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This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.

Background: Urinary incontinence (UI) and poor sleep negatively affect health-related quality of life (HRQoL). This study explored the UI-related factors and the relationships between UI, sleep quality, and HRQoL. Methods: This cross-sectional study collected data from 237 women with type 2 diabetes. Multivariate logistic regression was conducted to identify the factors associated with UI. One-way analysis of variance was used to compare the mean sleep quality and HRQoL scores of women without UI and those who experienced UI of varying severities. Correlation coefficients were estimated, and multivariate linear regression was conducted to examine the relationships between UI severity, sleep quality, and HRQoL. Results: Of the 237 women, 115 (48.52%) experienced UI and 139 (58.65%) were poor sleepers. The three factors associated with UI were advanced age, a higher body mass index, and a history of vaginal delivery. Significant associations between UI severity and sleep quality and between sleep quality and HRQoL were revealed. UI severity and night-time voiding frequency were both associated with sleep quality. Conclusions: One factor associated with UI (body mass index) is modifiable. UI severity is associated with sleep quality as the possible influence of night-time voiding frequency on sleep quality has been considered.

Fish sex-determining mechanisms can be classified as genotypic (GSD), temperature (TSD), or genotypic plus temperature effects (GSD+TE). Previous studies have shown that culturing water temperature during thermosensitive periods (TSP) could affect the expression of many genes in the gonad in some fish. However, few studies have focused on gene expression changes in the brain after temperature treatment during TSP in fish species. In this study, three families were developed by crossing XX neomales with XX females and one of them was used for transcriptome analysis. The results showed that a total of 105, 3164 and 4666 DEGs were respectively obtained in FC (female control) vs. FT (high temperature-treated females at TSP), FC vs. MC (male control), and MC vs. FT comparison groups. By profiling analysis, we show that the mRNA expression levels of 16 differentially expressed genes (DEGs) exhibited significant downregulation or upregulation after high temperature treatment and reached a similar level as that in MC. Among the 16 DEGs, LOC100699848 (lysine specific demethylase 6A) and Jarid2 contained JmjC domain, showing the possible important role of JmjC domain in response to temperature treatment in Nile tilapia. Kdm6b (lysine demethylase 6B) and Jarid2 have been shown to play important roles in reptile TSD, showing the relative conservation of underlying regulation mechanisms between TSD in reptile and TSD or GSD+TE in fish species. Finally, the transcriptome profiling was validated by quantitative real-time PCR in nine selected genes. These results provide a direction for investigating the GSD+TE molecular mechanism in fish species.

To summary the clinical diagnosis and treatment of primary aldosteronism (PA) in West China Hospital (WCH) of Sichuan University during 2009-2018.This study enrolled the patients diagnosed as PA and admitted in WCH of Sichuan University from January 2009 to December 2018. The information of the patients including epidemiological and clinical data, diagnosis and treatment as well as therapeutic outcomes were collected and analyzed.A total of 853 patients with 1 248 diagnostic cases were included in the analysis, and the diagnosis cases of PA increased year by year from 2009 to 2018. Most patients (74.33%) were confirmed the diagnosis in the Department of Endocrinology and Metabolism and then admitted to the hospital. PA was more frequent in female than in male, with a ratio of female to male about 1.34∶1. Hypertension was the most common chief complaint, in contrast, the proportion of fatigue and/or numbness as the symptoms of hypokalemia was declining. More and more patients were diagnosed because of imaging examination founding adrenal incidentoma. After 2016, more and more patients were diagnosed by recumbent saline suppression test and captopril challenge test, and the number of adrenal venous sampling to classify PA subtypes was increasing to help choosing different treatment options. The proportion of surgical treatment decreased year by year, and more and more patients adopted medical treatment or transferred to surgery with combined treatment instead of simple operation.During the past 10 years, remarkable progress was made in the diagnosis and treatment of PA. Hypertension was the most important clinical manifestation of PA, so the screening of PA in hypertensive patients should be strengthened. Adrenal incidentaloma has become prevalent manifestation of PA with an increasing trend, which needs more attention in clinical practice.

Renal cell carcinoma (RCC) is one of the most common malignancies. The immunogenomic landscape signature significantly correlates with the progression and prognosis of RCC. Novel therapeutic targets and prognostic indices in RCC are highly desirable. The TCGA database enables comprehensive immunogenomic landscape analysis. Differentially expressed immune-related genes (IRGs) were obtained from TCGA and GO analyses, and KEGG pathway analyses were performed to explore their functions and molecular mechanisms. Multivariable Cox analysis was utilized to calculate the risk score of each patient and locate survival-associated IRGs, thereby constructing a novel immune-related gene-based prognostic index (IRGPI). The correlation between IRGPI and immune cell infiltration was also investigated. A total of 41 differentially expressed IRGs were notably related to prognosis in RCC. GO functions and KEGG pathway analyses demonstrated that these genes were primarily associated with the tumour immune response and cytokine-cytokine receptor interaction pathway. An IRGPI based on seventeen survival-associated differentially expressed IRGs was constructed and exhibited a moderate predictive value in the prognosis of RCC patients and a powerful identification ability in refining the risk stratification of RCC patients. A close correlation was found between IRGPI and specific clinicopathological parameters, including age, gender, pathological stage, tumour stage, lymph node metastasis and distant metastasis. A positive correlation was found between IRGPI and the infiltration levels of neutrophils, dendritic cells, CD8+ T cells and B cells. Our results demonstrated the clinical significance and potential function of IRGs, providing additional data for prognostic risk prediction and immunotherapeutic target selection in RCC.

The first aim of this study was to compare nighttime voiding frequency (nocturia), serum hemoglobin A1c level, peripheral neuropathy score, and global sleep quality score in younger (40 to65 years) versus older (≥65 years) women with type 2 diabetes mellitus (DM). Additional aims were to identify factors associated with clinically relevant nocturia (≥2 episodes/night) and to analyze relationships between nocturia frequency, glycemic control, peripheral neuropathy, and sleep quality in these women.Cross-sectional study.Participants were 118 women older than 40 years and with type 2 DM. Their mean age was 65.25 (SD = 9.66) years; the mean duration since diagnosis of type 2 DM was 10.96 (SD = 7.66) years. The study setting was 2 metabolism and endocrinology outpatient departments located in Taipei City and Taoyuan, Taiwan.Data were collected using a questionnaire that queried sociodemographic information, lower urinary tract symptoms, and sleep quality. We also assessed peripheral neuropathy and lower extremity edema and obtained pertinent information from participants' medical records. Independent t tests, multivariate logistic regression analyses, Spearman's rank correlation coefficients, and one-way analysis of variance were used to address the 3 study aims.Analyses found that older women (aged ≥65 years) had a significantly higher nighttime voiding frequency, a higher peripheral neuropathy score, and a higher sleep quality score than younger (40 to65 years) women. Multivariate logistic regression analyses identified 4 factors associated with clinically relevant nocturia advanced age, elevated hemoglobin A1c level, suspected peripheral neuropathy, and lower extremity edema. Significant correlation coefficients were found between nighttime voiding frequency and serum hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. Analyses also found that women with a greater nocturia frequency had higher hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores.Healthcare professionals should screen for nocturia in women with type 2 DM and provide appropriate management for those experiencing nocturia.

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.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.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.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.UI symptoms may lead to increased healthcare resource utilization in patients with UI.

Background Women with breast cancer experience a wide spectrum of symptoms after diagnosis and treatment. Symptoms experienced by this specific population might not be fully assessed using available traditional Chinese-language symptom measures. Objectives The aim of this study was to examine the latent constructs and psychometric properties of the Chinese Breast Cancer Prevention Trial (C-BCPT) Symptom Scale. Methods Two hundred women with breast cancer were recruited in Taiwan. Psychometric properties, including construct validity, internal consistency, and test-retest reliability, of the C-BCPT Symptom Scale were tested after translating the original instrument. Results A 21-item C-BCPT Symptom Scale, with 7 extracted factors accounting for 72.26% of the total variance, resulted from an exploratory factor analysis. Construct validity was confirmed by significant correlations between scores on the C-BCPT Symptom Scale and the Taiwan-version Short Form-36 Health Survey (r = -0.49 to -0.53)/Greene Climacteric Scale (r = 0.81). Reliability coefficients for the overall scale/6 extracted factors (Cronbach's α = 0.72-0.88) and test-retest reliability (intraclass correlation coefficients = 0.77-0.94) of the translated instrument were satisfactory, whereas 1 reliability coefficient for 1 extracted factor was inadequate (Cronbach's α = 0.57). Conclusion An interpretable structure with preliminary acceptable psychometric properties of the C-BCPT Symptom Scale was obtained; the C-BCPT can help traditional Chinese-speaking healthcare professionals perform adequate assessments of the symptoms experienced by women with breast cancer. Implications for practice The C-BCPT Symptom Scale can be used in clinical practice and research to assess symptoms experienced by this specific population or effects of related interventions.

The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia. We searched electronic databases for randomized controlled trials using trial sequential analysis (TSA) to evaluate the incidence of reduced rescue analgesics, shivering, pruritus, nausea and vomiting when applying adjuvant intrathecal meperidine. Twenty-eight trials with 2216 patients were included. Adjuvant intrathecal meperidine, 0.05–0.5 mg kg−1, significantly reduced incidence of shivering (relative risk, RR, 0.31, 95% confidence interval, CI, 0.24 to 0.40; TSA-adjusted RR, 0.32, 95% CI, 0.25 to 0.41). Intrathecal meperidine also effectively reduced need for intraoperative rescue analgesics (RR, 0.27, 95% CI, 0.12 to 0.64; TSA-adjusted RR, 0.27, 95% CI, 0.08 to 0.91) and the incidence of pruritus was unaffected (RR, 2.31, 95% CI, 0.94 to 5.70; TSA-adjusted RR, 1.42, 95% CI, 0.87 to 2.34). However, nausea and vomiting increased (RR, 1.84, 95% CI, 1.29 to 2.64; TSA-adjusted RR, 1.72, 95% CI, 1.33 to 2.23; RR, 2.23, 95% CI, 1.23 to 4.02; TSA-adjusted RR,1.96, 95% CI, 1.20 to 3.21). Under TSA, these results provided a sufficient level of evidence. In conclusion, adjuvant low dose intrathecal meperidine effectively attenuates spinal anaesthesia-associated shivering and reduces rescue analgesics with residual concerns for the nausea and vomiting.

Objectives The present study aimed to compare the effects of music and music video interventions on objective and subjective sleep quality in adults with sleep disturbances. Design A randomized controlled trial was performed on 71 adults who were recruited from the outpatient department of a hospital with 1100 beds and randomly assigned to the control, music, and music video groups. Interventions During the 4 test days (Days 2–5), for 30 min before nocturnal sleep, the music group listened to Buddhist music and the music video group watched Buddhist music videos. They were instructed to not listen/watch to the music/MV on the first night (pretest, Day 1) and the final night (Day 6). The control group received no intervention. Main outcome measures Sleep was assessed using a one-channel electroencephalography machine in their homes and self-reported questionnaires. Results The music and music video interventions had no effect on any objective sleep parameters, as measured using electroencephalography. However, the music group had significantly longer subjective total sleep time than the music video group did (Wald χ2 = 6.23, p = 0.04). Conclusion Our study results increase knowledge regarding music interventions for sleep quality in adults with sleep disturbances. This study suggested that more research is required to strengthen the scientific knowledge of the effects of music intervention on sleep quality in adults with sleep disturbances. (ISRCTN94971645)

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.

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.

To explore the anatomical features of the external branch of the superior laryngeal nerve (EBSLN) and determine an effective approach for its preservation during endoscopic thyroidectomy (ET).From January 2017 to December 2018, a total of 405 consecutive patients with thyroid disease were retrospectively analyzed. These patients were divided into the ET group and the open thyroidectomy (OT) group according to the surgical approaches. There were 195 cases in the ET group including 43 males and 152 females, and 210 cases in the OT group including 65 males and 145 females. The dissection process of EBSLN, detection rate, distribution of identification methods of the EBSLN and rate of voice change were recorded.There were 205 EBSLNs detected under direct vision in ET group for a detection rate of 88.0%, while 158 EBSLNs were detected under direct vision in OT group for a detection rate of 58.1%. But with the assistant of intraoperative neuromonitoring (IONM), the number of EBSLNs detected visually reached up to 220 in ET group and 226 in OT group, respectively, for a visual detection rate of 94.4% and 83.1%, respectively. There were significant difference in the rate of direct visual identification, total visual identification with IONM. Stratified risk estimation indicated that the tumor size and location were risk factors for the direct visual dissection of EBSLN. Stratified analysis by tumor size indicated that when tumor diameter was ≤ 4 cm, the incidence of vocal cord fatigue and total vocal changes in ET group was significantly lower than that in OT group.Recognition and exposure of the EBSLN can be facilitated by the magnification and focusing function of high-definition endoscopy and the advantage of a 30° variable angle. Full exposure of the sternothyroid-laryngeal triangle and fine dissection along the superior thyroid vessels is beneficial for recognizing the EBSLN.

Background Social support plays an important role in adolescents' mental health and well-being, and even more so for disaster survivors. To measure the level of social support, one needs an appropriate tool to produce valid and reliable results; therefore, we aimed to measure the invariance across gender groups, and analyze the construct validity and reliability of the Indonesian version of the Multidimensional Scale of Perceived Social Support (MSPSS), a social support measurement tool which was theoretically constructed and has been well validated in many countries with various cultures and backgrounds. Methods A school-based assessment was conducted in junior and senior high schools in a post-disaster setting in Yogyakarta Province, Indonesia. We analyzed 299 adolescent survivors of a volcanic eruption, aged 12~18 years who completed a 12-item Indonesian version of the MSPSS. Results The factorial validity confirmed the three-factor structure of the scale (Family, Friends, and Significant Others) which met all of the criteria of parameter indices and provided evidence of high internal consistency reliability. The three-level measurement of invariance, which consisted of configural, metric, and scalar invariance, also performed very well across gender groups with our data and corresponded to the recommended parameters. Our composite reliability values were all fine (>0.7) and indicated that the items in the same construct were strongly correlated and reliable. Conclusions The Indonesian version of the MSPSS was shown to be a valid, reliable, theoretically constructed, and applicable instrument for adolescent disaster survivors.

Objectives To compare the effects of a diabetes pay-for-performance (P4P) program on diabetes-related/nondiabetes-related healthcare utilization/expenses between participants who adhered to the program and those who did not, and explore factors related to program adherence. Design A secondary data analysis with a natural experimental design. Setting Taiwan's National Health Insurance claims database (2001–2011) of newly diagnosed patients with diabetes in 2001 was used for the analyses. Participants The database under analyses contained 119,970 patients who were newly diagnosed with diabetes in 2001. Longitudinal data from 2001 to 2011 were obtained. A sample of 5592 patients who were enrolled in the diabetes P4P program during 2003–2006 was identified. After a 3-year follow-up of the enrolled patients, 2647 (47.3%) of them adhered to the program. To minimize the differences between the characteristics of the patients who adhered to the program and those who did not, propensity score matching was adopted. A total of 5294 patients (adherence: 2647 vs nonadherence: 2647) were included for analyses. Measurements We estimated utilization/expenses of healthcare services for both groups at 6 time points and applied t tests to test each utilization and expense of healthcare services between the 2 groups. A repeated-measures analysis of variance was applied to examine changes in the annual diabetes-related healthcare service expenses and total annual expenses by group. Logistic regression models were used to examine factors related to program adherence. Covariates included participant age, gender, diabetes-related complications, Charlson Comorbidity Index, Continuity of Care Index, time since diagnosis of diabetes, hospitalization in the previous year, and location receiving healthcare services. Results Total annual healthcare expenses spent by the adherence group were significantly lower than those of the nonadherence group. Gender, continuity of care, time since diagnosis of diabetes, hospitalizations in the previous year, and location receiving healthcare services were factors related to program adherence. Conclusions Long-term, beneficial effects of the diabetes P4P program might have been present if patients had adhered to the program. Interventions and strategies which could improve program adherence and continuity of care are suggested to achieve optimal disease control and clinical outcomes.

The lack of a suitable assessment tool may limit optimal stress management and impair the health-related quality of life of patients undergoing hemodialysis. The purpose of the study was to examine latent constructs and psychometric properties of the Vietnamese Hemodialysis Stressor Scale (HSS-V). In total, 180 patients receiving hemodialysis were recruited. Psychometric properties of the HSS-V, including the construct validity, internal consistency, and test–retest reliability, were tested after the instrument translation. The exploratory factor analysis resulted in a 24-item HSS-V with four extracted factors, which explained 58.32% of the total variance. The construct validity was confirmed by significant negative correlations between scores on the HSS-V and Vietnamese-version Short Form-36. The internal consistency (Cronbach’s α = .82-.91) and test–retest reliability (intra-class correlations coefficient = .91-.94) of the 24-item HSS-V were satisfactory. A simple structure and preliminary acceptable psychometric properties of the HSS-V were established and can serve as a basis for further studies.

Aims and objectives To examine changes in patients' bowel function and to compare patients' outcome among different operation and treatment after rectal resection. Background Anal-preserving surgery is the trend of treatment of colorectal cancer and bowel function after surgery needs to be concerned. Design Prospective cohort study. Methods A total of 38 patients with convenience sampling were recruited from a teaching hospital. The low anterior resection syndrome (LARS) score was used to assess bowel function disturbances before discharge and at 1 week, 1 month and 3 months after discharge. We followed the STROBE checklist to ensure rigour in our study. Results Approximately half of the patients experienced major LARS, including daily stool frequency of more than seven times and stool clustering at least once a week. The LARS scores observed at 1 month after discharge were significantly higher than those observed before discharge. Patients who received intersphincteric resection had higher LARS scores compared with those who received other surgeries. Furthermore, patients who underwent concurrent chemoradiotherapy, operation (OP) and chemotherapy had the highest LARS scores compared with those who underwent only an OP. Conclusion The patients experienced varied intestinal dysfunction after surgery based on their treatment plan and surgical method. Nurses should provide individualised health education for these patients. Relevance to clinical practice A health education booklet is recommended to educate patients about LARS symptoms and the techniques to adapt in their daily lives after surgery.

To evaluate the effect of the clinical nursing path integrated with the holistic nursing on advanced schistosomiasis patients with ascites.A total of 226 advanced schistosomiasis patients with ascites were randomly divided into a control group and an experimental group (113 cases each group). The subjects in the experimental group were nursed by the clinical nursing path integrated with the holistic nursing, while those in the control group were nursed only by the holistic nursing. Then the clinical relevant indexes of the two groups were observed, and the quality of life of the patients before and after hospital discharge was assessed.The improvement rate, satisfaction degree, and awareness rate of health knowledge of the patients in the experiment group were 93.8%, 100% and 97.4%, respectively, which were significantly higher than those of the control group (allThe clinical nursing pathway integrated with holistic nursing can effectively improve the improvement rate and decrease the mortality of the advanced schistosomiasis patients with ascites; meanwhile, it can shorten the hospitalization time and save the hospitalization cost. Therefore, this nursing model is suitable for popularization and application in the treatment and nursing work of the advanced schistosomiasis assistance.

To analyze the change of endemic situation of schistosomiasis in Jingzhou City of Hubei Province, so as to provide evidence for the development of future control strategy.The data of endemic situation of schistosomiasis and the implementation of integrated control measures were collected and analyzed in the 9 counties (districts, cities) of Jing-zhou City from 2004 to 2014.The endemic situation of schistosomiasis appeared a decline year by year since 2004. The prevalence of humanThe implementation of the key schistosomiasis program and whole-county promotion and province-ministry joint integrated control program results in effective control of schistosomiasis in Jingzhou City. However, further control programs are required to consolidate the achievements, interrupt and eliminate schistosomiasis.［

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.

Aims and objectives The purpose of this study was to translate the Rowland Universal Dementia Assessment Scale into Chinese and to evaluate the psychometric properties (reliability and validity) and the diagnostic properties (sensitivity, specificity and predictive values) of the Chinese version of the Rowland Universal Dementia Assessment Scale. Background The accurate detection of early dementia requires screening tools with favourable cross-cultural linguistic and appropriate sensitivity, specificity, and predictive values, particularly for Chinese-speaking populations. Design This was a cross-sectional, descriptive study. Methods Overall, 130 participants suspected to have cognitive impairment were enrolled in the study. A test-retest for determining reliability was scheduled four weeks after the initial test. Content validity was determined by five experts, whereas construct validity was established by using contrasted group technique. The participants' clinical diagnoses were used as the standard in calculating the sensitivity, specificity, positive predictive value and negative predictive value. Results The study revealed that the Chinese version of the Rowland Universal Dementia Assessment Scale exhibited a test-retest reliability of 0·90, an internal consistency reliability of 0·71, an inter-rater reliability (kappa value) of 0·88 and a content validity index of 0·97. Both the patients and healthy contrast group exhibited significant differences in their cognitive ability. The optimal cut-off points for the Chinese version of the Rowland Universal Dementia Assessment Scale in the test for mild cognitive impairment and dementia were 24 and 22, respectively; moreover, for these two conditions, the sensitivities of the scale were 0·79 and 0·76, the specificities were 0·91 and 0·81, the areas under the curve were 0·85 and 0·78, the positive predictive values were 0·99 and 0·83 and the negative predictive values were 0·96 and 0·91 respectively. Conclusion The Chinese version of the Rowland Universal Dementia Assessment Scale exhibited sound reliability, validity, sensitivity, specificity and predictive values. Relevance to clinical practice This scale can help clinical staff members to quickly and accurately diagnose cognitive impairment and provide appropriate treatment as early as possible.

To explore whether the intake of dietary carotenoids could protect against skeletal fluorosis in Guizhou province in which coal-burning fluorosis is endemic.A case-control study of 196 patients with skeletal fluorosis and 196 age and gender-matched controls was conducted in Zhijin, Guizhou Province. Face-to-face interviews were conducted to assess habitual dietary intake using a 75-item food frequency questionnaire and various covariates with structured questionnaires. Urinary fluoride was measured using an ion-selective electrode method. The genotype of superoxide dismutase 2 (SOD2) rs11968525 was detected by TaqMan method.We observed significant dose-dependent inverse associations of skeletal fluorosis with intake of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids (P-trend = 0.002 to 0.018), whereas α-carotene and β-cryptoxanthin intakes were not found to be related to skeletal fluorosis, after adjustment for potential confounders. The adjusted ORs and 95% CI of skeletal fluorosis for the highest versus lowest quartile were 0.30 (0.10, 0.86) for β-carotene, 0.23 (0.08, 0.66) for lycopene, 0.26 (0.10, 0.75) for lutein/zeaxanthin and 0.34 (0.14, 0.74) for total carotenoids (all P-trend0.05). Stratified analyses showed that the protective effects of lutein/zeaxanthin and total carotenoids on skeletal fluorosis were more evident for individuals with the AG+AA genotypes of SOD2 (rs11968525).Increased intakes of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids are independently associated with a lower risk of coal-burning skeletal fluorosis. SOD2 (rs11968525) polymorphisms might modify the inverse associations between dietary carotenoids and skeletal fluorosis.

Communities of color or low socioeconomic status are disproportionately affected by metal exposure given spatial variability of the ambient levels of these contaminants. Despite this, there is little research characterizing metal concentrations in blood among disadvantaged populations in the U.S., especially among pregnant women who are particularly vulnerable and difficult to access. Thus, we conducted a pilot study among disadvantaged pregnant women in Houston, Texas to assess willingness to participate in key activities of an epidemiologic study and characterize exposures to 16 metals. Thirty-one women attending a Medicaid-serving prenatal clinic were included in this pilot study and completed an interviewer-administered questionnaire. We obtained and measured metal compounds in whole blood samples for 22 of these women during third-trimester prenatal visits. Median whole blood concentrations of Ni, As, Cd, and Pb were 27, 1.4, 0.6, and 6.3 µg/L, respectively. Most women were willing to participate in critical aspects of a research study, including wearing a personal air-sampling badge for 2-3 days (87.1%), receiving ultrasounds (83.9%), and providing blood draws (64.5%). Despite the small sample, our results provide evidence of women's metal exposure and their willingness to participate in future research studies to elucidate exposure pathways and explore related health effects experienced among this population of disadvantaged pregnant women.

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.This study was a cross-sectional, correlational study with data collected from 275 women with type 2 diabetes.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.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.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.Healthcare professionals should screen for nocturia and poor sleep and offer appropriate nonpharmacological lifestyle management, behavioral interventions, or pharmacotherapy for women with diabetes.

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. Language: en

Background Only a few studies exist on the resilience of divorced women. Furthermore, relevant instruments for assessing the resilience of divorced immigrant Southeast Asian women are rare. Accordingly, the aim of this study was to develop and examine a new Resilience Scale-Chinese version (RS-C) that is specific to divorced immigrant Southeast Asian women in Taiwan. Methods The study was conducted in two phases. In phase 1, 20 items were used to evaluate face and content validities. In phase 2, a cross-sectional study was conducted. In total, 118 immigrant women participated in this study and were recruited from three nongovernmental organizations providing services for immigrants in Taipei City and Miaoli and Chiayi Counties. Psychometric properties of the instrument (i.e., internal consistency, test–retest reliability, item-to-total correlation, construct validity, and convergent validity) were examined. Significance was set at p < 0.05 for all statistical tests. Results The final 16-item RS-C resulted in a three-factor model. The three factors, namely personal competence, family identity, and social connections, were an acceptable fit for the data and explained 54.60% of the variance. Cronbach’s α of the RS-C was 0.85, and those of its subscales ranged from 0.77 to 0.82. The correlation value of the test–retest reliability was 0.87. The RS-C was significantly associated with the General Self-Efficacy scale and the Chinese Health Questionnaire-12. Conclusion The RS-C is a brief and specific self-report tool for evaluating the resilience of divorced immigrant Southeast Asian women and demonstrated adequate reliability and validity in this study. This RS-C instrument has potential applications in both clinical practice and research with strength-based resiliency interventions. However, additional research on the RS-C is required to further establish its reliability and validity.

Background: Music therapy is increasingly used to help heal patients. However, there is a significant gap in the literature about nurses’ attitudes toward and need for education in music therapy for nursing practice. This cross-sectional study was conducted to describe nurses’ attitudes toward music therapy and determine their need for education in music therapy. Methods: Participants included 1,197 nurses who were recruited from hospitals in different regions of Taiwan. Results: Participants expressed positive attitudes toward music therapy. Most participants were willing to learn about music therapy. “Skill in using musical instruments” was the most frequently identified educational need. Further study of the discrepancy between the attitudes toward “performing music therapy” and “learning music therapy” is needed to clarify why nurses expected that they would receive no support for attending music therapy education. Conclusion: Given participants’ attitudes toward music therapy and their motivation for learning, nursing administrators and educators may consider developing policies to further the advancement of music therapy in educational programs and practice. J Contin Educ Nurs. 2013;44(12):544–552.

Background Few studies have examined the prevalence of food intake difficulties and their associated factors among residents with dementia in long-term care facilities in Taiwan. The purpose of the study was to identify the best cutoff point for the Chinese Feeding Difficulty Index (Ch-FDI), which evaluates the prevalence of food intake difficulties and recognizes factors associated with eating behaviors in residents with dementia. Methods and findings A cross-sectional design was adopted. In total, 213 residents with dementia in long-term care facilities in Taiwan were recruited and participated in this study. The prevalence rate of food intake difficulties as measured by the Chinese Feeding Difficulty Index (Ch-FDI) was 44.6%. Factors associated with food intake difficulties during lunch were the duration of institutionalization (beta = 0.176), the level of activities of daily living-feeding (ADL-Q1) (beta = -0.235), and the length of the eating time (beta = 0.416). Associated factors during dinner were the illuminance level (beta = -0.204), sound volume level (beta = 0.187), ADL-Q1 (beta = -0.177), and eating time (beta = 0.395). Conclusions Food intake difficulties may potentially be associated with multiple factors including physical function and the dining environment according to the 45% prevalence rate among dementia residents in long-term care facilities.

This study is designed to evaluate the relationship between endometrial thickness and clinical/biochemical parameters in women with chronic anovulation. One hundred and twenty women with ovulatory dysfunction were prospective included, endometrial thickness and endocrine and metabolic parameters were measured. The interval between the examination day and the day of the most recent menstrual bleeding (the anovulatory interval) for the studied subject was an average of 145 ± 186 days. The endometrial thickness averaged 7.1 ± 3.2 mm. Correlation analyses revealed that the endometrial thickness was positively correlated with body mass index but was not correlated with age, serum androgens, or estradiol (E2) levels. We further classified the subjects into two groups based on endometrial thickness: Group A, endometrial thickness

Background Research-based evidence supports the therapeutic use of music to improve the sleep quality measured by self-reported questionnaires. However, scientific knowledge of the effects of music measured using standard polysomnography in chronic insomnia adults is currently insufficient. Objectives The objective of this study was to evaluate the effect of soothing music on objective and subjective sleep quality in adults with chronic insomnia. Methods Fifty participants were enrolled in a randomized controlled trial conducted in the sleep laboratory of a hospital, with 25 participants allocated to the music group and 25 to the control group. For four days, the experimental group was exposed to soothing music selected by the participants or researchers for 45min at nocturnal sleep time, whereas the control group was not exposed to music. Sleep was measured using polysomnography (PSG) and self-reported questionnaires. A general estimating equation was applied to analyze the data. Results After controlling for baseline data, the music group had significantly better scores for rested rating ( p =0.01), shortened stage 2 sleep ( p =0.03), and prolonged REM sleep ( p =0.04) compared to the control group, shown by the generalized estimating equations. However, there was no evidence of the effectiveness of music on other sleep parameters as measured by PSG. Additional findings indicate no difference in sleep quality between those who listened to their own preferred music ( n =10) and those who listened to music selected by the researchers ( n =15). Conclusion The results contribute to knowledge of the effectiveness of music as a therapy to improve sleep quality in adults experiencing insomnia. Listening to soothing music at nocturnal sleep time improved the rested rating scores, shortened stage 2 sleep, and prolonged REM sleep, but has little effect on sleep quality as measured by polysomnography and self-reported questionnaires.

To examine the psychometric properties of the Chinese version of the Sleep-Associated Monitoring Index (SAMI) in Taiwanese haemodialysis patients.An instrument translation and validation study.A haemodialysis (HD) unit in a university-affiliated medical centre in northern Taiwan.206 patients who were 18 or above, diagnosed with end-stage renal disease and under maintenance HD twice or thrice a week, 3 h or more per session for more than 3 months.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.Eight subscales emerged from the principal component analysis. Individual with insomnia had significantly higher total SAMI scores (p0.001). The SAMI total score significantly correlated to the PSQI, BDI, and BAI (r=0.65, 0.67, 0.67; all p0.001). 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 (p0.001). The SAMI-Chinese demonstrated an area under the receiver operation characteristic curve of 0.771 (SE=0.044; 95% CI: 0.685-0.857; p0.001) 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.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.

Objectives Meta-analysis studies of specific types of support groups are limited. We conducted a review and assessment of the effectiveness of support groups for caregivers of demented patients, and examined the impact of support group characteristics. Methods A search of multiple, electronic databases including the Cochrane Library, Medline, PUBMED, and others was conducted; studies published between 1998 and 2009 were collected. Thirty quantitative journal articles that were true and quasi-experimental controlled trials on support groups for non-professional caregivers, including mutual support, psychoeducational, and educational groups were analyzed. Outcome indicators were psychological well-being, depression, burden, and social outcomes. Results Support groups showed a significant positive effect on caregivers' psychological well-being (Hedge's g = −0.44, 95% CI = −0.73, −0.15), depression (Hedge's g = −0.40, 95% CI = −0.72, −0.08), burden (Hedge's g = −0.23, 95% CI = −0.33, −0.13), and social outcomes (Hedge's g = 0.40, 95% CI = 0.09, 0.71). The use of theoretical models, and length and intensity of group sessions had a significant impact on the effect sizes for psychological well-being and depression. Ratio of female participation (for psychological well-being and depression) and average age (social outcomes) were significant predictor variables. Conclusions Support groups benefit caregivers and findings of this meta-analysis serve as immediate guidance for group facilitators. Future research should include additional outcome variables with our defined factors on effectiveness collected as demographic characteristic data for comparison. A more comprehensive understanding of the effectiveness of support groups is indicated to enhance outcomes for caregivers and patients. Copyright © 2011 John Wiley & Sons, Ltd.

Brain-derived neurotrophic factor (BDNF) is needed to support neuronal survival and differentiation. It also promotes synaptic remodeling and modulates the function of many other neurotransmitters. BDNF is implicated in major depression (MD), and to a lesser extent, in schizophrenia. In the current study, we examined BDNF polymorphisms (G-712A, C270T and Val66Met) in 202 patients with MD and 323 patients with schizophrenia. Results were compared to 346 healthy individuals. The analysis revealed a strong association between the G-712A genotype distribution and MD ( p = 0.0005). The frequency of the -712A allele was significantly higher in MD patients than in the healthy controls ( p = 0.0007). The -712AG heterozygote was associated with higher Hamilton score in MD patients. No association was found between schizophrenia and the three BDNF variants. These findings support an important role of G-712A polymorphism of BDNF in MD, and may guide future studies to identify genetic risk factors for MD.

Background Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL). Objectives To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS. Design This study was a cross-sectional, questionnaire survey. Settings Three medical centers and five regional hospitals in Taipei were selected randomly. Participants In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26–35 years of age (mean=31.02, SD=6.32), had normal body mass index, and had never given birth. Most nurses' bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate. Methods Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t -tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS. Results Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS. Conclusions Although most of the nurses in this study were young (≦35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses' possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses' physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.

Music has been found to improve depressive symptoms and relaxation. However, few studies related to this issue have been conducted using music videos (MVs). The aim was to compare the effects of stimulative and sedative MVs on depressive symptoms and physiological relaxation (i.e., electromyography, heart rate variability, and skin conductance) in older adults with depressive symptoms. Using a 2-week crossover design, interventions alternated between watching a stimulative and sedative MV and vice versa. Each intervention lasted for 30 minutes on 1 day during the first week, and was then alternated to another intervention for 1 day during the following week. Stimulative MVs were more effective in treating depressive symptoms than sedative MVs. Stimulative and sedative MVs had beneficial effects on depressive symptoms and physiological relaxation compared with baseline data. These findings add new knowledge to the literature for health care providers to improve psychophysiological health in older adults with depressive symptoms. [Res Gerontol Nurs. 2016; 9(5):233–242.]

Supplemental Digital Content is available in the text, Evidence regarding the association between body mass index (BMI) and mortality in TB patients is limited and inconsistent. We investigated the effect of BMI on TB-specific and non-TB-specific mortality in TB patients. All adult Taiwanese with TB in Taipei, Taiwan, during 2011 to 2012 were included in this retrospective cohort study. Multinomial logistic regression was used to evaluate associations of BMI with cause of death in TB patients. Of the 1608 eligible patients, 83.6% (1345) were successfully treated, 3.3% (53) died of TB-specific causes, and 13.1% (210) died of non-TB-specific causes. Mean age was 64.6 years, and 67.5% of patients were male. After controlling for potential confounders, underweight was significantly associated with higher risks of all-cause mortality (adjusted odds ratio [AOR], 1.66; 95% confidence interval [CI], 1.21–2.30), TB-specific mortality (AOR, 2.14; 95% CI, 1.18–3.89), and non-TB-specific mortality (AOR, 1.58; 95% CI, 1.11–2.25) during TB treatment, while overweight was not. When gender differences on the association of BMI with mortality were considered, underweight only significantly increased risks of TB-specific (AOR, 2.37; 95% CI, 1.19–4.72) and non-TB-specific mortality (AOR, 1.58; 95% CI, 1.05–2.37) during treatment in male patients, but not female subjects. The present findings indicate that underweight was associated with higher risks of TB-specific and non-TB-specific mortality during TB treatment, particularly in male patients.

This study of Taiwanese women investigated effects of pelvic floor muscle training (PFMT) on urinary incontinence (UI) severity and on participants' knowledge and attitudes regarding UI and PFMT. Of 114 participants in a 4-h PFMT program, 55 suffering from UI completed 2 questionnaires, 1 before and 1 after the program. Among them, 78% reported experiencing UI under increased abdominal pressure, and 82% had suffered the condition for more than 1 year. Participants achieved reductions in UI severity after PFMT; and the program produced a significant difference in their knowledge about, though not in their attitudes toward, both UI and PFMT.

Because autism spectrum disorders are neurodevelopmental disorders and patients typically display symptoms before the age of three, one of the key questions in autism research is whether the pathology is reversible in adults. Here we investigate the developmental requirement of Shank3 in mice, a prominent monogenic autism gene that is estimated to contribute to approximately 1% of all autism spectrum disorder cases. SHANK3 is a postsynaptic scaffold protein that regulates synaptic development, function and plasticity by orchestrating the assembly of post synaptic density macromolecular signalling complex. Disruptions of the Shank3 gene in mouse models have resulted in synaptic defects and autistic-like behaviours including anxiety, social interaction deficits, and repetitive behaviour. We generated a novel Shank3 conditional knock-in mouse model, and show that re-expression of the Shank3 gene in adult mice led to improvements in synaptic protein composition, spine density and neural function in the striatum. We also provide behavioural evidence that certain behavioural abnormalities including social interaction deficit and repetitive grooming behaviour could be rescued, while anxiety and motor coordination deficit could not be recovered in adulthood. Together, these results reveal the profound effect of post-developmental activation of Shank3 expression on neural function, and demonstrate a certain degree of continued plasticity in the adult diseased brain., National Institutes of Health (U.S.) (Grant R01MH097104)

Background The study compared the sensitivity, specificity, and diagnostic value of the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in screening for mild cognitive impairment (MCI) and dementia. Methods A cross-sectional descriptive design was used, and 142 participants were screened for MCI and mild dementia by using the MoCA and MMSE. The receiver operating characteristic curves and the cutoff scores with the largest area under the curve (AUC) were determined and compared to calculate the sensitivity, specificity, and diagnostic value (positive predictive value [PPV] and negative predictive value [NPV]). Results The optimal MoCA cutoff scores for MCI and dementia were 24 and 20, respectively. According to these scores, the sensitivities were 0.88 and 0.79, the specificities were 0.74 and 0.80, the AUCs were 0.91 and 0.87, the PPVs were 0.93 and 0.74, and the NPVs were 0.74 and 0.87, respectively. The optimal cutoff MMSE scores for MCI and dementia were 27 and 24, respectively. Hence, the sensitivities were 0.88 and 0.84, the specificities were 0.70 and 0.86, the AUCs were 0.88 and 0.89, the PPVs were 0.94 and 0.80, and the NPVs were 0.81 and 0.88, respectively. Conclusion In the Chinese population, the MoCA is more efficient in screening for MCI than for dementia, whereas the MMSE is more efficient in screening for dementia than for MCI. The MoCA and MMSE can be used by clinical staffs for quick and accurate cognitive impairment screening, thus facilitating early and appropriate clinical intervention and treatment.

The present authors examined the effects of listening to music on psychophysiological parameters (blood pressure, heart rate, and respiratory rate) during preoperative and postoperative days and determined whether listening to music could lower pain intensity and opioid dosage during postoperative days in patients who underwent total knee replacements.This was a two group repeated measures design for 30 subjects aged 53-85 years who were scheduled for total knee replacement. Subjects were randomly assigned to either a music group or a control group. Psychophysiological parameters were obtained from patients' monitors. A visual analog scale was used to assess postoperative pain. Opioid dosage was recorded and converted to standardized units. Mann-Whitney U-test and generalized estimating equation analysis were used to compare groups.Respiratory rates while in the surgical waiting area were lower for the music group than for the control group (P = 0.02). There was no significant difference between these groups for blood pressure, heart rate, pain intensity, or opioid dosage. However, a within-group comparison showed that systolic blood pressure in the music group was significantly and consistently decreased during postoperative recovery (Wald = 9.21, P = 0.007).These results suggest that listening to music stabilized systolic blood pressure in patients during postoperative recovery. However, the effects of music on psychophysiological parameters, pain intensity, and opioid dosage in a surgical setting require further research.

This study was purposed to elucidate the prognostic values of ALIP (abnormal location of immature precursors)-like clusters and fibrous proliferation in bone marrow of AML patients in CR phase and the correlation between them. The bone marrow biopsy sections from 47 AML patients during admitting to relapse or till lost follow-up were examined retrospectively. The 47 patients were divided into pre-relapsed group and non-relapsed group according to relapse or not at end of follow-up. The concentration of ALIP-like cluster and reticulin fiber density (RFD) in sections were compared between the two groups respectively, the prognostic value of these two factors and the underlying relationship between them were estimated by statistical analysis. The results showed that ALIP-like cluster was (3.46 ± 2.71)/mm(2) during CR and RFD was (2.76% ± 1.50%) in pre-relapsed cases, which both were higher than those in non-relapsed cases (P0.05). Cases with ALIP-like cluster over 4/mm(2) or with RFD1.68% showed high relapse rates of 89.5% or 95.2% respectively. RFD were (2.47% ± 2.48%) and (2.44% ± 2.23%) in cases with4/mm(2) or ≤ 4/mm(2) respectively, there was no statistical significance (P0.05) . Meanwhile, the amount of ALIP-like cluster in CR not related with the paired RFD (r = 0.057, P0.05). It is concluded that both ALIP-like cluster in CR and RFD are poor prognostic factors for heralding early relapse. However, ALIP-like cluster and RFD show no correlation, and suggest that forming of ALIP not depends on fibrogenesis.

To determine the effect and mechanism of action of PML(NLS-) gene on emodin-induced apoptosis of human HL-60 cells.HL-60 cells were infected with recombinant adenovirus Ad-PML (NLS-) and Ad-KZ, respectively. The PML(NLS-) gene was detected by Real-time PCR(RT-PCR) and Western blot. The proliferation level of the HL-60 cells was determined by MTT method. The HL-60 cells were treated with 60 micromol/L emodin for 72 h and then analyzed by flow cytometry for their cell cycle and apoptosis rate. The transcription levels of apoptosis-related BCL-2, BAX and C-MYC genes were determined by RT-PCR. The translation levels of those genes were determined by Western blot.Compared with normal controls and the HL-60 cells infected with Ad-KZ, the mRNA and protein expression levels of PML(NLS-) gene increased significantly in the HL-60 cells infected with Ad-PML( NLS-). Increased proliferation levels of the Ad-PML (NLS-) infected HL-60 cells were observed in those treated with 60 pmol/L emodin, which showed decreased percentage of cells at Gx phase, increased percentage of cells at S phase, and decreased emodin-induced apoptosis. The levels of mRNA transcription and protein expression of BAX gene decreased, while those of BCL-2 and C-MYC genes increased significantly.The over-expression of PML(NLS-) gene might promote the proliferation and arrest the apoptosis of HL-60 cells by up-regulating the expressions of BCL-2 and C-MYC genes and down-regulating the expression of BAX gene.

Both enalapril and losartan are effective and widely used in patients with chronic kidney disease (CKD). This review aimed to evaluate the benefits of enalapril and losartan in adults with CKD.PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, without language limitations, for randomized controlled trials (RCT), in which enalapril and losartan were compared in adults with CKD. Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager software, ver. 5.2, was used for meta-analysis.Of 318 citations retrieved, 17 RCT (14 parallel-group and three cross-over) met our inclusion criteria. The pooled analysis for parallel RCT showed that the effects of enalapril and losartan on blood pressure, renal function and serum uric acid (UA) were similar. Meta-analysis indicated that patients taking enalapril had a higher risk of dry cough (risk ratio, 2.88; 95% CI, 1.11-7.48; P=0.03). Sensitivity analysis showed good robustness of these findings.Enalapril has similar effects to losartan on systemic blood pressure, renal function and serum UA in patients with CKD, but carries a higher risk of dry cough. Larger trials are required to evaluate the effects of these medications on clinical outcomes.

Background In 2009, the Tobacco Hazards Prevention Act (Taiwan) was amended to more effectively restrict smoking in indoor public places and workplaces in Taiwan. However, the lack of prohibitions for smoking in private homes may place family members at increased risk for exposure to environmental tobacco smoke (ETS). The aim of our study was to determine the factors associated with parental smoking in the presence of children at home. Methods In 2010, we performed a cross-sectional study of factors associated with parental smoking in the presence of children at home in Taiwan using self-administered questionnaires. Quota sampling was used to select five primary schools from four different regions of Taiwan. Parents were surveyed to identify parental smokers and 307 parental smokers were selected for participation in our study. Questionnaire data regarding parental smoking in the presence of children at home and related interactions among family members were analyzed. Hierarchical logistic regression was used to determine the best-fit model for examining the relationships among the variables related to parental smoking in the presence of children at home. Results Two-thirds of parents who smoked reported smoking in the presence of their children. The results of the hierarchical logistic regression analysis identified the smokers’ compliance with their family’s antismoking responses, mutual agreement with smoking bans, daily smoking, smoking more than 20 cigarettes per day, the education level of the parental smoker, and the annual family income as determinants of smoking in the presence of children at home. Conclusions Households with smoking parents should be targeted for interventions to encourage the adoption and enforcement of home smoking bans. Educational interventions that promote smoke-free homes for children and provide support to help parents stop smoking are critical factors in reducing the frequency of children’s ETS exposure in the home.

BACKGROUND: Asthma is a common chronic inflammatory disorder affecting about 300 million people worldwide. As a holistic therapy, yoga has the potential to relieve both the physical and psychological suffering of people with asthma, and its popularity has expanded globally. A number of clinical trials have been carried out to evaluate the effects of yoga practice, with inconsistent results. OBJECTIVES: To assess the effects of yoga in people with asthma. METHODS: Search methods: We systematically searched the Cochrane Airways Group Register of Trials, which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, and handsearching of respiratory journals and meeting abstracts. We also searched PEDro. We searched ClinicalTrials.gov and the WHO ICTRP search portal. We searched all databases from their inception to 22 July 2015, and used no restriction on language of publication. We checked the reference lists of eligible studies and relevant review articles for additional studies. We attempted to contact investigators of eligible studies and experts in the field to learn of other published and unpublished studies. Selection criteria: We included randomized controlled trials (RCTs) that compared yoga with usual care (or no intervention) or sham intervention in people with asthma and reported at least one of the following outcomes: quality of life, asthma symptom score, asthma control, lung function measures, asthma medication usage, and adverse events. Data collection and analysis: We extracted bibliographic information, characteristics of participants, characteristics of interventions and controls, characteristics of methodology, and results for the outcomes of our interest from eligible studies. For continuous outcomes, we used mean difference (MD) with 95% confidence interval (CI) to denote the treatment effects, if the outcomes were measured by the same scale across studies. Alternatively, if the outcomes were measured by different scales across studies, we used standardized mean difference (SMD) with 95% CI. For dichotomous outcomes, we used risk ratio (RR) with 95% CI to measure the treatment effects. We performed meta-analysis with Review Manager 5.3. We used the fixed-effect model to pool the data, unless there was substantial heterogeneity among studies, in which case we used the random-effects model instead. For outcomes inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and summarized the findings narratively. MAIN RESULTS: We included 15 RCTs with a total of 1048 participants. Most of the trials were conducted in India, followed by Europe and the United States. The majority of participants were adults of both sexes with mild to moderate asthma for six months to more than 23 years. Five studies included yoga breathing alone, while the other studies assessed yoga interventions that included breathing, posture, and meditation. Interventions lasted from two weeks to 54 months, for no more than six months in the majority of studies. The risk of bias was low across all domains in one study and unclear or high in at least one domain for the remainder. There was some evidence that yoga may improve quality of life (MD in Asthma Quality of Life Questionnaire (AQLQ) score per item 0.57 units on a 7-point scale, 95% CI 0.37 to 0.77; 5 studies; 375 participants), improve symptoms (SMD 0.37, 95% CI 0.09 to 0.65; 3 studies; 243 participants), and reduce medication usage (RR 5.35, 95% CI 1.29 to 22.11; 2 studies) in people with asthma. The MD for AQLQ score exceeded the minimal clinically important difference (MCID) of 0.5, but whether the mean changes exceeded the MCID for asthma symptoms is uncertain due to the lack of an established MCID in the severity scores used in the included studies. The effects of yoga on change from baseline forced expiratory volume in one second (MD 0.04 liters, 95% CI -0.10 to 0.19; 7 studies; 340 participants; I2 = 68%) were not statistically significant. Two studies indicated improved asthma control, but due to very significant heterogeneity (I2 = 98%) we did not pool data. No serious adverse events associated with yoga were reported, but the data on this outcome was limited. AUTHORS CONCLUSIONS: We found moderate-quality evidence that yoga probably leads to small improvements in quality of life and symptoms in people with asthma. There is more uncertainty about potential adverse effects of yoga and its impact on lung function and medication usage. RCTs with a large sample size and high methodological and reporting quality are needed to confirm the effects of yoga for asthma

BACKGROUND: Global efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. However, knowledge regarding intentions of young people to engage in protective sexual behaviors is still lacking in many countries around the world, especially in Sub-Saharan Africa where prevalence of human immunodeficiency virus is the highest. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland. METHODS: This cross-sectional survey was conducted using a anonymous questionnaire. A two-stage stratified and cluster random sampling method was used. Approximately one hundred pupils from each of four schools agreed to participate in the study, providing a total sample size of 403 pupils of which 369 were ultimately included for data analysis. The response rate was 98%. Structural equation modeling was used to analyse hypothesized paths. RESULTS: The TPB model used in this study was effective in predicting protective sexual behavior among Swazi in-school youths, as shown by model fit indices. All hypothesized constructs significantly predicted intentions for abstinence and condom use, except perceived abstinence controls. Subjective norms were the strongest predictors of intention for premarital sexual abstinence; however, perceived controls for condom use were the strongest predictors of intention for condom use. CONCLUSIONS: Our findings support application of the model in predicting determinants of condom use and abstinence intentions among Swazi in-school youths.

To understand the knowledge, risk behaviors and HIV prevalence in men who have sex with men (MSM) in thirteen cities.Target samples were chosen using the snowball-rolling method, with transverse KABP and HIV-antibody testing developed for those MSM in thirteen cities of Yunnan.A total of 1237 valid questionnaires and 1129 blood samples were collected. Basic knowledge on HIV and the rate of the response was 93.2%. 81.1% of the respondents had anal sex with male partners in the last six months, of them 49.7% could persistently using condoms in each anal sex episode. 29.0% of the respondents had sex with female partners in the last six months. The HIV prevalence among the studied MSM was 8.2% and the prevalence of syphilis among them was 3.9%. Most risky factors of those MSM infected by HIV would include: not persistently use condom when having sex and co-infection of syphilis.Both rates of HIV infection associated risk behaviors and HIV prevalence were high in MSM under study that called for more work on HIV prevention and control MSM in Yunnan.

Purpose: Sleep deficit affects neurobehavioral functioning, reduces attention and cognitive function, and negatively impacts occupational safety. This study investigated selective attention levels of nursing staff on different shifts. Methods: Using a prospective, randomized parallel group study, selective attention was measured using the d2 test in 62 nursing staff in a medical center in Taiwan. Findings: There were significant differences in selective attention indicators (E%) between the fixed-day-shift group (control group) and rotating-shift group (experimental group): The percentage of errors (E%) for night-shift workers in the rotating-shift group was higher than that of fixed-day-shift workers, while the total number of items scanned minus error (TN − E) and concentration performance (CP) scores were higher for fixed-day-shift workers. Within the experimental group, the error rate on night shift was 0.44 times more than that on day shift and .62 times more than on evening shift; the TN-E on night shift was 38.99 items less than that on day shift, and the CP was 27.68 items less on night shift than on day shift; indicating that staff on the night shift demonstrated poorer speed and accuracy on the overall test than did the staff on day shifts. Conclusions: Inadequate sleep and a state of somnolence adversely affected the attention and operation speed of work among night-shift workers. More than 2 days off is suggested when shifting from the night shift to other shifts to provide adequate time for circadian rhythms to adjust.

This study was purposed to detect the abnormal quantity and localization of pre-ALIP in bone marrow of acute myelocytic leukemia patients (AML) during the complete remission (CR) and investigate their correlation with AML relapse. The bone marrow biopsy and prognosis of 62 patients with CR were retrospectively analyzed. The bone marrow was divided into the pre-relapse group and the no-relapse group according to prognosis of patients. In order to clarify the correlation of abnormal quantity and localization of pre-ALIP with AML relapse, the number of single and double-cluster precursor cells and the sum of both were calculated, and their distance from bone trabeculae was surveyed with the computer image segment method. The results showed that the number of pre-ALIP in pre-relapse group (11 ± 11.71/mm(2)) and no-relapse group (8.33 ± 9.17/mm(2)) were more than that in normal control group (5.29 ± 4.00) (P0.01). The number of pre-ALIP more than 11/mm(2) was observed in 17 among all AML patients, and out of them 12 patients with pre-ALIP number11/mm(2) (70.6) were found in the pre-relapse group, which was higher than that in no-relapse group (P0.05). While the distance between pre-ALIP and trabeculae [(341.31 ± 266.16) µm] in pre-relapse group showed the tendency of migrating to the intermediate zone of bone trabeculae, compared with that in no-relapse group [(242.41 ± 174.65) µm, P0.01]. Moreover, about 77.8 of 18 patients showed the distance of pre-ALIP from trabeculae was more than 341 µm in the pre-relapse group, and significantly higher than that in no-relapse group (P0.01). It is concluded that the average number of "pre-ALIP" more than 11/mm(2) or the average distance from trabeculae longer than 341 µm in bone marrow sections during CR may be the indicators for early relapse of AML.