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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.

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.

Many studies have been proposed to prove that technical analysis can help investors make trading decisions. The moving average (MA) is a widely used technical indicator that plays an important role in this field since it directly reflects stock fluctuations. However, most studies ignore the parameter settings of the MA, which leads to underestimation of the potential of the MA. Therefore, this paper is the first attempt to remove all restrictions and extend the limits of the MA to take advantage of the MA’s capability well. It also uses different kinds of MA, such as the weighted moving average (WMA) and the exponential moving average (EMA), to compose trading strategies. Our system proposes the global best-guided quantum-inspired tabu search algorithm (GQTS), which is better at searching than traditional algorithms, to optimize trading strategies based on the MA. Furthermore, an innovative 2-phase sliding window is invented to consider more investment situations in changeable stock markets. In summary, this paper intended to investigate the ability of MA and proposed dynamic and intelligent trading strategies based on MA, GQTS, and 2-phase sliding window to assist investors to make trading decisions. The experiments show that the proposed system flexibly discovers better trading points. Our system outperforms traditional methods and beats the buy-and-hold strategy to yield significant profits both in developed and emerging stock markets.

Stock selection is an important issue in the stock market, and when assessing portfolio performance, return and risk are important conditions. The Sharpe ratio is a well-known assessment strategy that simultaneously considers portfolio return and risk. However, as the Sharpe ratio uses the average line to assess portfolio risk, it can easily assess a portfolio with stable uptrend as high risk, thus, this paper uses the trend ratio to address this problem. The trend ratio can assess a stable uptrend portfolio with low risk and identify a portfolio that has a higher daily expected return per unit daily risk. As the solution space in stock solution is huge, it is hard to use brute-force method to exhaust selections within a limited time. Thus, this paper uses the Global-best guided Quantum-inspired Tabu Search algorithm with Not-gate (GNQTS) to effectively optimize a portfolio given limited time. In addition, this paper uses 13 different kinds of sliding windows to train and test data, and identify a suitable period with a high trend ratio. The experimental results show that the proposed method can identify a portfolio with stable uptrend in the U.S. stock market. This paper does not exclude any stocks in the solution space; therefore, our method can comprehensively consider all the possible combinations of a portfolio. Moreover, we find some interesting phenomenon: the best single stock may not be contained in a portfolio and the stock with negative return cannot be excluded in the solution space. In addition, this study compares our portfolio performance with the portfolio guided by the Sharpe ratio; according to the experimental results, a portfolio guided by the trend ratio has more stable uptrend and lower risk than the Sharpe ratio. Thus, our method can outperform other assessment strategies.

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.

Objectives The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents. Methods A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants’ knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention. Results After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of Conclusions An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents. Practice implications In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Background High rates of early initiation and exclusive breastfeeding have been reported in Malawi, yet the underlying factors are unknown. Our objective is to examine the determinants of breastfeeding practices for mothers of infants less than 24 months old in Malawi. Methods A cross-sectional study was conducted using nationally representative data from the 2010 Malawi Demographic and Health Survey. Multivariate logistic regression analysis was used. Results Of 7282 women, 95.4% initiated breastfeeding within 1 hour after birth; thereafter 71.3% of women practiced exclusive breastfeeding, 6.1% predominantly breastfed, and 1.9% chose bottle feeding exclusively. The odds of early initiation were higher among women with frequent antenatal care visits and multiparous mothers. Similarly, frequent antenatal care visits and hospital delivery were positive determinants for exclusive breastfeeding. Infants at 6 months of age were more likely to predominantly breastfeed than they were at 1 month. The odds of bottle feeding were higher among women who were educated, who delivered at a hospital. Conclusions Optimal breastfeeding practices are highly prevalent in Malawi. Health care practice emphasizing frequent antenatal care visits that provide breastfeeding education and breastfeeding support in hospital care after childbirth are important for sustaining breastfeeding.

Background Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers. Research Aims (1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs. Methods Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted. Results Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5–7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: −1.33, 95% CI [−2.26, −0.40]) at postpartum 4–14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1–6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001). Conclusions Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

Secret sharing is a widely-used security protocol and cryptographic primitive in which all people cooperate to restore encrypted information. The characteristics of a quantum field guarantee the security of information; therefore, many researchers are interested in quantum cryptography and quantum secret sharing (QSS) is an important research topic. However, most traditional QSS methods are complex and difficult to implement. In addition, most traditional QSS schemes share classical information, not quantum information which makes them inefficient to transfer and share information. In a weighted threshold QSS method, each participant has each own weight, but assigning weights usually costs multiple quantum states. Quantum state consumption will therefore increase with the weight. It is inefficient and difficult, and therefore not able to successfully build a suitable agreement. The proposed method is the first attempt to build multiparty weighted threshold QSS method using single quantum particles combine with the Chinese remainder theorem (CRT) and phase shift operation. The proposed scheme allows each participant has its own weight and the dealer can encode a quantum state with the phase shift operation. The dividing and recovery characteristics of CRT offer a simple approach to distribute partial keys. The reversibility of phase shift operation can encode and decode the secret. The proposed weighted threshold QSS scheme presents the security analysis of external attacks and internal attacks. Furthermore, the efficiency analysis shows that our method is more efficient, flexible, and simpler to implement than traditional methods.

Background Despite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries. Objectives To assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario. Design A cross-sectional observational study. Settings One university four-year nursing program each in Indonesia, Taiwan, and Thailand. Participants A total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand. Methods The medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used. Results Overall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors. Conclusions Medication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global medication safety.

Background Perceived milk supply is an important modifiable factor for optimal breastfeeding. However, little is known about maternal perception of milk supply or how it impacts breastfeeding practices. The aim of this study was to examine relationships of perceived milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact with early initiation and exclusive breastfeeding among mothers of infants less than 6 months of age in Indonesia. Methods This was a cross-sectional study conducted in Yogyakarta City, Indonesia between August and October 2015. Maternal perception of milk supply was assessed using the Hill and Humenick Lactation Scale. Data on breastfeeding practices, and maternal and infant factors were collected using a structured questionnaire. Multiple regression and multivariate logistic regression analyses were performed to obtain estimates of associations. Results Thirty four percent of mothers had initiated breastfeeding within an hour after birth, and 62.4% of mothers were exclusively breastfeeding. High levels of perceived breast milk supply were reported in mothers who practiced skin-to-skin contact or rooming-in with their infants, experienced positive infant sucking behavior, or had high breastfeeding self-efficacy (p Conclusions In this study, skin-to-skin contact and breastfeeding self-efficacy are important determinants of perceived milk supply. Higher perception of milk supply was positively linked with exclusive breastfeeding. Our study highlights the importance of the assessment for mother’s perception of milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact in achieving optimal breastfeeding outcomes.

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).

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.

Background Fear of childbirth is a common health concern for women during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is widely used to measure childbirth fear during pregnancy. However, this instrument is yet to be validated in Malawi, Africa. Our study aimed to assess the psychometric properties of the W-DEQ questionnaire in Malawi. Methods Healthy pregnant women in the third trimester (N = 476) at a district hospital in Malawi were included. Fear of childbirth, depressive symptoms, and quality of life were assessed using the W-DEQ, the Edinburg Postnatal Depression Scale, and the World Health Organization Quality of Life scale, respectively. The construct validity, reliability, and convergent validity of the W-DEQ were examined using exploratory and confirmatory factor analyses, Cronbach’s alpha, and Pearson correlations. Results The mean age of participants was 28.2 (standard deviation = 6.8) years. Exploratory and confirmatory factor analysis of the Malawian version of the W-DEQ indicated a multidimensional structure with three factors: fear, negative appraisal, and a lack of self-efficacy, with acceptable goodness of model fit. The Malawian version of the W-DEQ showed a satisfactory internal consistency (α = 0.84) and was significantly correlated with depressive symptoms (r = 0.23, p r = − 0.17 ~ -0.26, ps Conclusions Our findings support the Malawian W-DEQ version being a reliable and valid instrument for measuring childbirth fear in African women.

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.

Objective To explore the quality of life (QOL) and related factors in early postnatal women. Design A descriptive, cross-sectional study. Setting Liwonde, Malawi. Participants Women who underwent a normal vaginal birth (N = 173) were included from August to September 2018. Measurements The QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL. Results The mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain. Conclusion and implications for practice The physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care.

This paper presents a novel dynamic group multi-party Quantum Key Agreement (DGMQKA) protocol, achieved by a multicast transmission method. The proposed method is able to achieve arbitrary number of groups and members under the same resources. In addition, it can be dynamically adjusted by joining a new member, combining two groups into one group, revoking an old member and dividing one group into two groups, for different and complex situations. Furthermore, the proposed protocol can be of help to research into Quantum Secret Sharing (QSS), which it complements. The security analysis shows that the proposed protocol can resist both external and internal attacks. In consumption comparison, the proposed protocol using the multicast transmission method is more effective than other current MQKA protocols.

Background Childbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi. Methods A cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support. Results The mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p

Purpose This study aims to evaluate the executive function and learning attention in children with internet addiction (IA). Design and methods Children aged 10-12 were screened by Chinese Internet Addiction Scale to compose the IA group and internet nonaddiction group. Their executive functions were evaluated by Stroop color and word test, Wisconsin card sorting test, and Wechsler digit span test. Learning attention was evaluated by Chinese concentration questionnaire. Findings Executive function and learning attention were lower in the IA group than in the internet nonaddiction group. Practice implications Executive function and learning attention are compromised by IA in children. Early interventions into the IA should be planned to maintain the normal development of executive function and learning attention in childhood.

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.

This paper is to develop data collection mechanisms in multi-hop IEEE 802.15.4e Time Slotted Channel Hopping (TSCH) networks. While scheduling, transmission link selection is considered based on the limitations of transmission conflict and transmission interference in ZigBee network topologies. Three scheduling algorithms for data collection are proposed. Furthermore, experiments are made for evaluating the performance of the proposed data scheduling mechanisms for multi-hop IEEE 802.15.4e TSCH networks.

SHIEH S.-H., CHEN H.-C., TSAI W.-C., KUO S.-Y., TSAI Y.-F. & LU C.-H. (2012) Impact of breast cancer patients' awareness on attendance at screening. International Nursing Review59, 353–361 Aim: The purpose of this study is to investigate the impact of breast cancer awareness on the attendance for screening among women with breast cancer prior to diagnoses of breast cancer. Background: Breast cancer is the most commonly diagnosed cancer for women in Taiwan and its incidence rate continues to increase. However, screening for breast cancer is still not common even if the incidence rate has topped the list from 2003 to 2010. Methods: A cross-sectional study was conducted among women diagnosed with breast cancer. Subjects (535 women) were recruited from two medical centres in central Taiwan. Information on attendance for breast cancer screening was collected by self-report. Chi-square test and logistic regression were utilized to analyse the relationships between awareness of breast cancer and attendance at screening. Findings: The results indicated that pre-diagnostic awareness of ‘the concept of early treatment relating to higher cure rate’[odds ratio (OR): 4.09; 95% confidence interval (CI): 1.12–14.9], ‘various breast cancer screening methods’ (OR:3.00; 95% CI: 1.23–7.30), ‘the coverage of breast cancer screening programme in the National Health Insurance’ (OR:1.76; 95% CI: 1.03–3.02) and ‘breast self-examination after each menstrual cycle’ (OR:3.42; 95% CI: 1.99–5.87) were all significantly associated with the screening procedures performed. Conclusions: Findings of this study indicated that particular attention should be paid towards enhancement of women's knowledge for prevention and early detection of breast cancer through educational efforts by nurse professionals, medical institutions and/or civil organizations.

Title. Childbirth-related fatigue trajectories during labour. Aim. This paper is a report on a study identifying trajectories of childbirth-related fatigue intensity changes over time and the influencing factors related to specific trajectory patterns. Background. Childbirth is a period of time that encompasses considerable physiological and psychological fatigue, often having an adverse impact on women in labour. Empirical studies on this issue are scarce. How childbirth-related fatigue changes over time, and factors influencing fatigue development, remain unclear. Method. A prospective, correlational design with repeated measures was used. Data were collected by self-reported measures and laboratory analysis of blood specimens. From December 2004 to November 2005 a convenience sample of 209 low-risk pregnant Taiwanese women was followed throughout the labour process. Repeated measures of fatigue were analysed by using a semiparametric mixture model. Variables explaining trajectory class membership were identified by means of logistic regression. Results. Two distinct trajectories of childbirth-related fatigue were identified: low intensity (30·8% of women) and high intensity (69·2% of women). Fatigue level of both classes intensified following labour. The fastest period of fatigue-increasing rate was in the active phase. After birth, fatigue levels in the high-fatigue intensity class remained high. Primiparas in the high-fatigue intensity class experienced significantly more anxiety and higher lactate concentration at admission than the low-intensity class. Conclusion. Caregivers should endeavour to prevent high levels of fatigue once women enter the labour phase. Women who present with high fatigue at onset of labour should be targeted for early intervention, especially in the period of rapid fatigue increase.

Stock price predicting is an important concern for investors, who by using high accuracy prediction systems are able to make a great profit. In recent years, artificial neural networks (ANNs) have shown promising results in this area, and have been improved in many ways. However, there are still some issues with ANN that remain unanswered, one of which is how to set the best parameters for ANN. Different combinations of setting parameters bring about different consequents, such as the constitution of input nodes, hidden nodes, and initial values of weight. Hence, we propose a simple but useful method, which only uses stock closing prices as inputs and experiments with different kinds of setting parameters. In addition, this paper enhances back propagation neural network (BPN) with a novel normalized function. System is applied to Taiwans Top 50 Exchange Traded Fund, S&P 500, and Shenzhen Composite to forecast the next day closing price. Given the experimental results, the proposed method shows excellent performance with the best set of parameters, and the innovative normalization method effectively improves accuracy. Moreover, our system provides better results in terms of accuracy of prediction than other systems. Finally, this study provides a method for how to design setting parameters in BPN.

Wireless sensor networks (WSN) can be widely used in many areas, such as environment monitoring, weather forecasting, traffic control, etc. The wormhole attack problem is an important issue in WSN since it causes many problems, such as routing error, a reduction in sensor lifetime and broken network topology. Several wormhole detection approaches have been proposed, but most of them need special hardware devices and consume a lot of system resources. This paper proposes a novel and efficient method to detect the wormhole attack without hardware equipment or requiring much information about WSN. The proposed method uses a moving average (MA) indicator, which has been commonly used in financial fields, to apply to neighbors of sensor nodes, it becomes a dynamic detection indicator of the number of neighbor nodes. Because the combinations are too numerous to arrange, we utilize a Quantum-inspired Tabu Search (QTS) algorithm. This algorithm is efficient and effective in finding the ideal combination of detection indicators to detect wormhole attacks in different scenarios. The simulation result shows our method is intuitive and efficiently detects wormhole.

The most powerful metaheuristics must be good at both exploitation and exploration. In the present day, metaheuristics are designed to reach a balance between these two capabilities for the sake of avoiding being trapped in the local optimum or unable to achieve convergence. For the first time in history, it is noteworthy that exploitation and exploration are both strong in the use of the Jaguar Algorithm (JA). In this paper, JA presents a simple but robust method inspired by the behaviors of jaguars. One feature of the jaguar is that once a jaguar is locked onto its prey, the jaguar moves directly and swiftly toward the target in the hunting area that has been established as its own territory. In addition, jaguars can hunt more efficiently when they take advantage of teamwork. This jaguar behavior parallels the behavior that makes JA more efficient than other well-known algorithms in exploiting and exploring. The experiment of this research reveals that an appropriate cooperation of jaguars could have various positive influences in regard to benchmark functions.

BackgroundAfter cesarean section (CS), women may be at great risk for sleep disturbance, but little is known about temporal changes in their sleep patterns and characteristics. We had two aims: 1) to identify distinct classes of sleep-disturbance trajectories in women considering elective CS from third-trimester pregnancy to 6 months post-CS and 2) to examine associations of sleep trajectories with body mass index (BMI), depressive symptoms, and fatigue scores.MethodsWe analyzed data from a prospective cohort study of 139 Taiwanese pregnant women who elected CS. Sleep components were assessed using the Pittsburgh Sleep Quality Index in third-trimester pregnancy, 1 day, 1 week, 1 month, and 6 months post-CS. Data were collected on depressive symptoms, fatigue symptoms, and BMI. Sleep-quality trajectories were identified by group-based trajectory modeling.ResultsWe identified three distinct trajectories: stable poor sleep (50 women, 36.0%), progressively worse sleep (67 women, 48.2%), and persistently poor sleep (22 women, 15.8%). Poor sleep was significantly associated with pre-pregnancy BMI and more baseline (third-trimester pregnancy) depressive and fatigue symptoms. At 6 months post-CS, women classified as progressively worse or persistently poor sleepers showed a trend toward higher BMI (pConclusionsWomen had three distinct sleep-disturbance trajectories before and after elective CS. These poor-sleep courses were associated with BMI and psychological well-being. Our findings suggest a need to continuously assess sleep quality among women considering elective CS and up to 6 months post-CS.

Previous epidemiological studies have established insomnia as a major risk factor for mood, anxiety, and substance use disorders. However, the associations between insomnia with sedative-hypnotic prescriptions and various psychiatric disorders have not been thoroughly examined. The current study involved evaluating the risk of psychiatric disorders, namely schizophrenia, mood, anxiety, somatoform, and substance-related disorders, over a 6-y follow-up period in three groups: patients with insomnia and sedative-hypnotic prescriptions (Inso-Hyp), those with insomnia and without sedative-hypnotic prescriptions (Inso-NonHyp), and those with neither insomnia nor sedative-hypnotic prescriptions (NonInso-NonHyp).We used a historical cohort study design to compare the risk of psychiatric disorders among the three groups. Data regarding these patients were derived from reimbursement claims recorded in Taiwan's National Health Insurance Research Database. Cox proportional hazards regression was used to compare the 6-y risk of subsequent psychiatric disorders among the Inso-Hyp, Inso-NonHyp, and NonInso-NonHyp groups.Compared with the Inso-NonHyp and NonInso-NonHyp group patients, the Inso-Hyp group patients exhibited a higher risk of psychiatric disorders, particularly bipolar disorders (adjusted hazard ratio [AHR]: 7.60; 95% confidence interval [CI]: 5.31-10.89 and AHR: 14.69; 95% CI: 11.11-19.43, respectively). Moreover, among the Inso-Hyp patient group, insomnia prescribed with benzodiazepine, a longer duration of sedative-hypnotic action, and higher doses of sedativehypnotics were significantly associated with a higher risk of depressive and anxiety disorders.The Inso-Hyp group exhibited a higher risk of developing psychiatric disorders than did the Inso-NonHyp and NonInso-NonHyp groups. The results regarding patients with insomnia and sedative-hypnotic prescriptions associated with the risk of psychiatric disorders can serve as a reference for care providers when managing sleep disturbances.

Anxiety and fatigue adversely affect women's postpartum recovery, but few effective non-pharmacological interventions are known to relieve these two common and unpleasant symptoms.To examine the efficacy of an auricular acupressure intervention provided during early postpartum in reducing anxiety, fatigue levels, cortisol levels, blood pressure, and heart rate.A single-blind, randomised controlled trial.A 40-bed postpartum unit.Women who underwent caesarean section were randomly allocated to two groups: intervention (auricular pressure, n=40), and control (usual care, n=40).The intervention group received auricular acupressure on the shenmen acupoint twice a day (9 AM and 5 PM), and the control group received usual postpartum care. Serum cortisol levels were assessed by immunochemiluminescence, with blood pressure and heart rate assessed by electric sphygmomanometer. Anxiety and fatigue symptoms were assessed using the State Anxiety subscale of the State-Trait Anxiety Inventory and the Fatigue Continuum Form, respectively.Of the 76 women who completed the study, those who received auricular acupressure had significantly lower mean cortisol levels (mean difference=4μg/dl, p0.05), heart rate (mean difference=9.2 beats/min, p0.001), anxiety symptoms (mean difference=3.8, p0.01), and fatigue symptoms (mean difference=7.1, p0.01) than women in the control group at 5 days postpartum.Auricular acupressure is an effective non-pharmacological method for reducing cortisol levels, heart rate, anxiety, and fatigue in early postpartum after caesarean section.

Pain is common in patients after orthopedic surgery. The 11-face Faces Pain Scale has not been validated for use in adult patients with postoperative pain. To assess the validity of the 11-face Faces Pain Scale and its ability to detect responses to pain medications, and to determine whether the sensitivity of the 11-face Faces Pain Scale for detecting changes in pain intensity over time is associated with gender differences in adult postorthopedic surgery patients. The 11-face Faces Pain Scale was translated into Vietnamese using forward and back translation. Postoperative pain was assessed using an 11-point numerical rating scale and the 11-face Faces Pain Scale on the day of surgery, and before (Time 1) and every 30 minutes after (Times 2-5) the patients had taken pain medications on the first postoperative day. The 11-face Faces Pain Scale highly correlated with the numerical rating scale (r = 0.78, p.001). When the scores from each follow-up test (Times 2-5) were compared with those from the baseline test (Time 1), the effect sizes were -0.70, -1.05, -1.20, and -1.31, and the standardized response means were -1.17, -1.59, -1.66, and -1.82, respectively. The mean change in pain intensity, but not gender-time interaction effect, over the five time points was significant (F = 182.03, p.001). Our results support that the 11-face Faces Pain Scale is appropriate for measuring acute postoperative pain in adults.

BACKGROUND The Internet has been gaining worldwide popularity in recent years, but a loss of control over Internet use might lead to negative impacts on our daily lives. OBJECTIVES This study explored the effects of Internet addiction on autonomic nervous system function through heart rate variability (HRV) analysis. METHODS This was a cross-sectional design. Data were collected from 240 school-aged children who completed the Chinese Internet Addiction Scale and Pittsburgh Sleep Quality Index questionnaires. Spectral analysis was used to measure HRV. Independent t test was used to compare differences in characteristics and HRV between groups. A 2-way analysis of variance was used to examine group differences in HRV. RESULTS Internet addicts had significantly lower high frequency (HF) percentage, logarithmically transformed HF, and logarithmically transformed total power and significantly higher low frequency percentage than did nonaddicts. Internet addicts who had insomnia had higher low frequency percentage and lower HF percentage, logarithmically transformed HF, and logarithmically transformed total power compared with nonaddicts who did not have insomnia. CONCLUSIONS Internet addiction is associated with higher sympathetic activity and lower parasympathetic activity. The autonomic dysregulation associated with Internet addiction might partly result from insomnia, but the mechanism still needs to be further studied.

Reversible logic plays an important role in quantum computation, which is a promising research field. The reversible logic synthesis problem focuses on generating a reversible circuit automatically and finding the lowest cost when an output function is given. The synthesis of reversible logic circuits can be formulated as a combinatorial optimization problem. This paper proposes a new evolutionary algorithm for synthesizing reversible circuits based on Quantum-Inspired Tabu Search Algorithm (QTS). The proposed algorithm uses the QTS-based approach to find fewer gates and reduce the cost of reversible circuits. This method is simpler, has better performance in computational cost, and reduce the gate counts of reversible circuits. This paper also compares experimental results with other heuristic and evolutionary algorithms. The final outcome shows that the QTS-based approach performs much better than other algorithms.

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.

Background: Breast engorgement is a common problem that affects the initiation and duration of breastfeeding. Limited solutions are available to relieve the discomfort associated with breast engorgement. Thus, further investigation of methods to achieve effective relief of symptoms is critical to promote breastfeeding success. Purpose: The purpose of this study was to determine the effects of two breast caremethods, that is, scraping (Gua-Sha) therapy (administered to the experimental group) and traditional breast care (i. e., massage and heating; administered to the control group). Methods: A randomized controlled trial was conducted on 54 postpartum women at a Level Ⅲ medical teaching hospital. Participant inclusion criteria included postpartum breastfeeding women (a) who had an uncomplicated delivery and (b) who were experiencing breast engorgement problems. The Gua-Sha protocol selected appropriate acupoint positions, which included ST16, ST18, SP17, and CV17. Each position was lightly scraped seven times in two cycles. For the control group, we used hot packs and massage for 20 min in accordance with recommendations given in an obstetrical technique textbook. Results: Results showed no statistical differences between the two groups at baseline. Body temperature, breast temperature, breast engorgement, pain levels, and discomforting levels were statistically different between the two groups at 5 and 30 min after intervention (p＜.001). The results of generalized estimating equation analysis indicated that, with the exception of body temperature, all variables remained more significant (p＜.0001) to improving engorgement symptoms in the experimental group than those in the control group, after taking related variables into account. Conclusions and Implications for Practice: Our findings provided empirical evidence supporting that Gua-Sha therapy may be used as an effective technique in the management of breast engorgement. By using Gua-Sha therapy, nurses can handle breast engorgement problems more effectively in primary care and hence help patients both physically and psychologically.

BackgroundDepression and anxiety are important mood changes in childbearing women. However, changes in depression and anxiety over time in women who undergo an elective cesarean section (CS) have not yet been elucidated. We aimed to characterize the trajectories of depressive and anxiety symptoms, and patterns of co-occurrence, and examined the associated predictors of depression and anxiety courses.MethodsA prospective longitudinal study of childbearing women (N = 139) who underwent a CS was conducted. Depressive and anxiety symptoms were respectively assessed using the Edinburgh Postnatal Depression Scale and State Anxiety Inventory, in the third trimester and at 1 day, 1 week, and 1 and 6 months postpartum.ResultsGroup-based modeling identified three distinct trajectories of depressive symptoms: group 1 (low, 30.9%), group 2 (mild, 41.7%), and group 3 (high, 27.3%). Four group trajectories of anxiety symptoms were identified: group 1 (low, 19.4%), group 2 (mild, 44.6%), group 3 (high, 28.8%), and group 4 (very high, 7.2%). Mild symptoms of both depression and anxiety were the most common joint trajectory. Depression trajectories were significantly related to anxiety trajectories (pConclusionsDistinctive trajectories and co-occurrence patterns of depressive and anxiety symptoms were identified. Our findings suggest a need for greater attention to continuous assessment of psychological well-being among women who undergo an elective CS.