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Introduction: Integrating assistive technology (AT) into occupational therapy (OT) education is critical to educating students to utilize AT to enhance individual independence. This study aims to describe the development of a science, technology, engineering, arts, and mathematics (STEAM)-based AT curriculum in OT and evaluate its effectiveness using the Kirkpatrick model. Methods: An 18-week STEAM-based AT curriculum was created with lectures, hands-on activities, and a simulation exam. A one-group pretest–posttest observational study was undertaken with 40 undergraduate students to gauge its effectiveness. Their professionalism was evaluated using a multidimensional checklist, whereas a satisfaction survey gathered their feedback on the curriculum experience. Results: Level 1: Participants reported high satisfaction (mean = 4.61, SD = 0.36), with a 97.5% agreement. Level 2: 95% (n = 38) passed the AT curriculum exam. Level 3: Therapists and patients expressed satisfaction with participants' AT skills (therapists: t (39) = 12.22, p < 0.001; patients: t (39) = 8.84, p < 0.001). Level 4: Participants showed significant improvement in professionalism (t (39) = 16.45, p < 0.001). Lastly, using the Kirkpatrick model, the STEAM-based AT curriculum passed the evaluation. Conclusions: The STEAM-based AT curriculum in OT enhances professionalism and potentially boosts patient satisfaction with AT services provision. [ABSTRACT FROM AUTHOR]

Objective: Accidental pharyngeal fishbone ingestion is a common complaint in ear, nose, and throat clinics. Approximately two-thirds of the accidentally ingested fishbones can be removed using tongue depressors and indirect laryngoscopy. However, the remaining third is challenging to identify and remove using these methods. These difficult fishbones require identification and removal via more advanced approaches. Video-guided laryngoscope is used to deal with difficult fishbones in our center. This study aimed to explore the risk factors for difficult fishbones. Methods: A prospective study was performed at a teaching hospital on 2080 patients. Univariate and multivariate analyses were performed to identify the risk factors. Results: The common fishbone locations were the tonsils (39.8%; defined as STEP-I), tongue base (37.1%), vallecula (13.3%; STEP-II), and hypopharynx (9.8%; STEP-III). With increasing STEP level, the ratio of difficult fishbones correspondingly increased (Z = 13.919, P <.001), and the proportions were 21.1%, 41.9%, and 70% in STEP-I, II, and III, respectively. In particular, fishbones in STEP-III (vs STEP-I) had a higher risk of difficult fishbones (odds ratio [OR]: 11.573, 95% CI: 7.987-16.769). Complaints of neck pain (yes vs no), foreign body sensation (yes vs no), and shorter length of fishbones always had a lower risk of difficult fishbones (OR: 0.455, 95% CI: 0.367-0.564; OR: 0.284, 95% CI: 0.191-0.422; OR: 0.727, 95% CI: 0.622-0.85). Missing teeth (yes vs no), swallowing behavior after fishbone ingestion (yes vs no), and male patients (vs female) had a higher risk of difficult fishbones (OR: 1.9, 95% CI: 1.47-2.456; OR: 1.631, 95% CI: 1.293-2.059; OR: 1.278, 95% CI: 1.047-1.56). Conclusions: Neck pain, foreign body sensation, fishbone length, patient age and sex, tooth status, and swallowing behavior after fishbone ingestion are independent risk factors for difficult fishbones. [ABSTRACT FROM AUTHOR]

Five new sesquiterpenoids, including a campherenane-type (1), a bergamotane-type (2), a drimane-type (3), and two bisabolane-type (5-6) sesquiterpenoids have been isolated from Biscogniauxia sp. 71-10-1-1. Their structures were determined by spectroscopic analyses, quantum chemical ECD calculations,13C chemical shifts calculations, and X-ray crystallography. This is the first report of campherenane-type and drimane-type sesquiterpenoids from Biscogniauxia. Furthermore, the anti-inflammatory assays of all compounds are evaluated, and the results showed that compounds 3 and 7 exhibited the effects against the production of the pro-inflammatory cytokine TNF-α. [ABSTRACT FROM AUTHOR]

Objectives: Metabolic syndrome (MetS) and hepatitis C virus (HCV) are associated with a higher risk of impaired pulmonary function (iPF). This study aimed to investigate the relationships among MetS, iPF, and viral hepatitis. Methods: This community-based study enrolled participants undergoing annual health check-ups in southern Taiwan between March and December 2019. We performed multivariable logistic regression analyses adjusted for demographics and characteristics to identify the factors associated with iPF. Results: A total of 2337 participants completed examinations, of whom 928 (39.7%) had iPF. The participants with iPF were elderly (68.8 ± 12.8 years old) and predominately female (63%). MetS increased the risk of iPF (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27–1.81, p < 0.001). Beyond age (OR 1.03, 95% CI 1.02–1.04) and smoking (OR 1.309, 95% CI 1.004–1.705), female sex (OR 0.74, 95% CI 0.59–0.93) and high education level (OR 0.96, 95% CI 0.94–0.98, p < 0.001) protected against iPF. HCV was not significantly associated with iPF (OR 1.17, 95% CI 0.90–1.52, p = 0.235) in multivariable analysis. MetS was associated with a higher risk of iPF in the non-HBV/HCV group (OR 1.86, 95% CI 1.54–2.26) and HBV alone group (OR 3.44, 95% CI 1.89–6.28), but not in the HCV alone group (OR 1.02, 95% CI 0.64–1.62). Discussion: MetS was an independent predictor of iPF, especially the restrictive type, and had different effects in the HBV/non-viral hepatitis and HCV groups. Female sex and education were inversely associated with iPF. [ABSTRACT FROM AUTHOR]

Background: Improving chewing function of older adults increases the health-related quality of life. Few studies indicated the correlation between tongue, lip strength on masticatory performance in older people. The study aimed to investigate the association between lip, tongue strength on chewing pattern in aging population. Methods: The older adults had independent daily intake without assistance were enrolled. They had intact dentition and no periodontitis. To estimate the number of chewing strokes and chewing time by consuming a cornstarch cookie were used to represent chewing pattern. Lip and tongue pressure were evaluated with an Iowa Oral Performance Instrument. Linear regression analysis was used to analyze the lip and tongue pressure associated with the chewing time and strokes. Spearman's correlation analysis was utilized to evaluate the associations among chewing time and chewing strokes or lip and tongue pressure. Results: 35 women and 35 men with an average age of 73.2 years were investigated. Tongue pressure was significantly related to the chewing time and the number of chewing strokes (p = 0.01 and 0.03). There was a close association between chewing time and the number of chewing strokes (p < 0.0001). The correlation between lip and tongue pressure was significant (p < 0.0001). Conclusion: The tongue strength significantly related to chewing ability in aging population. Increasing the tongue strength greatly reduced the number of chewing strokes and chewing time. Good masticatory ability could increase the motor function of tongue; raising the tongue strength might be able to improve mastication in older adults. [ABSTRACT FROM AUTHOR]

The current study examined the effects of accumulated short bouts of walking on glycosylated hemoglobin (HbA1c) and homeostasis model assessment of insulin resistance (HOMA-IR) of older adults with type 2 diabetes. Differences in variables between models of accumulated bouts of walking and 10,000 steps were also investigated. Sedentary participants (N = 38) were randomized into one of three groups: accumulated 10-minute bouts of walking at 100 steps/min (10/100MW), accumulated 10,000 steps (10KS), or control. HbA1c, HOMA-IR, blood lipids, and cardiorespiratory fitness (VO2max) were assessed before and after the intervention. VO2max, HbA1c, and HOMA-IR in the 10/100MW and 10KS groups showed significant and comparable improvements postintervention compared to preintervention (p < 0.05). Furthermore, the change in average daily step count was significantly associated with the change in HbA1c of the two walking groups (r = −0.61 for 10KS and r = −0.63 for 10/100MW; p < 0.05). Accumulated short bouts of walking at 100 steps/min and 10,000 steps daily improved HbA1c and HOMA-IR of older adults with type 2 diabetes. [Research in Gerontological Nursing, 16(5), 250–258.] [ABSTRACT FROM AUTHOR]

Aims: The study aimed to explore farmers' self‐care behaviours including oral hygiene, remaining natural teeth, cardiometabolic risks, hepatitis, risk of stroke and their determinant factors. Methods: This cross‐sectional study was conducted between June 2020 and March 2021 in the south‐western remote areas of Taiwan. We recruited current farmers who participated in an annual community health screening conducted by a collaborated local hospital. Data were collected through face‐to‐face interviews using a semi‐structured questionnaire. Blood samples were drawn and stored in the central laboratory of the cooperating hospital. The study outcomes included cardiometabolic risks, the remaining natural teeth, and farmers' self‐care behaviours including oral hygiene, adopting a healthy diet and substance use. Results: Overall, 183 current farmers (55.2% women, aged 66.9 ± 11.7 years) were enrolled. Abnormal blood pressure, high risk of stroke, metabolic syndrome and hepatitis C virus infection were found among the participants. The average remaining teeth were 12.1, 73.2% of participants had <20 teeth; 90.2% and 71% did not undergo regular dental check‐ups and scaling or use dental floss, respectively. The determinant factors associated with the remaining teeth included a high risk of stroke, teeth scaling and dental floss use. Although only 3.8% felt mentally distressed, many farmers were unaware of having potential cardiometabolic diseases and curable viral hepatitis, and only two had received antiviral treatment. Conclusion: The farmers in this study had a high prevalence of cardiometabolic risks, a high probability of stroke, inadequate number of remaining teeth and poor oral hygiene behaviours. These findings can provide evidence to develop health promotion programmes for farmers. Impact: This study demonstrates the health needs of farmers. We strongly recommend that community nurses empower farmers to engage in self‐care behaviours through tailored health promotion programmes. For instance, by discussing cardiometabolic risk prevention from the farmers' perspectives to improve their health literacy. [ABSTRACT FROM AUTHOR]

The present study investigated the effects of a far-infrared radiation (FIR) lamp therapy on changes in muscle damage and proprioception markers after maximal eccentric exercise of the elbow flexors (EF: Study 1) and the knee flexors (KF: Study 2) in comparison to a sham treatment condition. In each study, 24 healthy sedentary women were assigned to a FIR or a sham treatment group (n = 12/group). They performed 72 maximal EF eccentric contractions (Study 1) or 100 maximal KF eccentric contractions (Study 2) with their non-dominant limbs. They received a 30-min FIR (wavelength: 8–14 µm) or sham treatment at 1, 25, 49, 73 and 97 h post-exercise to the exercised muscles. Maximum voluntary isometric contraction (MVC) torque, muscle soreness, plasma creatine kinase activity, and proprioception assessed by position sense, joint reaction angle, and force match were measured before, and 0.5, 24, 48, 72, 96 and 120 h post-exercise. The outcome measures showed significant changes (P < 0.05) at 0.5-hour post-exercise (before treatment) similarly (P > 0.05) between the conditions in both studies. However, changes in all measures at 24–120 h post-exercise were smaller (P < 0.05) for the FIR than sham condition in both studies. For example, MVC torque returned to the baseline by 72 h post-exercise for the FIR condition in both studies, but was still 19 ± 6% (Study 1) or 17 ± 12% (Study 2) lower than the baseline at 120 h post-exercise for the sham condition. These results suggested that the FIR lamp therapy was effective for accelerating recovery from muscle damage. FIR lamp therapy was effective for recovering muscle strength and proprioception 1–3 days faster to the baseline. FIR lamp therapy was effective for attenuating muscle soreness by 55–60%, and reducing peak plasma CK activity by 45–89%. The effects of the FIR lamp therapy appear to be greater than other therapeutic interventions for eccentric exercise-induced muscle damage that have been investigated previously. [ABSTRACT FROM AUTHOR]

Background: Duchenne muscular dystrophy (DMD) is a rare hereditary muscular disease. The role of eosinophils in DMD has not been clarified. This study aims to evaluate the association between peripheral blood eosinophil count and severity and prognosis of DMD. Methods: A retrospective cohort study was performed for 145 DMD patients between January 2012 and December 2020. Clinical data of 150 healthy children were collected as a control group. Logistic regression and Cox regression analyses were used to explore the influences of eosinophil count on DMD severity and prognosis. Results: Eosinophil count in DMD group was lower than the control group (Z = 2.163, P = 0.031). It was negatively correlated with Vignos scale score, Spearman correlation coefficient was p = 0.245, P = 0.040 (at admission),p = 0.137, P = 0.032 (at follow-up); was a protective factor for high Vignos scale score at admission [odds ratio (OR) = 0.038, 95%CI: 0.002–0.752, P = 0.032] and follow-up (OR = 0.033,95%CI: 0.001–0.121, P = 0.039). The Cox regression analysis indicated that elevated eosinophil count was correlated with better therapeutic efficacy for DMD patients [hazard ratio (HR) = 2.218, 95%CI: 1.154–3.924, P = 0.016]. Conclusion: Eosinophil count in peripheral blood was correlated with the severity of DMD. It could indicate the therapeutic efficacy and prognosis of DMD patients to a certain extent. Eosinophils may be a potentially valuable biomarker or therapeutic target for DMD. [ABSTRACT FROM AUTHOR]

To compare the group- and individual-level responsiveness of the Barthel Index (BI) and modified BI (MBI) in patients with early subacute stroke. The BI and MBI scores of 63, 63, and 55 patients were retrieved at 3 time points with a 3-weeks interval. The group-level responsiveness was examined using paired t-test and standardized response mean (SRM). The individual-level responsiveness was examined by the percentage of patients who achieved significant improvement exceeding the corresponding minimal detectable change. At the group level, the MBI showed significantly larger SRMs than did the BI in the 1st–2nd assessment (1.10 vs. 0.81 [95% CI of mean difference = 0.05–0.38]) and the 2nd–3rd assessment (0.94 vs. 0.72 [95% CI of mean difference = 0.04–0.41]). At the individual level, the MBI detected significantly more patients with significant improvement than the BI for the 1st–2nd assessments only (34.9 vs. 25.4% [95% CI of mean differences = 3.2–17.5]). The MBI has better responsiveness than the BI at both the group and individual levels in the patients with early subacute stroke. The MBI is recommended for clinical and research use as an outcome measure for patients with stroke. The MBI is recommended for clinical and research applications because of its superior ability to detect subtle changes in ADL performance in patients with subacute stroke. The MBI and the BI have equal responsiveness for patients whose magnitude of improvement of ADL is substantial. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of dose calculation accuracy on inverse linear energy transfer (LET) optimization for intensity‐modulated proton therapy, and to determine whether adding more beams would improve the plan robustness to different dose calculation engines. Methods: Two sets of intensity‐modulated proton therapy plans using two, four, six, and nine beams were created for 10 prostate cancer patients: one set was optimized with dose constraints (DoseOpt) using the pencil beam (PB) algorithm, and the other set was optimized with additional LET constraints (LETOpt) using the Monte Carlo (MC) algorithm. Dose distributions of DoseOpt plans were then recalculated using the MC algorithm, and the LETOpt plans were recalculated using the PB algorithm. Dosimetric indices of targets and critical organs were compared between the PB and MC algorithms for both sets of plans. Results: For DoseOpt plans, dose differences between the PB and MC algorithms were minimal. However, the maximum dose differences in LETOpt plans were 11.11% and 15.85% in the dose covering 98% and 2% (D2) of the clinical target volume, respectively. Furthermore, the dose to 1 cc of the bladder differed by 11.42 Gy (relative biological effectiveness). Adding more beams reduced the discrepancy in target coverage, but the errors in D2 of the structure were increased with the number of beams. Conclusion: High modulation of LET requires high dose calculation accuracy during the optimization and final dose calculation in the inverse treatment planning for intensity‐modulated proton therapy, and adding more beams did not improve the plan robustness to different dose calculation algorithms. [ABSTRACT FROM AUTHOR]

Curcumin is known to suppress the progression of colorectal cancer by inhibiting cancer cell proliferation. In this study, we explored the role of ferroptosis in the antiproliferative properties of curcumin. The effect of curcumin on ferroptosis In Vitro was evaluated in HCT-8 cells. Ferroptosis was first blocked by ferrostatin-1 (Fer-1) and the antiproliferative effect of curcumin was evaluated by determining the levels of ferroptotic markers, including glutathione (GSH), SLC7A11, GPX4, iron, malondialdehyde (MDA), and reactive oxygen species (ROS). An agonist and an inhibitor of PI3K were also used to verify the signaling pathway involved in the antiproliferative effects. Curcumin repressed HCT-8 cell proliferation in a dose-dependent manner. Treating HCT-8 cells with curcumin significantly downregulated GSH, SLC7A11, and GPX4, while significantly increasing levels of iron, MDA, and ROS. In addition, curcumin promoted ferroptosis and reduced proliferation of HCT-8 cells by suppressing the PI3K/Akt/mTOR pathway, and these effects were antagonized by Fer-1. The effects of curcumin were antagonized by a PI3K agonist and reinforced by a PI3K inhibitor. Curcumin triggers ferroptosis and suppresses proliferation of colorectal cancer cells by inhibiting the PI3K/Akt/mTOR signaling pathway. These results indicate its potential as a treatment against colorectal cancer. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain. Background: Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown. Design: This study employed a single‐arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4‐week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines. Methods: This multi‐site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ‐C30). Results: Generalised estimating equations showed participants who completed at least one follow‐up measurement (N = 80) over 4‐weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation. Conclusions: The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer. Relevance to clinical practice: The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life. Trial registration details: This study was registered in ClinicalTrials.gov. Identifier: NCT04315831. [ABSTRACT FROM AUTHOR]

Antrodia salmonea (AS) is a genus of Antrodia, an epiphyte of Cunninghamia konishii in Taiwan. AS has been reported to have potential therapeutic effects on different diseases, including diarrhea, abdominal pain, and hypertension. AS has been reported to have anticancer effects on numerous cancer types, such as ovarian carcinoma and triple-negative breast cancer. Our previous studies demonstrated that antrocins and triterpenoids are possibly bioactive compositions. However, the effects of AS on prostate cancer remain unknown. Therefore, we investigated the role of AS in prostate cancer growth, apoptosis, and cell cycle regulation. The results showed that AS extracts significantly inhibited the proliferation of prostate cancer LNCaP cells in a dose-dependent manner and increased the levels of apoptotic markers (cleaved PARP and cleaved caspase 3/8/9). In addition, the cell cycle-related proteins CDK1, CDK2, CDK4, and their respective specific regulators Cyclin B1, Cyclin A, and Cyclin D were also affected. Besides, AS treatment increased p53 protein levels and slowed its degradation in LNCaP cells. Interestingly, we found that AS treatment reduced both total protein and Ser-81 phosphorylation levels of the androgen receptor (AR). Notably, the increase of nuclear p53 was accompanied by the down-regulation of AR, suggesting a reverse regulation between p53 and AR in LNCaP cells was triggered by AS treatment. These findings suggest that AS extracts trigger the apoptosis of prostate cancer cells through the reverse regulation of p53 and AR and elucidate that AS extracts might be a potential treatment for androgen-dependent prostate cancer in the near future. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore whether dual‐lumen power injectable peripherally inserted central catheters (PICCs) could be effectively and safely applied in allogeneic hematopoietic stem cell transplantation (allo‐HSCT) and for serum cyclosporine level monitoring. Background: Compared to conventional central venous access devices, PICC provides a feasible route not only for fluid infusion, but also for blood sample collection in patients undergoing oncological treatments. Design: A prospective observational study was conducted according to the STROBE guidelines. Methods: We prospectively evaluated the applications and complications of power injectable PICCs in 52 consecutive allo‐HSCT recipients. We also compared the cyclosporine levels in 188 paired blood samples, simultaneously obtained via power injectable PICCs and percutaneous venous puncture, to investigate whether power injectable PICC is a feasible route for cyclosporine concentration monitoring in allo‐HSCT. Results: The median PICC placement duration was 29 days. The insertion‐site blood oozing and central line‐associated bloodstream infection rates were 36.5% (19/52) and 26.9% (14/52), respectively, indicating the feasibility of these PICCs for various applications in allo‐HSCT. No power injectable PICC‐related thrombotic adverse events were identified; 90.4% (47/52) of cases with power injectable PICC removal occurred because of lack of medical utility, suggesting that power injectable PICC‐related complications were manageable. However, cyclosporine levels in samples obtained via these PICCs were significantly higher than those in samples obtained via percutaneous venous puncture (261.5 ± 139.2 vs. 232.4 ± 253.6 ng/ml; p = 0.019 [set 1]; 254.8 ± 89.3 vs. 225.1 ± 233.3 ng/ml; p<0.001 [set 2]; 283.6 ± 103.9 vs. 238.0 ± 254.7 ng/ml; p = 0.006 [set 3]; 291.0 ± 94.9 vs. 266.0 ± 274.7 ng/ml; p = 0.016 [set 4]). Conclusion: The power injectable PICC is a feasible venous access device for allo‐HSCT. Relevance to clinical practice: The dual‐lumen power injectable PICCs provided a reliable access for blood sample collection, decreasing the number of blind percutaneous venous punctures in allo‐HSCT. However, its application in cyclosporine level monitoring needs further investigation. [ABSTRACT FROM AUTHOR]

To compare the test–retest reliability and random measurement errors of the Barthel Index (BI) and modified Barthel Index (MBI) in patients with chronic stroke. The intraclass correlation coefficient (ICC) and the minimal detectable change (MDC) were applied respectively to examine the test–retest reliability (about 2 weeks apart) and the random measurement errors. The MDC% was used to adjust the cut-off score for determining whether a real change had been achieved, if heteroscedasticity existed. A total of 60 patients participated. The BI and MBI both had high ICCs (0.94 and 0.94, respectively) with small MDCs (16.2 and 15.4, respectively) and MDC%s (21.2% and 19.0%, respectively), indicating that both measures have comparable reliability in repeated assessments. However, moderate associations (r = −0.47 for the BI and −0.59 for the MBI) were found between the means of tests and retests and the absolute values of change scores, indicating heteroscedasticity. These findings suggest that a fixed MDC value is not appropriate for determining the real change in both measures because the amount of random measurement error varies with the patients' ADL function. The MBI, which showed excellent test–retest reliability and relatively lower random measurement error than the BI, appears to be a better ADL measure. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error. The MBI is recommended for clinical and research applications because it has better test–retest reliability and relatively lower random measurement error than those of the original BI. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error when the MBI or the BI is used. [ABSTRACT FROM AUTHOR]

Little is known about whether venous thromboembolism (VTE) causes worse critical limb events in populations with atrial fibrillation (AF). A retrospective cohort study using claims data from Taiwan's National Health Insurance program between 2001 and 2013 compared AF patients with or without VTE. Outcomes were percutaneous transluminal angioplasty (PTA), amputation, systemic thromboembolism, all-cause mortality, cardiovascular death, ischemic stroke, and acute myocardial infarction. Patients (n = 316,817) with newly diagnosed AF were analyzed; of those, 2514 (0.79%) had VTE history. After inverse probability of treatment weighting, a history of VTE was significantly associated with higher risks of PTA (3.3 vs 2.2%; subdistribution hazard ratio [SHR] 1.47; 95% confidence interval [CI] 1.17–1.84); above knee amputation (0.7 vs 0.3%; HR 2.15; 95% CI 1.10–4.21); systemic thromboembolism (5.8 vs 3.9%; SHR 1.48; 95% CI 1.21–1.80); all-cause mortality (53 vs 46.4%; HR 1.20, 95% CI 1.12–1.29); and cardiovascular death (34.8 vs 29.4%; HR 1.25, 95% CI 1.14–1.36). In conclusion, VTE might increase the risk of critical lower limb events (PTA and above-knee amputation), systemic thromboembolism, and mortality in the AF population. However, current data cannot confirm a causal relationship between VTE and clinical outcomes in this population. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate the effect of an enterovirus board game on improving knowledge of enterovirus for elementary school children in Taiwan. Design: A pilot study with a one‐group pretest‐posttest design. Sample: Using convenience sampling, 27 children were recruited from a single elementary school in Taiwan in June 2020. Measurements: Demographic data were collected and the children completed an enterovirus knowledge questionnaire. Statistical analyses included descriptive statistics, McNemar test, and Wilcoxon test. Intervention: Each experimental group of four to five children participated in a 40‐min enterovirus board game. Results: After using the board game, the children had significantly higher mean scores for enterovirus knowledge. Specifically, the children had a higher proportion of correct answers for seven questions related to enterovirus after playing the game compared to before. Conclusions: Board games designed for elementary school‐aged children can support public health education and help prevent outbreaks of infectious diseases such as enterovirus. [ABSTRACT FROM AUTHOR]

Background: Healthy aging with dignity and aging in place are important for Taiwanese individuals. Although Taiwan did not experience COVID-19 outbreaks prior to May 2021, many older adults have been encouraged to stay at home since the beginning of the global pandemic in January 2020. Such shelter-in-place recommendations have resulted in significant lifestyle changes, limiting activities associated with aging with dignity such as exercise and community engagement. Few studies have explored how to promote or maintain holistic health practices and physical fitness in older adults residing in rural communities during the COVID-19 pandemic. This pilot study aimed to establish an interdisciplinary collaboration with community care workers (CCWs) and evaluate the impact of an innovative summer camp (ISC) program for older adults residing in rural areas. Methods: A quasi-experimental pre-post-test design with an interdisciplinary collaborative approach was implemented. The ISC program was based on a standardized protocol of modified Baduanjin exercise combined with three recreational breathing games. Participants were recruited from three community centers around the western coastal region of Yunlin County between June and August 2020. The ISC program was designed and executed by a nurse-led health promotion research team that collaborated with trained CCWs for 90 min per day, five days per week, for 12 weeks. Participants and CCWs wore facemasks during all activities. Paired t-test was used to measure changes in physical biomarkers, pulmonary lung function, and health-related fitness changes. Results: Sixty-eight participants completed the ISC program. The ISC program significantly improved the participants' physiological biomarkers and health-related fitness, including reduced body weight, waistline, and systolic blood pressure, and increased forced vital capacity, biceps arm flexion, and ability to sit and stand from a chair, step with a knee up in situ, and stand on one foot with eyes open. Most participants reported that they felt happy, satisfied, and hoped that this program would be continued in their community center. Conclusions: This interdisciplinary, collaborative ISC program improved physical biomarkers and health-related fitness in older adults. Despite limitations, results strongly suggested that primary healthcare providers and CCWs can employ the described ISC program to promote wellness in older adults. [ABSTRACT FROM AUTHOR]

To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function. Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale. Eighty-eight patients and 16 therapists participated. The correlations (r= 0.64 and 0.65; R-squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those (r = 0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations (r = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations (r = 0.12–0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system. The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings. Neither therapist- nor patient-reported balance function and change could effectively reflect the scores resulting from objective assessments. The routine use of objective balance assessments should not be replaced by therapists' subjective judgments. Communications regarding the balance function measured by objective assessments between therapists and patients can help patients to better understand their balance function and progress. [ABSTRACT FROM AUTHOR]

In response to population aging, there is an increase in demand for the coverage of and the necessary services provided by home health care and home care for socially vulnerable groups. This study explored whether the instructions and recommendations offered by pharmacists during their home visits play a key role in the factors that influence a patient's prognosis. A home health care database was analyzed in this study. The subjects received home visits from pharmacists. There were 262 subjects following the exclusion of closed cases that were not due to improved outcomes or death. To validate the research framework, multiple regression analysis was employed for model validation. The level of consciousness and Barthel Index score mediated the effects of multimorbidities, and these mediating effects significantly affected patient outcomes (improvement or death). The medication-related knowledge and instructions for correct medication use provided by pharmacists did not exhibit significant moderating effects on the influence of a patient's level of consciousness and Barthel Index score on their improved outcomes. However, the pharmacists' provision of instructions and recommendations for patient self-care had significant moderating effects on the path by which patients with multimorbidities experienced improved outcomes through higher total Barthel Index scores. In comparison with physician home visits, which merely cover the treatments for diseases, pharmacists also play a vital role in home health care. Pharmacists provide patients with medication-related knowledge and instructions for correct medication use. This study addressed aspects that have not been considered in previous studies. [ABSTRACT FROM AUTHOR]

Background: Tyrosine kinase inhibitors (TKIs) have shown long‐term survival benefits in patients with chronic myeloid leukemia (CML). Nevertheless, significant concern has been raised regarding long‐term TKI‐associated vascular adverse events (VAEs). The objective of this retrospective cohort study was to investigate the incidence of VAEs in Taiwanese patients with CML treated with different TKIs (imatinib, nilotinib, and dasatinib) as well as potential risk factors. Materials and Methods: We conducted a retrospective cohort study using the Taiwan Cancer Registry Database and National Health Insurance Research Database. Adult patients diagnosed with CML from 2008 to 2016 were identified and categorized into three groups according to their first‐line TKI treatment (imatinib, nilotinib, and dasatinib). Propensity score matching was performed to control for potential confounders. Cox regressions were used to estimate the hazard ratio (HR) of VAEs in different TKI groups. Results: In total, 1,111 patients with CML were included in our study. We found that the risk of VAEs in nilotinib users was significantly higher than that in imatinib users, with an HR of 3.13 (95% confidence interval (CI), 1.30–7.51), whereas dasatinib users also showed a nonsignificant trend for developing VAEs, with an HR of 1.71 (95% CI, 0.71–4.26). In multivariable logistic regression analysis, only nilotinib usage, older age, and history of cerebrovascular diseases were identified as significant risk factors. The annual incidence rate of VAEs was highest within the first year after the initiation of TKIs. Conclusion: These findings can support clinicians in making treatment decisions and monitoring VAEs in patients with CML in Taiwan. Implications for Practice: This study found that patients with chronic myeloid leukemia (CML) treated with nilotinib and dasatinib may be exposed to a higher risk of developing vascular adverse events (VAEs) compared with those treated with imatinib. Thus, this study suggests that patients with CML who are older or have a history of cerebrovascular diseases should be under close monitoring of VAEs, particularly within the first year after the initiation of tyrosine kinase inhibitors. Concerns have been raised regarding long‐term adverse events related to tyrosine kinase inhibitor (TKI) treatment. This article reports on the incidence of TKI‐associated vascular adverse events in a cohort of Taiwanese patients with chronic myeloid leukemia. [ABSTRACT FROM AUTHOR]

Objective To investigate the autonomic nervous dysfunction in patients with Alzheimer's disease (AD) and its relationship with cognitive function. Methods A total of 160 AD patients were enrolled in Shanghai Jinshan Zhongren Aged Care Hospital from July 2020 to June 2021. Mini - Mental State Examination (MMSE), Montreal Cognitive Assessment - Basic (MoCA - B) and Scale for Outcomes in Parkinson's Disease - Autonomic (SCOPA - AUT) were used to assess the cognitive and autonomic nervous function of AD patients, and the occurrence of orthostatic hypotension (OH) in AD were evaluated with the lying and standing blood pressure testing. Spearman rank correlation analysis was used to analyze the correlation between autonomic nervous function and cognitive function. Results Compared with the mild AD group, the scores of MMSE, MoCA-B and their subitems were lower (P = 0.000, for all), and SCOPA - AUT score (P = 0.000) and its subitem of digestive system (P = 0.000), urinary system (P = 0.000) and body temperature (P = 0.001) were increased in the severe AD group. The incidence of OH was 32.22% (29/90). Spearman rank correlation analysis showed that the SCOPA-AUT sore (rs = - 2.980, P = 0.000; rs = - 3.580, P = 0.000) and its subitem of digestive system (rs = - 2.730, P = 0.000; rs = - 3.160, P = 0.000), urinary system (rs = - 3.000, P = 0.000; rs = - 3.240, P = 0.000) and body temperature (rs = - 0.244, P = 0.005; rs = - 3.270, P = 0.000) were negatively correlated with MMSE and MoCA - B scores. Conclusions The autonomic nervous dysfunction and its subitem of digestive system, urinary system and body temperature were significant correlated with the cognitive impairment in AD patients. However, there is a lower incidence of OH in AD. [ABSTRACT FROM AUTHOR]

Bone morphogenetic protein 6 (BMP6) is a regulatory peptide secreted by oocytes and granulosa cells that locally regulates folliculogenesis and follicular development. To determine BMP6 location, we studied BMP6 expression in human follicles using immunohistochemistry, real-time polymerase chain reaction (RT-PCR) and western blot analysis. RT-PCR was performed on 354 individual cumulus cell (CC) masses from 48 women to investigate the relationship between BMP6 mRNA expression in CCs and oocyte developmental potential. Results showed that BMP6 protein was mainly located in oocytes from preantral follicles and in granulosa cells from antral follicles. BMP6 mRNA expression was much higher in oocytes than in CCs and mural granulosa cells (mGCs) from preovulatory follicles (p < 0.01), and BMP6 protein level was higher in CCs than in mGCs (p < 0.05). BMP6 mRNA expression was higher in CCs from immature oocytes than in those from mature oocytes (p < 0.05). However, BMP6 mRNA expression in CCs was not associated with oocyte fertilization, embryo morphological grading, or implantation. In conclusion, BMP6 was mainly expressed in oocytes at all human follicular developmental stages and BMP6 mRNA expression in CCs may be negatively correlated with oocyte maturation. BMP6 expression could therefore be used as a biomarker of oocyte maturation. [ABSTRACT FROM AUTHOR]

Aim: To develop an instrument to investigate geropsychiatric psychological symptoms, health problem nursing knowledge (GPN‐K), geropsychiatric psychological symptoms and health problem nursing attitude scale (GPN‐A) in clinical practice for nursing students. Design: Instrument development and cross‐sectional study for psychometric testing. Methods: Construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), and internal consistency was calculated using Cronbach's α. Results: A total of 300 students have completed the questionnaires (85.71% response rate). The CFA of GPN‐K showed good fitness and validity. The Kuder‐Richardson 20 (KR‐20) value of the internal consistency reliability is 0.64. The GPN‐A overall content validity index is 0.95. A three‐factor structure was shown by exploratory factor analysis. The three factors are communication and care, helping others improve and problem evaluation tendency. The total variance explained is 59.01%. Cronbach's alpha of GPN‐A equals 0.84, which represents good internal consistency. [ABSTRACT FROM AUTHOR]

Aims: To identify different classes of change pattern/ trajectory of tobacco smoking behaviour after diagnosis of lung cancer using multi‐wave data and to explore factors associated with the class membership. Design: This is a multi‐wave observational study. Methods: Smoking behaviour data were collected at diagnosis and then every month for 6 months from 133 newly diagnosed people with lung cancer who had recently quit smoking or continued to smoke at diagnosis. These patients were recruited from three medical centres and data were collected from May 2014 to January 2017. Smoking behaviour was assessed based on patients' self‐reports on whether they smoked during the last month (yes/no) for a total of seven times. Mixture latent Markov model and logistic regression were used to analyse data. Results: Two latent classes of smoking trajectory were identified among recent quitters or current smokers of people with lung cancer, namely "perseverance for abstinence" and "indecisive for abstinence." Patients who were younger age (OR = 0.95, p = 0.026), exposure to second‐hand smoke (OR = 3.35, p = 0.012) and lower self‐efficacy for not smoking (OR = 0.96, p = 0.011) were more likely to belong to the class of "indecisive for abstinence." Conclusions: Heterogeneous classes of smoking trajectory existed in newly diagnosed people with lung cancer. The risk factors associated with a less favourable smoking trajectory can be incorporated into tailored smoking‐cessation programs for patients newly diagnosed with lung cancer. Impact: The dynamic trajectory of smoking behaviour had not been adequately explored among newly diagnosed people with lung cancer. Two classes of smoking trajectory and the predictors associated with the class membership were identified. These findings suggest that the diagnosis of cancer is a teachable moment for smoking cessation. Patients with younger age, lower self‐efficacy of not smoking and exposure to second‐hand smoke at home need special attention. [ABSTRACT FROM AUTHOR]

Aims : Many people work in agriculture and aquaculture. Owing to the specific working environments and climate changes, some literatures indicated that agriculture and aquaculture workers have cardiovascular diseases. It is important to attain sustainable development goal for these workers. However, few studies have investigated the factors associated with cardiometabolic risks and their perception among these workers. To explore the health needs and perception of cardiometabolic risks and associated factors among agriculture and aquaculture workers. Methods and results : A community-based, cross-sectional study design was used. This study was part of a nurse-led health-promotion programme designed to examine the health needs of agriculture and aquaculture workers between March and December 2019 in Yunlin County, Taiwan. This study was conducted in 30 rural villages. Health screening for five cardiometabolic risks was identified by a local hospital collaborated with the study. Six hundred and fifty-six participants with a mean age of 66 years completed this study. The mean number of cardiometabolic risk factors was 2.6, and the prevalence of metabolic syndrome was 54.1%. Most participants had misperceptions regarding their abnormal biomarkers. Age, education level, female gender, increased biomarker misperception (P < 0.001), and betel nut chewing (P < 0.01) were the determinant factors associated with cardiometabolic risks. Conclusion : These findings demonstrated a high prevalence of cardiometabolic risks, unhealthy behaviours, and misperceptions of cardiometabolic risk among the study population. This study highlights the need for clinicians and primary healthcare providers to attempt to increase the level of cardiometabolic risk literacy by initiating culturally tailored health-promotion programmes. [ABSTRACT FROM AUTHOR]

Background: Patients with traumatic injuries are often accompanied by emotional disorders, which seriously impede functional gains. The objective of this study was to identify the prevalence and risk factors associated with underlying anxiety and depression in orthopaedic trauma patients. Methods: From July 2015 to December 2017, all orthopaedic trauma patients were included in the retrospective study. Patients with conditions that might affect cognitive impairment were excluded from the study. Basic demographic data were collected. All patients were screened for emotional disorders on admission using a simple questionnaire called "Huaxi Emotional-Distress Index" (HEI). Bivariate analyses and logistic regression were used to identify the factors associated with a HEI score of > 8. Results: One hundred and sixty-two patients (8.1%) had a HEI score of > 8. About 1.0% of enrolled patients had severe emotional disorders (HEI score ≥ 17). The reasons caused by emotional disorders in patients with orthopaedic trauma were a higher Injury Severity Score (ISS), a higher visual analogue score (VAS) and type of surgery. On logistic regression, marital status was a protective factor for emotional disorders, while VAS and ISS were the risk factors for emotional disorders. Conclusions: Although a significantly low percentage of orthopaedic trauma patients in our setting have emotional disorders, traumatic orthopaedic surgeons still need to pay attention to the risk of emotional disorders and integrate effective screening tools into clinical practice to screen for these factors and stratify emotional disorders. Appropriate targeted psychological intervention and treatment should be adopted according to the stratification of emotional disorders. [ABSTRACT FROM AUTHOR]

Background: Sedentary behaviours may be related to factors such as self-efficacy, mood and social support. However, there is a paucity of longitudinal follow-up studies examining factors related to sedentary behaviour from physical-psychosocial perspectives in patients with heart failure. Aims: The purpose of this study was to explore the multidimensional associated factors and impacts of sedentary behaviour in heart failure patients. Methods: A longitudinal design was used. A convenience sample of 128 heart failure patients recruited from two large medical centres in northern Taiwan was obtained. Patients were interviewed with structured questionnaires to assess physical activity, symptom distress, exercise self-efficacy, anxiety and depression, social support, sleep quality and quality of life before discharge and at 3 and 6 months after discharge. Results: Heart failure patients reported low physical activity and tended to be sedentary. Sedentary behaviour was gradually reduced from hospitalization to 6 months after discharge. Sleep quality, quality of life, analgesic use, symptom distress and exercise self-efficacy were significant associated factors that explained 42.1–51% of the variance in sedentary behaviour. Patients with high sedentary behaviour had significantly greater depression and poorer sleep and quality of life than those with low sedentary behaviour at hospitalization and showed a significant improvement in depression at 3 and 6 months after discharge. Conclusion: Sedentary behaviour is common in heart failure patients and has impacts on depression and quality of life. An appropriate physical activity programme focusing on disease self-management and enhancing self-efficacy is needed for heart failure patients to improve their sedentary behaviour and quality of life. [ABSTRACT FROM AUTHOR]

Aims: To identify key factors influencing institutional nurses' self‐perceived competencies in spiritual care. Background: In the past decade, interest in spiritual care has been increasing; however, in long‐term care facilities, limited knowledge is available about nurses' competencies in spiritual care. Methods: The cross‐sectional study was conducted with 202 nurses in 11 long‐term care facilities. Data were collected in a survey using the Spirituality and Spiritual Care Rating Scale, the Nurse Spiritual Care Therapeutics Scale, the Spiritual Care Competence Scale and demographic questions. Data were analysed using stepwise linear regression. Results: Study findings revealed that nurses' perceptions of spirituality and spiritual care, frequency of spiritual care provision and self‐satisfaction with the spiritual care given all significantly predicted overall spiritual care competence, which together explain 58% of the total variance. Conclusions: Improving nurses' perceptions of spirituality and spiritual care and encouraging the performance of spiritual care may be an effective pathway to enhance the spiritual care competence of institutional nurses. Implications for Nursing Management: Additional continuing education on spiritual care topics and the establishment of clear guidance and support from institutional administrators are required to enable nurses to deal with spiritual issues as they arise and improve the quality of holistic care. [ABSTRACT FROM AUTHOR]

Self‐management helps patients understand their illnesses and learn about disease‐related skills so they can better manage their situation. However, published studies on the effectiveness of self‐management for chronic obstructive pulmonary disease (COPD) are heterogeneous. Quasi‐experimental design was used to investigate the effectiveness of a self‐management program in self‐care efficacy and quality of life in patients with COPD. Sixty participants who had experienced COPD were assigned to control group (usual care) or experimental group (self‐care program) (1:1 ratio) according to a purposeful sampling at a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale, the Clinical COPD Questionnaire were used to analyze data. The Medical Research Council dyspnea scale was more significant improvement in the 2 months after discharge in the experimental group than in the control group. The COPD Self‐Efficacy Scale and Clinical COPD Questionnaire scores in the experimental group within 3 months after discharge were significantly improved compared with the control group. These findings demonstrate the application and initial effect of this self‐management program. [ABSTRACT FROM AUTHOR]

The prevalence of metabolic syndrome and its components continue to increase among patients with serious mental illness. This cross‐sectional study investigated whether metabolic syndrome prevalence and risk factors differ between male and female patients with serious mental illness. In total, 260 eligible patients were recruited from two hospitals. The data on demographic characteristics, lifestyle behaviour factors, biochemistry, and anthropometry were collected. Analyses were performed using multivariate logistic regression. Metabolic syndrome prevalence was 40.8% (35.1% in men and 46.8% in women). Among patients aged 40–49 years, metabolic syndrome prevalence was higher in men; however, the trend was reversed among patients aged 50 years or older. Notably, gender‐specific metabolic syndrome risk factors were observed. In men, they included low education level, high body mass index (BMI), prolonged illness, comorbid physical illness, and diagnosis of bipolar disorder, whereas they included being married, old age, and high BMI in women. Our findings suggest that mental health professionals should consider the gender‐ and age‐based metabolic syndrome prevalence trend in patients with serious mental illness when designing interventions for the study population to minimize metabolic syndrome prevalence. [ABSTRACT FROM AUTHOR]

Purpose: To explore the prevalence of hepatitis C virus (HCV) infection as well as the levels of liver health literacy and association with the health status of people with HCV through the nurse‐led community health development goal of global elimination. Methods: A community‐based, cross‐sectional study was conducted between July 2018 and June 2019 in coastal Western Yunlin County, Taiwan. This study was conducted at five townships, and serum HCV antibody (anti‐HCV) screening was used for the identification of potentially infected people by a collaborating local hospital. Results: Of the 1,963 adults from rural areas enrolled in this study, 321 (16.4%) were anti‐HCV positive, 237 (73.8%) reported that they were unaware of their HCV positivity, and none of them were provided information on direct‐acting antiviral agent therapy. The levels of anti‐HCV positivity were higher among female patients (p <.05), elderly people (p <.001), those with a low education level (p <.001), and those from the Sihu Township within Yunlin County (p <.001). Participants with anti‐HCV positivity tended to have lower intakes of vegetables (p <.01) and fruit (p <.05), a greater number of comorbidities (p <.05), as well as a greater incidence of abnormal liver (p <.001) and renal function (p <.001) compared to those with anti‐HCV negativity. Multivariable linear regression analysis showed that the presence of HCV infection and a greater number of metabolic syndrome components were associated with poor liver and renal function. Conclusions: These findings showed a high prevalence of HCV infection among adults living in rural areas, who had low literacy levels on hepatitis, unhealthy lifestyles, and abnormal liver and renal function. Clinical Relevance: Clinicians and primary healthcare providers should initiate efforts to increase the levels of liver health literacy by increasing the accessibility to infection confirmation tests and reducing the number of barriers to the reception of antiviral treatment. [ABSTRACT FROM AUTHOR]

The labor force participation rate for adults aged 55 years and older has increased nearly 10% over the past two and a half decades. As workers age, they frequently experience increased chronic health conditions and impaired sleep, which may negatively influence their self-rated health (SRH) and work performance. This study aimed to examine the associations between nonrestorative sleep (NRS) and work performance (i.e., difficulty concentrating or having lower productivity at work) and associations between demographic and sleep characteristics with SRH in middle-aged workers. We conducted a secondary data analysis among working middle-aged adults 50 to 65 years of age (N = 392) from the 2008 Sleep in America Poll. Respondents frequently reported impaired sleep such as frequent insomnia symptoms, NRS, and short sleep duration. Nonrestorative sleep was associated with decreased work performance such as trouble organizing work, doing work over due to mistakes, and lower productivity. Nonrestorative sleep and short sleep duration were significantly associated with lower SRH. Strategies for the early detection of impaired sleep and implementation of interventions to improve sleep may improve SRH and work performance in working middle-aged adults. [ABSTRACT FROM AUTHOR]

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Background: Individuals with disabilities have health needs similar to the general population. Smoking and metabolic syndrome have emerged as major cardiovascular risks that contribute to systemic inflammation and mortality. However, few studies have focused on the association between smoking and cardiometabolic risks in adult men with disabilities. Aims: This study explored the prevalence of smoking and its association with cardiometabolic risk and associated factors among male adults with disabilities. Methods: This study was part of a nurse-led health-promotion program designed to examine the health needs in health programs for adults with disabilities. A community-based, cross-sectional study was conducted between July 2013–December 2014, in Chiayi County, Taiwan. Results: Of the total of 964 male participants enrolled in this study, 874 (90.7%) participants had complete data sets. The prevalence of cigarette smoking and metabolic syndrome were 42%, and 33.3%, respectively. More than half (62.7%) had high blood pressure and 43.5% had central obesity. Compared with non-smokers, smokers tended to engage in less frequent regular exercise (p<0.001), eat fewer vegetables and fruit (p<0.05), and drink less water (p<0.05). After adjusting for potential confounding variables, multivariable logistic regression analysis showed that smoking was an independent factor for cardiometabolic risk. Conclusion: The present findings show a high prevalence of cigarette smoking, unhealthy lifestyle, and cardiometabolic risk among adult men with disabilities. Clinicians and primary healthcare providers should reduce the consequences thereof by initiating innovative health promotion programs. [ABSTRACT FROM AUTHOR]

Background: Lifestyle is among the most important factors affecting individual health status. Limited access to health information may limit the ability of people with visual impairment or blindness to practice healthy lifestyles. However, no studies have investigated how lifestyle practices affect health specifically in visually impaired and blind populations. Purpose: The aim of this study was to investigate the lifestyle behaviors of visually impaired and blind massage therapists (VIBMTs) in Taiwan. Methods: This exploratory study used a purposive sampling technique to recruit 50 VIBMTs who were employed at massage stations in southern Taiwan. All of the participants completed the Health-Promoting Lifestyle Profile II (HPLP-II) and a survey of demographic characteristics. Descriptive and inferential statistical tests, including the Mann–Whitney U test and the Kruskal–Wallis H test, were used. Statistical significance was defined as p <.05 in two-tailed tests. Results: Fifty participants completed both the HPLP-II and the demographic survey. The mean subscale score for the HPLP-II was 2.52 ± 0.37. The lowest scores were on the physical activity (2.09 ± 0.67) and nutrition (2.35 ± 0.39) subscales, and the highest scores were on the spiritual growth (2.89 ± 0.56) and interpersonal relations (2.79 ± 0.46) subscales. Scores on the stress management and physical activity subscales were significantly higher in men than in women (p <.05). In addition, mean HPLP-II scores were significantly higher in VIBMTs who exercised regularly compared with those who did not (p <.05). Compared with nonsmokers, current smokers had significantly higher scores on the stress management subscale (p <.05). Conclusions/Implications for Practice: The low physical activity scores in this population may be improved by developing physical activity programs for the home and workplace and by establishing community recreational and exercise facilities for visually impaired populations. The low scores for nutrition may be improved by establishing nutrition education programs that are designed specifically for VIBMTs to increase their consumption of fresh produce and other healthy foods and by requiring food manufacturers to use labels that may be easily read or understood by visually impaired populations. [ABSTRACT FROM AUTHOR]

Objective. This review is to assess the efficacy and safety of acupotomy therapy in chronic nonspecific neck pain. Methods. We searched six computerised databases. Randomized controlled trials incorporating acupotomy therapy alone or combined with other conventional treatments for chronic nonspecific neck pain were included. Two reviewers screened each literature and extracted data independently according to Cochrane Reviews’ Handbook (5.1). The Cochrane Collaboration’s RevMan 5.3 software was applied for meta-analysis. Results. A total of ten trials involving 433 patients were enrolled. The pooled analysis indicated that acupotomy therapy showed a significant improving short-term and long-term effect on effective rate and cure rate. Meta-analysis demonstrated that acupotomy therapy group was superior to control group in restoring cervical lordosis and debasing VAS score. The result of continuous data did not support statistical significance of acupotomy therapy in adjusting clinical symptom score. For adverse events, acupotomy group did not reveal obvious superiority compared to control group. Conclusions. Acupotomy therapy may be beneficial to chronic nonspecific neck pain patients. To strengthen supportive evidence, future, more rigorously designed clinical trials, adequate adverse events, and follow-up project are recommended. [ABSTRACT FROM AUTHOR]

Adolescent obesity is a crucial public health concern, and understanding its risk factors can facilitate the establishment of prevention policies. In this study we investigated the prevalence of adolescent obesity in Taiwan, determined the influential factors, and compared the prevalence of obesity in our study population with international indices. The cross‐sectional study was an analysis of data from the 2010–2011 Nutrition and Health Survey in Taiwan, an anthropometric measurement and questionnaire survey of adolescents aged 11–18 years. Our sample was 1,826 adolescents (910 males and 916 females). Data were analyzed using logistic regression modeling. Based on body mass index standards specific to Taiwan norms, the prevalence of overweight and obesity in Taiwan adolescents was 12.4% and 16.8%, respectively. The prevalence was lower when international indices of overweight and obesity were applied. In logistic regression, obesity was linked to male gender, an obese father, overweight or obese mother, poor dietary attitudes, and perceived low dietary benefits. Monitoring and preventing adolescent obesity should focus on both adolescents and their parents. When planning behavioral change and education for adolescent obesity, health professionals and policy‐makers should view the family as a unit. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore cigarette smoking and health-promoting behaviours among disadvantaged adults before their tuberculosis diagnosis and after their tuberculosis treatment. Background. Although tuberculosis infection is associated with impaired immune function, healthy lifestyle habits can play a role in improving the immune system. However, limited research has explored the health-promoting behaviours and cigarette smoking habits among tuberculosis patients in Taiwan. Design. A cross-sectional retrospective study with a convenience sample. Methods. This study was conducted between May 2013-June 2014 with 123 patients at a rural district hospital in Chiayi County, Taiwan. Statistical analyses included descriptive statistics, univariate analysis and stepwise regression analysis. Results. Tuberculosis tended to be associated with less education, male sex, malnutrition, cigarette smoking and unhealthy lifestyle habits before the tuberculosis diagnosis. The percentage of smoking decreased from 46-9% before to 30-2% after the tuberculosis diagnosis. Body mass index and health-promoting behaviours also significantly improved after tuberculosis treatment. After controlling for potential confounding factors, multivariate analysis identified chronic disease and completed treatment as significant factors that were associated with current health-promoting behaviours. Conclusions. A high prevalence of cigarette smoking and low levels of health-promoting behaviours were observed before the diagnosis and during or after completing tuberculosis treatment. Relevance to clinical practice. This study's findings indicate the importance of promoting healthy lifestyle changes among tuberculosis patients; aggressive measures should be implemented immediately after the first diagnosis of tuberculosis. Furthermore, health promotion and smoking cessation programmes should be initiated in the general population to prevent activation of latent tuberculosis infection, and these programmes should specifically target men and rural residents. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore gene expression changes in fatigued men with nonmetastatic prostate cancer receiving localized external beam radiation therapy (EBRT). Methods: Fatigue was measured in 40 men with prostate cancer (20 receiving EBRT and 20 controls on active surveillance) using the Functional Assessment of Cancer Therapy–Fatigue (FACT-F). EBRT subjects were followed from baseline to midpoint and end point of EBRT, while controls were seen at one time point. EBRT subjects were categorized into high- and low-fatigue groups based on change in FACT-F scores from baseline to EBRT completion. Full genome microarray was performed from peripheral leukocyte RNA to determine gene expression changes related to fatigue phenotypes. Real-time polymerase chain reaction and enzyme-linked immunosorbent assay confirmed the most differentially expressed gene in the microarray experiment. Results: At baseline, mean FACT-F scores were not different between EBRT subjects (44.3 ± 7.16) and controls (46.7 ± 4.32, p = .24). Fatigue scores of EBRT subjects decreased at treatment midpoint (38.6 ± 9.17, p = .01) and completion (37.6 ± 9.9, p = .06), indicating worsening fatigue. Differential expression of 42 genes was observed between fatigue groups when EBRT time points were controlled. Membrane-spanning four domains, subfamily A, member (MS4A1) was the most differentially expressed gene and was associated with fatigue at treatment end point (r = −.46, p = .04). Conclusion: Fatigue intensification was associated with MS4A1 downregulation, suggesting that fatigue during EBRT may be related to impairment in B-cell immune response. The 42 differentially expressed fatigue-related genes are associated with glutathione biosynthesis, γ-glutamyl cycle, and antigen presentation pathways. [ABSTRACT FROM AUTHOR]

Aim This study examined the effect of underlying contextual factors on the intention to stay in nurses. Background Workplace promotion, social support, work stress, job satisfaction and organisation-based self-esteem (OBSE) are psychosocial factors influencing the intention to stay in nurses. However, few studies have analysed the relationships among these factors. Method A cross-sectional survey was conducted and a sample was recruited in convenience sampling method from a medical centre in Taiwan. A total of 791 nurses completed a self-report questionnaire over a 3-month period in 2013. Results Social support, work stress, job satisfaction and OBSE significantly affected the intention to stay in nurses. Furthermore, social support and job satisfaction showed a positive direct effect on the intention to stay and an indirect effect on the intention to stay; the indirect effect was mediated by OBSE. Conclusion Organisation-based self-esteem mediates the effects of social support and job satisfaction on the intention to stay in nurses. Implications for Nursing Management The results showing the influence of OBSE on the intention to stay in nurses can serve as insight for hospital managers to make decisions when encouraging and managing employees. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to (a) test the fit of the hypothesized model for new nurses' intent to leave and (b) determine the extent to which personal characteristics, work conditions, and work-related fatigue predict intent to leave among new nurses. Design and Methods This study was a cross-sectional survey study. A total of 162 new nurses were recruited. A hypothesized model was proposed for model testing. Structural equation modelling was used for data analysis. Findings Work conditions only had an effect through work-related fatigue on new nurses' intent to leave. Personal characteristics did not have a significant effect on new nurses' intent to leave. The final model showed a good fit. Work-related fatigue, work conditions, and health explained 65% of the variance in new nurses' intent to leave. Conclusions Work-related fatigue was a major determinant of new nurses' intent to leave. More attention should be paid to fatigue reduction strategies among new nurses. Clinical Relevance Work-related fatigue should be monitored, particularly for new nurses who work more than 10 hr per day and who have greater workloads. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prenatal exposure to perfluoroalkyl substances (PFAS) has been associated with lower birth weight in epidemiologic studies. This association could be attributable to glomerular filtration rate (GFR), which is related to PFAS concentration and birth weight. OBJECTIVES: We used a physiologically based pharmacokinetic (PBPK) model of pregnancy to assess how much of the PFAS-birth weight association observed in epidemiologic studies might be attributable to GFR. METHODS: We modified a PBPK model to reflect the association of GFR with birth weight (estimated from three studies of GFR and birth weight) and used it to simulate PFAS concentrations in maternal and cord plasma. The model was run 250,000 times, with variation in parameters, to simulate a population. Simulated data were analyzed to evaluate the association between PFAS levels and birth weight due to GFR. We compared simulated estimates with those from a meta-analysis of epidemiologic data. RESULTS: The reduction in birth weight for each 1-ng/mL increase in simulated cord plasma for perfluorooctane sulfonate (PFOS) was 2.72 g (95% CI: -3.40, -2.04), and for perfluorooctanoic acid (PFOA) was 7.13 g (95% CI: -8.46, -5.80); results based on maternal plasma at term were similar. Results were sensitive to variations in PFAS level distributions and the strength of the GFR--birth weight association. In comparison, our meta-analysis of epidemiologic studies suggested that each 1-ng/mL increase in prenatal PFOS and PFOA levels was associated with 5.00 g (95% CI: -21.66, -7.78) and 14.72 g (95% CI: -8.92, -1.09) reductions in birth weight, respectively. CONCLUSION: Results of our simulations suggest that a substantial proportion of the association between prenatal PFAS and birth weight may be attributable to confounding by GFR and that confounding by GFR may be more important in studies with sample collection later in pregnancy. [ABSTRACT FROM AUTHOR]

Stern's value-belief-norm ( VBN) theory of environmentalism suggests that perceiving adverse effects from global warming could promote mitigation behaviour. The VBN theory of environmentalism postulates a causal chain of five variables: values, the New Environmental (or Ecological) Paradigm ( NEP), awareness of consequences ( AC), ascription of responsibility ( AR) to self-beliefs, and personal norms ( PN). Given a limited number of studies with East Asian participants, this study examines the applicability of the VBN theory model in predicting pro-environmental behaviour in Taiwan to enhance the intercultural validation. A questionnaire study was conducted among 757 Taiwanese respondents. The results of structural equation modelling analysis and Sobel tests confirm the direct and mediatory effects of the causal sequence of the variables in the VBN theory of pro-environmental behaviour, with NEP, AC beliefs, AR beliefs, and PN all bearing a mediating relationship between their antecedent and outcome variables in the causal chain. We elucidate the research results of the intercultural validation of the VBN theory model in this empirical study to clarify pro-environmental behaviour. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare the influence of a systematic nursing intervention on primary caregivers' knowledge and skills about nasogastric tube feeding and the number of nasogastric tube-related complications with that of routine nursing instructions Background To ensure the quality of care and reduce the incidence of complications, it is crucial that primary caregivers receive comprehensive health education about nasogastric tube feeding before hospital discharge. Design A quasi-experimental research with pretest/post-test evaluations. Methods The control group included 127 inpatients whose caregivers received routine education about nasogastric tube feeding, while the experimental group included 106 inpatients whose caregivers received systematic nursing intervention including comprehensive educational pamphlets and video education. The evaluation questionnaire included demographic variables, a nasogastric tube care knowledge scale, and a nasogastric tube skills assessment scale. The post-test was administered after the caregiver performed nasogastric tube feeding for the first time, and complications were noted at follow-up within three months of discharge. Results In terms of post-test knowledge and skills, the experimental group scored significantly higher than the control group, despite no difference in the pretests. In addition, the incidence rates for constipation, diarrhoea and abdominal distention were lower in the experimental group. Conclusions Systematic nursing intervention, including comprehensive educational pamphlets and video education, significantly improved the knowledge and skills of primary caregivers for nasogastric tube feeding. The increased ability of caregivers may have contributed to less incidence of complication. Relevance to clinical practice The results of this study underlined the importance of developing nasogastric tube-related nursing interventions and educational strategies for clinical nurses, home care nurses and caregivers. The research tool used here may serve as a reference for assessing the technical operations of healthcare professionals and the knowledge and skills of caregivers. [ABSTRACT FROM AUTHOR]

Pin site infection is a common complication after fracture fixation and bone lengthening, and daily pin site care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and pin site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative pin site care methods of daily care or noncare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%, P = 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily care group versus the noncare group (70% versus 20%, P = 0.001). In the low-temperature season, the infection rate per patient was not significantly different in the daily care group versus the noncare group (10% versus 27.3%, P = 0.33). We recommend that careful monitoring of infection signs, rather than pin site cleaning, would be appropriate in the treatment of pediatric supracondylar humeral fractures, especially during the summer months. [ABSTRACT FROM AUTHOR]

Aims This study was designed to evaluate the efficacy of an aerobic exercise programme on fatigue for Taiwanese breast cancer women under radiotherapy (RT). Background Cancer-related fatigue has been widely reported by patients undergoing radiotherapy as strongly and profoundly interfering with their quality of life. Evidence has shown that exercise can be beneficial to patients with breast cancer. Design A quasi-experimental design was used. Methods Patients with early-stage breast cancer scheduled for radiotherapy were invited to participate. The first 28 women who agreed to participate were assigned to the intervention group with a six-week mild- to moderate-intensity aerobic exercise training programme during their radiotherapy. The next 30 women were assigned to the routine care control group without special exercise intervention. Fatigue was measured at pre-radiotherapy and weekly after starting radiotherapy for six weeks using the Taiwanese version of the Brief Fatigue Inventory. Results The mean age of these 47 women was 50·3 years (standard deviation = 9·5). The baseline fatigue severity for the intervention group and control group were 3·04 and 2·95 respectively; and the baseline fatigue interference for the intervention group and the control group were 3·48 and 3·55 respectively. The student t-test showed no group differences in baseline fatigue severity, fatigue interference, or haemoglobin levels. Multivariate analyses showed a significant group-by-time-interaction effect for fatigue severity and interference ( p ≦ 0·001); the fatigue severity and interference decreased significantly over time for women in the intervention group but increased over time for women in the control group. Conclusions The mild- to moderate-intensity aerobic exercise programme reduces the fatigue of Taiwanese women with breast cancer undergoing radiotherapy. The issues of cancer-related fatigue should also be discussed as they relate to other treatment modalities. Relevance to clinical practice Aerobic exercise intervention should be offered as an option for women with breast cancer to alleviate cancer-related fatigue when undergoing radiotherapy. [ABSTRACT FROM AUTHOR]