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Objective: Chinese herbal medicine (CHM) is quite popular in Asia. The purpose of this study is to investigate the benefits of decreasing the risk of cirrhosis in patients with non-alcoholic fatty liver disease (NAFLD) by using CHM. Design: We performed a 1:3 propensity score-matched cohort study to analyze patients with NAFLD diagnosed between January 1, 1997 and December 31, 2011 through the Taiwanese National Health Insurance Research Database. Patients who received CHM therapy from the initial date of diagnosis of NAFLD to December 31, 2011 were included in the CHM group. Patients who were not treated with CHM during the same interval were categorized in the non-CHM group. Cox regression model was used to adjust for sex, age, comorbidities, and drug use. Hazard ratios were also compared between the two groups. Results: A total of 13,072 patients were identified after 1:3 propensity score matching. The patients had similar basic characteristics. A lower cumulative incidence of cirrhosis was found in the CHM cohort (log-rank test, p < 0.0001). Finally, 176 patients in the CHM cohort (4.66 per 1000 person-years) and 582 patients in the non-CHM cohort (7.92 per 1000 person-years) developed cirrhosis (adjusted hazard ratios 0.63, 95% confidence interval 0.53–0.75). The effect of CHM to lower cirrhosis incidence was independent of sex, drug use, and comorbidities, including diabetes mellitus, hypertension, and cardiovascular diseases. Patients older than 40 years of age and without comorbidities such as chronic obstructive pulmonary disease, hyperlipidemia, alcoholism, tobacco use, or obesity also benefited from CHM. Conclusions: Our study is the first large-scale investigation in Taiwan that shows the association between patients with NAFLD and cirrhosis prevention after CHM intervention. The results may be useful for treatment and for decision making for patients and clinical doctors. Further restricted trials are needed to support our findings. [ABSTRACT FROM AUTHOR]

To date, many efforts have been made to explore how to support driver's decision-making process with advisory information. Previous studies mainly focus on a single modality, e.g. the visual, auditory or haptic modality. In contrast, this study compares data from two simulator studies with 50 participants in total, where the visual vs. the auditory modality was used to present the same type of advisory traffic information under the same driving scenarios. Hereby we compare the effect of these two modalities on drivers' responses and driving performance. Our findings indicate that modality influences the drivers' behaviour patterns significantly. Visual information helps drivers to drive more accurately and efficiently, whereas auditory information supports quicker responses. This suggests that there are potential benefits in applying both modalities in tandem, as they complement each other. Correspondingly, we present several design recommendations on Advisory Traffic Information Systems. [ABSTRACT FROM AUTHOR]

Abstract: In the present study, we examined patterns of benzodiazepine (BZD) use in nurses, and compared the characteristics of frequent users with those of infrequent users. Data on all nurses enrolled in the study were derived from the reimbursement claim records in Taiwan's National Health Insurance Research Database for the period 2004–2008. The case group comprised 33 588 nurses with BZD use, and the control group was exactly matched to each case according to age and sex. The patterns of occasional, frequent, and daily BZD use demonstrated an increasing trend from 2004 to 2008. This trend was observed for most of the BZD with a short or intermediate half‐life. Older nurses (>45 years) and those with greater experience (≥5 years) were more likely to use BZD frequently. Moreover, the risk of frequent BZD use increased significantly when nurses exhibited comorbid depression (adjusted odds ratio (aOR): 2.58), anxiety (aOR: 1.78), or sleep disorders (aOR: 2.29) compared with infrequent BZD use. The results indicated that nurses with BZD use had comorbidities of anxiety, depression, and sleep disorders. The increasing trend of patterns of BZD use and its association with sleep disorders, depression, and anxiety can be used as references for stress and sleep management in nurses. [ABSTRACT FROM AUTHOR]

Purposes To explore correlates of nocturia, compare sleep quality and glycemic control for women with and without nocturia, and examine relationships of nocturia with sleep quality and glycemic control in women with diabetes. Design This study was a cross-sectional, correlational study with data collected from 275 women with type 2 diabetes. Methods Data were collected using a structured questionnaire. Multivariate logistic regression analyses were used to identify correlates. Chi-squared tests were used to identify candidate variables for the first logistic regression model. A one-way analysis of variance was used to compare sleep quality and glycemic control for women with and those without nocturia. Pearson correlations were used to examine the relationships of nocturia with sleep quality and glycemic control. Findings Of the 275 participants, 124 (45.1%) had experienced nocturia (at least two voids per night). Waist circumference, parity, time since diagnosis of diabetes, sleep quality, and increased daytime urinary frequency were correlated with nocturia after adjusting for age. Compared to women without nocturia, women who had nocturia reported poorer sleep quality. A significant correlation was found between the number of nocturnal episodes and sleep quality. Conclusions Nocturia and poor sleep are common among women with diabetes. The multifactorial nature of nocturia supports the delivered management and treatments being targeted to underlying etiologies in order to optimize women's symptom management. Interventions aimed at modifiable correlates may include maintaining a normal body weight and regular physical exercise for maintaining a normal waist circumference, and decreasing caffeine consumption, implementing feasible modifications in sleeping environments and maintaining sleep hygiene to improve sleep quality. Clinical Relevance Healthcare professionals should screen for nocturia and poor sleep and offer appropriate nonpharmacological lifestyle management, behavioral interventions, or pharmacotherapy for women with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: To explore the differences in sleep parameters between nurses working a slow, forward rotating shift and those working a fixed day shift. Method: A longitudinal parallel-group comparison design was used in this prospective study. Participants (female) were randomly assigned to a rotating shift or a fixed day shift group. Participants in the rotating shift group worked day shift for the first 4 weeks, followed by evening shift for the second and night shift the third. Those in the day shift group worked day shift for all 12 weeks. Each kept a sleep diary and wore an actigraph (actigraph data were used to calculate total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE]) for 12 days, from Workday 1–4 in each of Weeks 4, 8, and 12. Results: TST in nurses working evening rotating shift was higher than that for those working the day or night rotating shift and fixed day shift. WASO was significantly longer on Day 2 for rotating shift participants working evening versus day shift. SOL and SE were significantly shorter and lower in rotating shift nurses working night versus both day and evening shifts. Conclusions: A comprehensive understanding of the sleep patterns and quality of nurses with different work shifts may lead to better management of work shifts that reduces the influence of shift work on sleep quality. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the effectiveness of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of haemodialysis patients. Background A high number of end-stage renal disease patients on haemodialysis are bothered by pruritus. Hyperphosphataemia was reported to be related to pruritus. Design An experimental design was applied. Methods Ninety-four patients who received haemodialysis between September 2013 and December 2013 at a medical centre in Taipei, Taiwan, were recruited. An experimental group received individual systematic nursing instruction by the investigator through a nursing instruction pamphlet and reminder card for taking medication. A control group received traditional nursing instruction. The pruritus, blood phosphorus level and five-day diet records were evaluated before and after intervention. Results The experimental group had a low-phosphorus diet intake compared with the control group ( p < 0·001). A significant difference in serum phosphorus level was observed between the experimental and control groups ( p = 0·002). Incidence of pruritus was lower in the experimental group than in the control group ( p < 0·001). Conclusion A systematic nursing instruction included using a pamphlet, pictures and reminder cards, the patients' blood phosphorus levels decreased, the patients consumed more low-phosphorus food, and pruritus decreased. Relevance to clinical practice This study recommends that clinical nursing staff include systematic nursing instruction as a routine practice for dialysis patients. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of this study was to investigate the effects of a music intervention on hospitalised psychiatric patients with different levels of anxiety. Background In clinical practice, psychiatric inpatients and nurses routinely suffer from anxiety. A music intervention may possibly be useful, but knowledge as to how useful and how effective it is in patients with different levels of anxiety is limited. Design The study design was a three-group, repeated-measures experimental study. Methods Subjects were 22 psychiatric patients who were divided into three groups based on their level of anxiety. They listened to 20 minutes of music each day for 10 days and were assessed using the Beck Anxiety Inventory before and after the music intervention and at a one-week follow-up; an electroencephalogram and finger temperature were monitored before and during the music intervention. Results Anxiety levels of all three groups showed a significant difference ( p = 0·0339) after the intervention. The difference alpha and beta electroencephalogram percentages for all three groups showed a significant difference ( p = 0·04; p = 0·01). The finger temperature showed a non-significant difference ( p = 0·41). Conclusions A music intervention can effectively alleviate the anxiety of hospitalised psychiatric patients who suffer from all levels of anxiety. Relevance to clinical practice The study recommends a practice in alleviating anxiety. Effective lower-cost interventions to reduce anxiety in psychiatric inpatient settings would be of interest to nurses and benefit patients. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop a Chinese version of the Disaster Preparedness Evaluation Tool and validate its psychometric properties. Background An adequate disaster preparation programme for nurses has not been developed in Taiwan. To develop an exhaustive and effective educational programme on disaster preparation for nurses, a multidimensional instrument is required for assessing the disaster preparation level of nurses. Design A cross-sectional study was conducted. Methods In total, 1550 of 2226 public health nurses in 15 counties completed the self-administrated questionnaire. We randomly selected 805 samples to examine the factor structure and factor model by using exploratory factor analysis and confirmatory factor analysis. The convergent validity was measured using the average variance extracted and composite reliability. Results Five factors, namely postdisaster management, skills, knowledge of self-preparation in a disaster, knowledge to respond in the community, and knowledge to respond in the workplace, were extracted, and explained 65·13% of the total variance. An acceptable model fit was identified using confirmatory factor analysis. The Cronbach's α coefficient of the Chinese version of the Disaster Preparedness Evaluation Tool was 0·97. Significant values of the average variance extracted greater than 0·5 indicated convergent validity. Conclusion The Chinese version of the Disaster Preparedness Evaluation Tool is a reliable and valid instrument for measuring disaster preparation. Relevance to clinical practice The Chinese version of the Disaster Preparedness Evaluation Tool provides reliable and valid measures that can be used to evaluate the disaster preparedness of nurses. The items in the instrument can be used to identify the dimension of disaster management in all stages, and can form the essential foundation of an education and training programme for public health nurses to reduce the harm of disasters and promote community resilience. [ABSTRACT FROM AUTHOR]

Aim. To examine changes in quality of life among patients with breast cancer and factors related to it, during the first three months after diagnosis. Background. Numerous studies have examined quality of life among cancer survivors or among patients with cancer after aggressive treatment; such research has demonstrated that quality of life in the third month after surgery can significantly predict quality of life in the long run. In contrast, changes in quality of life causes among patients during the acute treatment phase have not been well studied. Design. Prospective longitudinal study. Methods. Newly diagnosed patients with breast cancer were recruited during 2008-2009. Sixty-one cases completed the four data collections on the day before operation and one, two and three months after surgery. Data were collected using the Functional Living Index-Cancer, Symptom Distress Scale, the Self-Efficacy Scale and a 0-10 Anxiety Numeric Rating Scale. Generalized Estimating Equations were applied for data analysis. Results. There were significant changes in quality of life over the three months following surgery, and the worst quality of life was observed in the first month after surgery. Less advanced stages of cancer, lower anxiety, less symptom distress and higher perceived self-efficacy in the preoperative interview could significantly predict which patients experienced more positive quality of life trends. Fatigue, limited shoulder function and perceived poor appearance were the most significant factors predicting changes of quality of life. Conclusion. Preoperative physical and psychological factors, as well as sense of self-efficacy for managing the cancer, are important factors for predicting changes in patients' quality of life. Relevance to clinical practice. Healthcare providers should be alert to factors contributing to changes of quality of life among patients receiving chemotherapy. Interventions based on these results should be developed and their effectiveness tested for their impact on breast cancer patients' quality of life. Clinical interventions based on these results should be developed to improve breast cancer patients' quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the reliability of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C) used in Taiwan. According to the authors, the psychometric properties of MFSI-SF-C were assessed in cancer inpatients. They add that the difference between the fatigue of cancer patients and the healthy patients in the community was significant. They indicate that the validity of MFSI-SF-C was good when comparing fatigue with depression and quality of life.

Background: The prevalence and incidence of the main risk factors for urinary incontinence (UI) have both increased over time. In addition, official statistics indicate that Taiwan is on course to evolve from an aging society into an aged society within the next decade. However, most of the studies in the literature that address the natural history of UI target Western and other non-Asian populations. Taiwan lacks knowledge of the natural history of UI. Purpose: The aims of this research were to study the trends in the use of urodynamic and surgical procedures for various subtypes of UI and to investigate the relationship between UI and healthcare resource utilization. Methods: The data on 1 million, randomly selected people who were enrolled in the Taiwan National Health Insurance program between 2000 and 2008 were extracted from the Longitudinal Health Insurance Database. The population and all procedures were identified based on the International Classification of Disease, Ninth Revision, Clinical Modification codes. Annual incidence of UI was calculated on an annual basis, and trend analysis was performed using logistic regression models. The association between UI and healthcare utilization was examined using generalized linear models in a gamma distribution with a log link function. Results: Overall, the trend in the annual incidence for all types of UI increased significantly (p <.01). Significantly increasing trends in the use of urodynamic procedures over time were observed for mixed and other types of UI (p <.01). In addition, a significantly increasing trend was observed in the annual rates of surgical procedures that were received by patients with urge or stress UI (p <.05). Patients with UI showed significantly higher healthcare resource utilization, including number of ambulatory visits, number of hospitalizations, average ambulatory care expenditures, and average days of hospitalization, than those without UI. However, limited information is available on the conservative treatment of UI in the database. Conclusions: UI symptoms may lead to increased healthcare resource utilization in patients with UI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the psychometric properties of the Chinese version of the Sleep-Associated Monitoring Index (SAMI) in Taiwanese haemodialysis patients. Design: An instrument translation and validation study. Setting: A haemodialysis (HD) unit in a university-affiliated medical centre in northern Taiwan. Participants: 206 patients who were 18 or above, diagnosed with end-stage renal disease and under maintenance HD twice or thrice a week, 3h or more per session for more than 3 months. Methods: A principal component analysis was used to examine the construct validity of the SAMI. The participants were classified into poor (n =160) and good sleepers (n =46) using a cut-off value of 5 on the Pittsburgh Sleep Quality Index (PSQI). All participants filled out the Beck Depression Inventory (BDI) and Back Anxiety Inventory (BAI) along with the SAMI. Internal consistency was examined by the Cronbach''s α. To assess test–retest reliability, the participants were asked to fill out the SAMI on a second occasion at a 2-week interval. Results: Eight subscales emerged from the principal component analysis. Individual with insomnia had significantly higher total SAMI scores (p <0.001). The SAMI total score significantly correlated to the PSQI, BDI, and BAI (r =0.65, 0.67, 0.67; all p <0.001). Cronbach''s α was 0.95 for the entire scale. The intra-class correlation coefficient between the initial and retest SAMI total score was 0.72 (p <0.001). The SAMI-Chinese demonstrated an area under the receiver operation characteristic curve of 0.771 (SE=0.044; 95% CI: 0.685–0.857; p <0.001) in detecting individuals with poor sleep. A cut-off value of 51 indicated a sensitivity of 0.86 and a specificity of 0.63 in distinguishing between poor and good sleepers. Conclusions: The SAMI-Chinese demonstrated excellent construct validity, contrast group validity, external validity, internal consistency, and satisfactory test–retest reliability. It also demonstrated satisfactory diagnostic ability for insomnia. [Copyright &y& Elsevier]