clearly understand the factors that influence the intention to provide underused assets. The research findings can help companies participating in the sharing economy to induce people to share.

Use of interprofessional education has greatly expanded and is widely used to foster interprofessional collaborative practice competency in health professionals, especially during medical emergencies. Identifying the interprofessional education delivery mode that can maximize learning outcomes within available resources is crucial for achieving the sustainability of an interprofessional education program.To examine the learning outcomes of simulation-based interprofessional education and video-enhanced interactive discussion interprofessional education modules and to analyze the variable costs between these two interprofessional education modules.A prospective quasi-experimental study.A medical university in Northern Taiwan.24 medical students and 48 nursing students enrolled in a 4-week simulation-based interprofessional education or video-enhanced interactive discussion interprofessional education program.Students' medical task performance, critical medical task performance, team behavior performance, and interprofessional collaboration attitude were examined at the pretest and posttest by using an objective structured checklist and team performance rating scale with a hands-on simulation model and structured questionnaires. The variable costs for simulation-based interprofessional education and video-enhanced interactive discussion interprofessional education were estimated upon the completion of the course.All learning outcomes significantly improved for both the groups from the pretest to posttest. After the intervention, the simulation-based interprofessional education group exhibited significantly higher scores in medical task performance, critical medical task performance and team behavior performance than the video-enhanced interactive discussion interprofessional education group at the posttest. No significant difference was noted in interprofessional collaboration attitude between the groups. Cost analysis revealed that the simulation-based interprofessional education program was approximately two times more expensive in terms of staffing costs and required 1.3 times greater space charges than the video-enhanced interactive discussion interprofessional education program.Both simulation-based interprofessional education and video-enhanced interactive discussion interprofessional education modules effectively improved medical and nursing students' medical task performance, critical medical task performance and team behavior performance. The simulation-based interprofessional education group had more favorable learning outcomes, but the associated costs were higher. Educators should consider both learning outcomes and cost when choosing a design strategy simulation-based interprofessional education vs. video-enhanced interactive discussion interprofessional education for interprofessional education module development.

To evaluate the effects of an integrated childbirth education intervention on reducing childbirth fear, anxiety, and depression, and improving dispositional mindfulness.A two-arm parallel, single-blind randomised controlled trial.A teaching hospital in Northern Taiwan.Pregnant women ≥ 20 years of age with a singleton pregnancy (12-24 weeks gestation) and their support partners were recruited. All women included in the study had a score of ≥ 7 points on a fear of childbirth visual analogue scale.The intervention group (n = 53) received an 8-week course in a childbirth education programme, which included (1) childbirth education using simulation-based learning that highlighted coping with labour pain and (2) instruction in mindfulness breathing, body scans, stretching, sitting meditation, and mindfulness walking. Support partners were invited to participate. The control group (n = 53) received the usual standard prenatal care.The primary outcome of fear of childbirth was assessed using the Wijma Delivery Expectancy/Experience Questionnaire. The secondary outcomes of anxiety, depression, and dispositional mindfulness were assessed with the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory Scale, and the Mindful Attention Awareness Scale, respectively. Repeated data were collected at baseline, 36 weeks gestation, and 1 week postpartum.Ninety-one mothers completed the study, with a mean age of 33.9 years (SD = 4.4), and most were primipara (n = 83). The baseline measurements did not differ between the groups. Compared with the control group, there were significant differences in all measures from baseline for the intervention group: the scores were significantly lower for fear of childbirth (mean difference (MD) =-14.8 ∼ -23.7, p.01), symptoms of anxiety (MD =-7.4 ∼ -6.4, p.01), and depression (MD =-3.7 ∼ -3.5, p.01); the levels of dispositional mindfulness were significantly higher (MD =4.9 ∼ 5.7, p.01) at 36 weeks gestation, and 1 week postpartum.The 8-week integrated childbirth education intervention was effective in reducing the fear of childbirth in pregnant women. The mindfulness techniques were easily learnt and applied by the participants. Using these techniques during pregnancy and labour enhanced participants' mental health and coping. The integrated childbirth education which includes pregnant women and their support partners could be easily taught by midwives in other contexts.

Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes.A single-blind, randomised controlled trial.A prenatal clinic of a teaching hospital.First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group.A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months.Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p.001), and postpartum at 1-week (p.001), 1-month (p.001) and 3-months (p.01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p.001) and 6-months postpartum (MD: 7.0, p.05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p.05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p.02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05).The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.Registered with www.clinicaltrials.gov (NCT03807726).

This research proposes the first one-out-of-two quantum oblivious transfer (QOT) scheme that does not have a two-level structure and is not subject to Lo’s no-go theorem. Instead, the proposed scheme is a simple and efficient approach based on nonorthogonal states. The nonorthogonality causes one of a pair of messages to be unable to be measured to achieve the irreversible goal of discarding a message, resulting in a one-out-of-two selection effect. The proposed QOT protocol is therefore built directly on quantum resources rather than on a two-level structure in which two classical keys must first be created using quantum resources (all-or-nothing QOT) and then a one-out-of-two protocol is built from there. Furthermore, the proposed protocol allows Alice and Bob to test each other’s loyalty by comparing measurement results. In addition, the relationship with the no-go theorem is discussed in detail; this relationship is often overlooked in other studies. A security analysis demonstrates that the proposed protocol is secure against both external and internal attacks. In addition, an efficiency analysis shows that the proposed protocol is more efficient than other, two-level-structured protocols.

In recent years, since the adoption of the IEEE 802.11p and IEEE 1609 standards, Vehicular Ad hoc Networks (VANETs) have received a significant amount of attention in Ad hoc Network studies. Vehicular safety applications have thus played an important role in VANETs, and many emergency broadcast systems have been proposed. However, some of these broadcast mechanisms might result in the broadcast storm problem. The emergency broadcast strategy proposed in this paper is that when a car accident occurs, the vehicle’s sensors detect impacts and immediately send emergency messages to inform other vehicles nearby. In addition, we propose a way to eliminate redundant broadcasts and to ensure that emergency messages can be transmitted properly. We propose a stability function to estimate the reliability of the transponder. The backoff procedure of this proposed method assigns appropriate waiting times to different forwarders. The proposed scheme is implemented with NS2 simulator based on WAVE/DSRC standards. Simulation results show that the proposed protocol exhibits outstanding performance in terms of forwarding counts, packet loss rate, and delay time in different environments. In addition, our protocol maintains stability in different vehicle density scenarios so that each vehicle receives emergency messages and holds a low latency to ensure that the driver has adequate safety response time to enhance traffic safety.

With recent advances in camera and visual computing technology, visual surveillance is playing a significant role in wireless sensor networks (WSNs) and cyber-physical systems (CPSs). It can be used in civilian areas for traffic control and security monitoring. Deployment is an important and fundamental issue in a WSN/CPS. Many issues, such as the quality of service, energy efficiency, and lifetime, are based on the placement of sensors. Different heuristic and deterministic methods have been proposed to achieve optimal deployment. In this paper, we propose a novel algorithm, called the Quantum-inspired Tabu Search algorithm with Entanglement (QTSwE), which is based on both the Quantum-inspired Tabu Search (QTS) algorithm and quantum entanglement feature. QTSwE is applied to a deployment problem to determine the minimum number of sensors required and their locations. This paper analyzes the property of the deployment problem and calls this phenomenon dependency. It uses the concept of quantum entanglement to build the initial positions of sensors to tackle the dependency of variables. The QTS is then used to find better solutions iteratively. Moreover, we use local search to enhance the search capability of QTS and to avoid being trapped in local optima. The experiment results showed that QTSwE outperformed other deployment approaches and used the least number of sensors to satisfy the monitoring requirement and topology connectivity. With QTSwE, the performance of surveillance system deployment has improved further.

Objectives The primary goals of this study were to determine the effects of a physical activity intervention on the set-shifting aspect of executive function and to explore the potential mechanistic role of cardiac autonomic control, as assessed by heart rate variability (HRV), in the relationship between physical activity and executive function in obese young adolescents. Method Obese young adolescents were randomized either to participate in a physical activity program (n = 25) or to serve as the wait-list control (n = 25) for a 3-month intervention. Outcome measures included physical fitness, obesity status, executive function, and HRV; these measures were assessed at baseline and within 1 week of the conclusion of the intervention. Results The physical activity program improved the participants' physical fitness and obesity status. The program also improved executive function-related set-shifting performance, as measured by the total number of errors, and increased the HRV indices of normalized low frequency (nLF) and normalized high frequency (nHF). A positive correlation between the nHF time changes and the total number of errors was also observed. Conclusion These findings suggest that 3 months of a physical activity intervention effectively increase physical fitness and improve the set-shifting aspect of executive function in obese young adolescents. Furthermore, the physical activity-related alterations in cardiac autonomic control, particularly the parasympathetic response, may be associated with enhanced executive function. (PsycINFO Database Record

Background Enhancing breastfeeding self-efficacy and intention is crucial for successful breastfeeding. Educational interventions highlighting breastfeeding self-efficacy and breastfeeding plans have been developed to help mothers initiate and sustain breastfeeding practices. Research aim This study aimed to determine whether the use of theory-based educational interventions, i.e., the theory of breastfeeding self-efficacy or theory of planned behavior, is associated with improved breastfeeding outcomes and to identify key factors of effective breastfeeding educational programs. Methods We used electronic databases and reference lists of articles to identify published randomized controlled trials of educational programs that adopted the breastfeeding self-efficacy theory or theory of planned behavior. Results In total, 24 randomized controlled trials were identified, and 5678 mothers were included in those studies, with 4178 mothers in the breastfeeding self-efficacy group and 1500 mothers in the theory of planned behavior group. Mothers who received theory-based interventions had better breastfeeding outcomes for up to 6 months postpartum (standardized mean difference =0.63, 95% confidence interval: 0.34~0.92 for self-efficacy scores at 1~2 months; odds ratio =1.82, 95% confidence interval: 1.27~2.61 for the exclusive breastfeeding rate at 1~2 months; and odds ratio =2.19, 95% confidence interval: 1.24~3.89 for the exclusive breastfeeding rate at 3~6 months). Mothers who were from non-Organization for Economic Co-operation and Development countries, were of older age, had participated in an educational program in a hospital setting, or had used an integrative class format had higher levels of self-efficacy and longer breastfeeding durations to 6 months. Conclusions Theory-based educational interventions are effective in improving breastfeeding self-efficacy and exclusive breastfeeding rates at 6 months. Future breastfeeding educational programs incorporating the theories of breastfeeding self-efficacy and planned behavior would be helpful in promoting sustained breastfeeding practices among mothers.

Background Sleep disturbances, such as insomnia, excessive daytime sleepiness, and poor-quality sleep, are common among nursing students and are closely linked with academic performance. Objectives To examine the prevalence of sleep disturbances and academic performances in male and female nursing students and to determine gender-specific effects on the relationship between sleep disturbances and academic performance. Design A cross-sectional study design was adopted. Settings This study was conducted in a school of nursing in Indonesia. Participants A total of 492 undergraduate students (103 males and 389 females) were included. Methods Data pertaining to the biosociodemographic characteristics, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Morningness-Eveningness Questionnaire, and Beck Depression Inventory were collected from July 1, 2018 to September 30, 2018. Academic performance was measured using grade point average of the academic year 2017–2018. A multivariate logistic regression model was used for data analyses. Results The prevalence of poor sleep quality, insomnia, and daytime sleepiness was 66.0%, 45.6%, and 24.3%, respectively, in male nursing students and 71.5%, 52.4%, and 28.8%, respectively, in female nursing students. For circadian rhythm preferences, 66% male and 51.7% female nursing students were categorized as intermediate- and morning-type people, respectively. Insomnia was the only variable among sleep disturbances that significantly correlated with the risk of poor academic performance in female nursing students even after adjustment of covariates. Conclusions Sleep disturbances were highly prevalent among female and male nursing students, and insomnia was substantially associated with poor academic performance in female nursing students. Identifying sleep disturbances among nursing students and designing effective interventions to specifically target them are required to improve academic performance of female nursing students.

Aims and objectives To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation. Background Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored. Design A randomised experimental design with three-cohort prospective comparisons. Methods In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility-enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education (T0), immediately after education (T1), before cardiac catheterisation (T2) and one day after cardiac catheterisation (T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009–September 2010 and analysed using descriptive statistics, chi-squared tests, one-way analysis of variance, Scheffe's post hoc test and generalised estimating equations. Results All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups (p = 0·004). Conclusions The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education. Relevance to clinical practice As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care.

Positive schizotypy is associated with non-right-handedness, which includes left- and mixed-handedness. However, because the underlying mechanisms might be different, it is important to examine whether both left- and mixed-handedness are associated with a high incidence of schizotypy. During 2009-2010, we used both the Perceptual Aberration Scale and Schizotypal Personality Questionnaire to assess 1315 undergraduate students in Taiwan for schizotypy and the Annett handedness questionnaire to assess handedness. Among the three-way classifications based on Annett's grouping, the fully left-handed group appeared to have the lowest score of positive schizotypy; next was the fully right-handed group and then the mixed-handed. Among the three-way classifications driven from cluster analysis, mixed-handers showed highest score of positive schizotypy. When handedness was treated continuously, both direction (e.g., Hand Preference Index) and consistency (e.g., Either hand use score) indicators were significantly correlated with schizotypy. The results of regression analyses showed that the quadratic handedness measure were negatively associated with schizotypy. The results remained similar after correcting for social pressure on left-handedness. In conclusion, the relationship between schizotypy and mixed-handedness appears to be cross-cultural. The dichotomous classification of handedness, right- vs. non-right-handedness, appears to be insufficient. Additional studies on the distinct mechanisms of mixed- and left-handedness are warranted.

In this ongoing longitudinal study of adolescent twins/sibling pairs and their parents in Taipei, we aimed to investigate the genetic and environmental influences on adolescent behavioral development, metabolic risk factors, and the associations between the two. Special focus is on anxious depression, metabolic profile, and hormonal factors such as cortisol and leptin. The first wave of assessment was completed during the period of 2002 to 2005 and included 192 twin pairs, 6 triplets, 56 sibling pairs and their first-degree relatives (484 parents and 142 siblings). We are currently in the process of a second wave assessment as follow-up. Dimensional psychological assessments using self-report questionnaires, as well as categorical assessments based on semistructured clinical interviews, were performed. All subjects received a 2-hour oral glucose tolerance test at the examination site. The metabolic phenotypes including body mass index, blood pressure, levels of glucose, insulin, and lipid profile as well as related hormonal levels were measured. Zygosity was determined using DNA, except for a few twins whose DNA was not available. Such a combination of detailed psychological assessments and metabolic function tests is expected to help shed light on the interrelation of psychological well-being and metabolic functioning.

Fatigue is not only a distressful symptom that is prevalent during labor; it may also interfere with the ability of laboring women to adjust to pain and bear down in the second labor stage as well as hinder maternal recovery and impair postpartum maternal-role performance. Childbirth-related fatigue is a frequent cause of physical and mental discomfort during labor and increases the likelihood of medical interventions such as instrumental delivery and cesarean section. Even so, as this fatigue is widely regarded as an inevitable part of the labor experience, little attention has been given to mediative interventions. In light of the above, this paper illustrates the definition and characteristics of childbirth-related fatigue during labor, analyzes the factors that affect this fatigue, and summarizes relevant nursing-care principles. It is hoped this paper increases nurse awareness of childbirth-related fatigue during labor and helps nurses take appropriate early prevention and intervention measures to reduce the adverse effects of fatigue and improve intrapartum care quality.生產疲憊：一個重要卻常被忽略的症狀疲憊不僅是常見於生產過程的不適症，亦為干擾產婦調適產痛、第二產程用力、產後復舊以及承擔母性任務等能力的重要因素。是已知易影響其身心舒適，甚至是提高器械及剖腹產機率的產時健康問題。雖然如此，卻常被視為待產必然的經歷，而未受到應有的重視。基於此，本文首先闡釋生產疲憊的定義與特性、分析影響生產疲憊的因素，並綜整生產疲憊的照護要點，以增加護理人員對生產過程疲憊的認識，進而能及早採取適當的預防和處理措施，減輕疲憊的不良影響，提昇產時照護品質。

BackgroundThe present study aimed to (a) characterize 10-year trajectory patterns of depressive symptoms and (b) investigate the association between depressive trajectory and subsequent obesity, metabolic function and cortisol level.MethodIn a prospective study of Taiwanese adults aged ⩾60 years (n=3922) between 1989 and 1999, depression was assessed using a 10-item short-form of the Center for Epidemiologic Studies Depression Scale and information on body mass index (BMI) was collected by self-report. A subsample (n=445) of the original cohort in 1989 was drawn to assess metabolic variables and cortisol levels in a 2000 follow-up. After trajectory analyses were performed, multinomial logistic regression analyses were used to estimate the association estimates.ResultsWe identified four distinctive trajectories of depressive symptoms: class 1 (persistent low, 41.8%); class 2 (persistent mild, 46.8%); class 3 (late peak, 4.2%); and class 4 (high-chronic, 7.2%). The results from both complete cases and multiple imputation analyses indicated that the odds of obesity were lower in the class 2, 3 or 4 elderly, as compared with those in class 1, while the odds of underweight were higher. The classes of older adults with more and persistent depressive symptoms showed a trend toward having both a lower BMI (p=0.01) and a higher cortisol level (p=0.04) compared with those with low depressive symptoms.ConclusionsIncremental increases in depressive symptoms over time were associated with reduced risk of obesity and higher cortisol levels.