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With the rapid advancement of technology, integration of computer-mediated communication (CMC) has been widely used in recent English as a foreign language teaching and learning. Despite the prevalence of online CMC discussions, previous studies have not drawn conclusive results, and empirical evidence on how online discussions affect student reading comprehension is limited. Thus, the purpose of this study was to conduct a quasi-experimental research to investigate how asynchronous and synchronous discussions influenced the reading comprehension of 50 university students in a Taiwanese collaborative learning context. A quasi-experimental design was conducted with multiple observations before and after the intervention. Research instruments included reading comprehension tests, a questionnaire survey, and a semi-structured interview. Major findings suggested that most of the participants used the synchronous discussion mode more frequently than the asynchronous mode when performing online reading tasks. Nevertheless, with increased asynchronous discussions, students' reading comprehension scores and satisfaction increased as well. Although the learners generally accepted both online discussion modes, the interview results revealed several drawbacks as well as advantages of the online discussion environments. Limitations of the study and implications for instructional pedagogy and future research were presented and discussed.

Previous studies have been done to research the effects of different electronic feedback (e-feedback) modes of helping English as a foreign language (EFL) students improve their writing. The purpose of this study was to employ online peer feedback (OPF) and automated corrective feedback (ACF) to assess EFL learners' writing performance in the areas of sentence complexity, grammatical accuracy, and lexical density. Our major findings suggest that OPF is potentially more useful than ACF in improving sentence writing, making fewer grammatical errors, and producing more types of lexical items. Nevertheless, we also found that the majority of students favored the use of ACF for the purpose of producing a richer vocabulary. Less skilled writers tended to make greater improvements than higher-skilled writers in producing more sentences and lexical items after OPF use; however, the difference was not statistically significant. Based on our research results, we discuss and present the implications of these findings for pedagogical instruction and future research.

Background/Objectives: Transitional attachment objects, such as blankets, play a critical role in childhood by helping children manage separation anxiety and regulate emotions. Although attachment to these objects often decreases as children grow older, it may persist into adulthood and influence emotion regulation and stress responses. Their influence on emotion regulation in adulthood remains uncertain. This study investigates the relationship between object attachment and emotion regulation, with a focus on responses to stress among college students. The study objectives include examining whether emotional regulation varies based on an individual's attachment to objects and investigating the role and significance of objects in the emotional regulation of adults with object attachment. Methods: Forty-five participants aged 18–22 were recruited to participate and completed the Object Attachment Security Measure (OASM) and the Emotional Regulation Questionnaire (ERQ). Participants were categorized into two groups based on their OASM scores: those with attachment objects (the OA group) and those without (the control group). The OA group was randomly assigned into two experimental groups: (1) Carry-but-cannot-touch (CBCT) and (2) Carry-and-touch (CAT). The CBCT group was not allowed to physically interact with their attachment objects during the recovery phase, whereas the CAT group could do so. Psychophysiological data, including Standard Deviation of NN Intervals (SDNN) and respiratory rate, were collected during three phases: baseline, stress, and recovery. Results: There were no differences in the ERQ scores between the OA and control groups, as well as between the CAT and CBCT subgroups. However, physiological indicators revealed that the CAT group exhibited higher SDNN during recovery than the CBCT group, suggesting that physical interaction with the attachment object enhanced stress regulation and promoted relaxation. Conclusions: While object attachment did not impact self-reported emotional regulation, it did influence physiological responses to stress, indicating that attachment objects may facilitate emotional recovery through tactile interaction. These findings highlight the potential of attachment objects as adaptive tools for stress management in young adults. [ABSTRACT FROM AUTHOR]

Blended learning is an instructional approach that combines traditional face-to-face learning and online learning. There have been debates on the effectiveness and practicality of blended learning use in higher education, yet studies that specifically examine blended discussions to support EFL learning and teaching are still scarce. Thus, this study aimed to explore how variables such as face-to-face, asynchronous, and synchronous discussions in the blended learning environment influenced students' learning motivation and reading achievement. Fifty-one students at a private university in southern Taiwan participated in this study. The research results showed that students' reading scores significantly improved after participating in the blended discussion activity. The highest-scoring group outperformed the other two proficiency groups after applying face-to-face and asynchronous discussion modes. However, no significant difference was found among different proficiency-level learners in synchronous discussion mode. Moreover, students' asynchronous discussion had a significantly moderate influence on their reading performance. Based on the research results, pedagogical implications, limitations, and future research are discussed and presented.

The ability to read English efficiently and effectively is important for medical students because they have to read a lot of medical texts published in English. This is challenging especially for non-native speakers. This study measures Taiwanese medical students' self-perceived use of metacognitive strategies while reading printed texts and hypertexts, and also the potential impact of hypertext on English reading comprehension. The results of the study showed that the strategies used the most by the printed text and hypertext groups were problem-solving strategies, followed by global strategies; whereas support strategies were least used. Learners in the printed text group reported more strategy use of reading slowly and using background information than the learners in the hypertext environment. A significant reading improvement and positive correlations were found between the strategies of guessing content, checking guesses, and guessing unknown words on hypertext comprehension enhancement. Such results suggested that the majority of students frequently used the three specific strategies and the degree of such strategy uses was reliably predicted by their comprehension scores. Based on the investigation results, limitations and future research are discussed and presented.

With the rapid growth of technology, many language acquisition approaches have been added to computer-assisted language learning applications. Thus, this study investigated the impact of online autonomous learning on English as a Foreign Language (EFL) students' reading ability. Sixty-five students from two reading classes at One University in Southern Taiwan were divided into an experimental group (integration of online reading and teacher-guided intervention) and a control group (teacher-guided intervention). The results demonstrated that there was a significant difference in the reading scores between the experimental and control groups. A significant difference was also found between the pre- and post-test scores in the experimental group; however, this pre- and post-test difference was not observed in the control group. Students in the experimental group also noted an obvious enhancement to their reading due to the requisite planning, monitoring, and evaluating activities practiced during online learning. Based on the research results, suggestions for future study are discussed.

AIM: The aim of this study was to explore the relationship between regular exercise, depression, and fall among the community older people to find out the predictors of fall. METHODS: This study applied cross-sectional and correlational study design. The study recruited 285 community older people by using the questionnaires which included social-demographic data, regular exercise, depression, and whether fall history questionnaires were used in this study. RESULTS: The mean score of the depression scale for older people was 3.47 (SD 2.92). People who took anti-hypertensive or anti-diabetes drugs have higher risks of falls than those who did not (B = 1.659; p < .001; Exp (B) = 5.256). Community-dwelling older people with regular exercise have a lower risk of falls than those without (B = -1.485; p < .001; Exp(B) = 0.227). CONCLUSION: Rehabilitation programs designed to improve both the older people's physical function and mental health played very important roles in preventing falls. It is necessary to undergo depression screening programs for the community older people in order to detect older people depression in advance and prevent the incidence of falls. [ABSTRACT FROM AUTHOR]

The effective use of reading strategies has been recognized as an important way to increase reading comprehension in hypermedia environments. The purpose of the study was to explore whether metacognitive strategy use and access to hypermedia annotations facilitated reading comprehension based on English as a foreign language students' proficiency levels. The primary investigation finding revealed that the strategies used the most were problem-solving strategies, followed by global strategies, whereas support strategies were used the least. The specific strategy of guessing content was used much more frequently which was reliably predicted by their comprehension scores; on the contrary, reading slowly might hinder hypermedia reading comprehension. Regarding the frequency of access to annotations, background information was viewed the most frequently, while word glossary was identified as least frequently; no significant relationship, however, was observed among proficiency levels, frequency of annotation use, and reading strategies. Based on further think-aloud investigation results, limitations and future research are discussed and presented.

This study examined the effect of online metacognitive strategies, hypermedia annotations, and motivation on reading comprehension in a Taiwanese hypertext environment. A path analysis model was proposed based on the assumption that if English as a foreign language learners frequently use online metacognitive strategies and hypermedia annotations, then they would increase their learning motivation, which, in turn, would enhance their hypertext comprehension performance. Participants consisted of 37 English majors enrolled at a private university in southern Taiwan. The results revealed that online metacognitive strategies most significantly predicted learning motivation and motivation directly affected hypertext comprehension. However, metacognitive strategies and hypermedia annotations did not directly affect hypertext comprehension. Consistent with expectations, motivation was found to mediate the relation between online metacognitive strategies and hypertext comprehension. On the other hand, the relation between hypermedia annotations and hypertext comprehension mediated by motivation was not obvious. Finally, the implications of these findings for future research are discussed and presented.

With the rapid growth of computer technology, some printed texts are designed as hypertexts to help EFL (English as a foreign language) learners search for and process multiple resources in a timely manner for autonomous learning. The purpose of this study was to design a hypertext system and examine if a 14-week teacher-guided print-based and hypertext reading intervention might benefit non-traditional EFL students' reading comprehension. Non-traditional EFL students are older students with greater work experience. The primary investigation finding revealed no significant difference in comprehension between the teacher-guided print-based and hypertext intervention conditions, though a significant mean improvement was found after hypertext learning. EFL learners' attitudes also supported that both teacher-guided print-based and hypertext interventions merit reading comprehension performance. In addition, there appears to be a significantly strong and positive relationship between the perceived usefulness of hypertext reading and attempt of future hypertext use, suggesting that the majority of non-traditional EFL learners made a positive willingness and prediction to use the hypertext system in their future reading, but that the degree of usefulness of hypertext reading was not reliably predicted by their hypertext comprehension scores. Based on the investigation results, limitations and future research are discussed and presented.

This study mainly focused on investigating listening strategy uses at different proficiency levels for different linguistic patterns. Three main questions were examined in regards to Taiwanese listeners of English as a foreign language (EFL): (1) For listeners with different proficiency levels, which pattern may result in a higher level of listening comprehension when the negative, functional, and contrary-to-fact statements are used? (2) Are there any significant differences between item type and proficiency level? (3) What are the differences and frequency in listening strategy use reported by individual listeners? To explore the above issues, a quantitative research method was applied, including a self-perceived survey, a t-test technique, and an analysis of variance. Results of this study demonstrate that listeners with both advanced and beginning proficiency levels yielded higher scores on contrary-to-fact statements, followed by functional expression and then negative expression. Advanced proficiency listeners mostly used the combination of various strategies when listening to contrary-to-fact statements, while beginning-level listeners heavily employed memory strategies when listening to negative expression. Implications for EFL educators to recognize the directions of instructional practices for enhancing listening comprehension are presented. (Contains 4 tables.)

This study focused on examining the overall effect of using email on the improvement of writing performance in aspects of syntactic complexity, grammatical accuracy and lexical density, as well as investigating the relation between the number of email exchanges and writing performance. Subjects in this study were 40 non-traditional EFL students enrolled in an intermediate reading class at a university in Taiwan. By applying qualitative and quantitative research methods, the major finding demonstrates that students made improvements on syntactic complexity and grammatical accuracy. An increase in lexical density, however, was not observed in this study. Another finding suggests that exchanging email messages with their peers at least four times might have a greater overall improvement on their writing performance. Findings from students' self-reports reveal that the email approach was a positive strategy that helped improve students' foreign language learning and attitudes towards English. Instructional implications for designing an effective email task to enhance foreign language writing development and attitudes are also presented. (Contains 4 tables.)

Copyright of Journal of Taiwan Agricultural Research is the property of Taiwan Agricultural Research Institute, Council of Agriculture, Executive Yuan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purposes of this study were to develop a new measure, the Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (FBPAS-MI) and to validate the psychometrics. This study included two phases. In Phase I, a literature review and five focus groups were conducted to develop an item bank. Then, expert consultation and cognitive interviews were used for content validity. In Phase II, 147 participants with severe mental illness were recruited from 10 community-based psychiatric rehabilitation centers in Taiwan to examine the psychometrics. Principal axis factoring method with direct oblique rotation was used to identify the underlying constructs of FBPAS-MI. Concurrent validity, internal consistency and test-retest reliability were examined. The results revealed five domains in the facilitator subscale (15 items) and two domains in the barrier subscale (11 items). Both subscales showed satisfactory internal consistency (all Cronbach's α >0.80); the concurrent validity and test-retest reliability were established. This study confirmed that the FBPAS-MI is a valid and reliable scale to understand perceived facilitators and barriers to physical activity for severe mental illness. The FBPAS-MI can provide useful information in the development of individualized health promotion program for this population. The Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (i.e., FBPAS-MI) is a valid and reliable assessment to examine key factors affecting physical activity participation among people with severe mental illness. Psychiatric rehabilitation practitioners could use the FBPAS-MI to help develop and tailor individualized physical activity promotion programs based on identified facilitators and barriers to activity. [ABSTRACT FROM AUTHOR]

Background: Physicians should be equipped with professional competence in health literacy to communicate more effectively with patients with limited health literacy. However, the health literacy curriculum has not yet been refined globally, and is scarce in Taiwan's medical education. We implemented an innovative instructional module to attain professional competence in health literacy among medical students and investigated its effects. Methods: We adopted a quasi-experimental design and recruited 204 fifth-year Taiwanese medical students between December 2019 and May 2020. Participants who worked as clerks at the Department of Family Medicine of three medical schools in northern Taiwan were assigned to the experimental group through convenience sampling. A total of 98 students received a three-hour innovative instruction, including medical simulation videos, role-playing, and board games. Both the experimental and control groups completed the online pre-test and mail-in post-test. A generalized estimating equation was applied to measure the effects of the intervention. Results: There was a significant difference between the experimental and control groups in terms of professional competence in health literacy in all three aspects. In terms of knowledge, the experimental group improved 12% more than the control group (𝛽=0.12, 95% CI: 0.05 ~ 0.19, p = 0.001). In terms of attitude, the experimental group improved by an average of 0.27 more points per question than the control group (𝛽=0.27, 95% CI: 0.08 ~ 0.46, p = 0.007). As for skill, the experimental group improved by an average of 0.35 more points per question than the control group (𝛽=0.35, 95% CI: 0.14 ~ 0.55, p = 0.001). Conclusion: The proposed innovative instructional module significantly improved fifth-year medical students' professional competence in health literacy, which is expected to benefit their future medical practices. [ABSTRACT FROM AUTHOR]

Objective: The role of ideal cardiovascular health (CVH) metrics in developing hearing loss remains uncertain. Thus, our objective was to analyse the connection between hearing loss and ideal CVH metrics in a 10‐year retrospective cohort. Study Design: Retrospective cohort study. Setting: A health management centre in Taiwan. Participants: Participants who underwent the first annual health check‐up between 2000 and 2006 and with a follow‐up check‐up more than ten years later. Main outcome measures: Hearing thresholds were measured at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Individuals with a best ear pure‐tone audiometry four‐frequency average of >25 dB HL were defined as having hearing loss. The ideal CVH metrics were classified into 7 categories based on the American Heart Association's definition. The associations of hearing loss with the sum of the ideal CVH metrics and each ideal CVH metric were examined by multiple logistic regression analysis. Results: The present study consisted of 6974 participants. The 10‐year follow‐up showed that the odds ratio (OR) of hearing loss was.74 for participants with 5–7 ideal CVH metrics (95% CI,.59–.93, p =.01) compared with those with 0–2 ideal CVH metrics. Among the CVH metrics, participants with an ideal smoking status might have reduced odds of developing hearing loss; the OR was.72 (95% CI,.58–.89, p =.003). Conclusions: Participants with an increased number of ideal CVH metrics and better performance on the smoking metric had a significantly protective effect regarding hearing loss development. [ABSTRACT FROM AUTHOR]

Background: Worldwide citrus production is severely threatened by Asiatic citrus canker which is caused by the proteobacterium Xanthomonas citri subsp. citri. Foliar sprays of copper-based bactericides are frequently used to control plant bacterial diseases. Despite the sequencing of many X. citri strains, the genome diversity and distribution of genes responsible for metal resistance in X. citri subsp. citri strains from orchards with different management practices in Taiwan are not well understood. Results: The genomes of three X. citri subsp. citri strains including one copper-resistant strain collected from farms with different management regimes in Taiwan were sequenced by Illumina and Nanopore sequencing and assembled into complete circular chromosomes and plasmids. CRISPR spoligotyping and phylogenomic analysis indicated that the three strains were located in the same phylogenetic lineages and shared ∼3,000 core-genes with published X. citri subsp. citri strains. These strains differed mainly in the CRISPR repeats and pathogenicity-related plasmid-borne transcription activator-like effector (TALE)-encoding pthA genes. The copper-resistant strain has a unique, large copper resistance plasmid due to an unusual ∼40 kbp inverted repeat. Each repeat contains a complete set of the gene cluster responsible for copper and heavy metal resistance. Conversely, the copper sensitive strains carry no metal resistance genes in the plasmid. Through comparative analysis, the origin and evolution of the metal resistance clusters was resolved. Conclusion: Chromosomes remained constant among three strains collected in Taiwan, but plasmids likely played an important role in maintaining pathogenicity and developing bacterial fitness in the field. The evolution of pathogenicity factors and horizontal gene transfer events were observed in the three strains. These data suggest that agricultural management practices could be a potential trigger for the evolution of citrus canker pathogens. The decrease in the number of CRISPR repeats and pthA genes might be the result of adaptation to a less stressful environment. The metal resistance genes in the copper resistant X. citri strain likely originated from the Mauritian strain not the local copper-resistant X. euvesicatoria strain. This study highlights the importance of plasmids as 'vehicles' for exchanging genetic elements between plant pathogenic bacteria and contributing to bacterial adaptation to the environment. [ABSTRACT FROM AUTHOR]

In Taiwan, numerous crops are threatened by Xanthomonas diseases such as citrus bacterial canker caused by X. citri subsp. citri and tomato bacterial spot mainly caused by X. euvesicatoria pv. perforans. Foliar sprays of copperbased bactericides have been frequently used for control of plant bacterial diseases. However, in Taiwan not much attention was paid on copper-resistant (CuR) Xanthomonas spp. and their impact on disease control efficacy of copperbased bactericides. In this study, CuR Xanthomonas isolates were collected from citrus and tomato in Taiwan. Compared with the pronounced effect on the copper sensitive isolate, spraying of copper hydroxide at the recommended rate of 0.5 kg/ha could not protect tomato plants against bacterial spot caused by the CuR isolate. Phylogenetic analysis of concatenated copper resistance genes, copL, copA, and copB, indicate that the Taiwanese CuR isolates belong to the worldwide clade. In addition to the three previously reported variants of the copB gene, analysis of complete copB sequences from xanthomonads associated with citrus and solanaceous hosts revealed the other three variants of copB and their global distribution. Copper-resistant Xanthomonas isolates from Taiwan have the two unreported variants of copB genes which differ from the other three previously reported types in the sizes and structures. The information provided here reveals the necessity to develop and include alternative measures rather than relying on foliar sprays of copper bactericides for sustainable control of tomato bacterial spot in Taiwan. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Taiwan Agricultural Research is the property of Taiwan Agricultural Research Institute, Council of Agriculture, Executive Yuan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study aimed to evaluate the differences in nurses' willingness to discuss palliative care with terminally ill patients and their family members. Methods: The participants were randomly recruited from registered staff nurses ≥20 years of age who were responsible for clinical inpatient care in a tertiary hospital in northern Taiwan. A semi-structured questionnaire was administered to evaluate nurses' experiences of discussing do-not-resuscitate (DNR) decisions and their willingness to discuss palliative care with terminal patients and their family members. The differences in nurses' experiences regarding DNR and willingness to discuss palliative care with terminally ill patients and their family members were compared using the Chi-square test. Logistic regressions were used to analyze factors associated with nurses' willingness to discuss palliative care with patients and their families. Results: More participants had experienced initiating discussions about DNR with patients' families than with patients (72.2% vs 61.9%, p < 0.001). Unadjusted logistic regression analysis showed that the experiences of actively initiating DNR discussions with patients were a significant factor associated with palliative care discussion with patients (odds ratio [OR] = 2.91, 95% confidence interval [CI]: 1.09-7.79). On the other hand, the experiences of actively initiating DNR discussions with patients and with patients' families were significant factors associated with palliative care discussion with patients' families (OR = 3.84, 95% CI: 1.22-12.06 and OR = 3.60, 95% CI: 1.19-10.90, respectively). After adjusting for covariates, no significant factors were found to be independently associated with nurses' willingness to discuss palliative care with patients and their family members. Conclusion: There are significant differences in nurses' willingness to discuss palliative care with patients and their family members. Further research is needed to evaluate factors associated with nurses' willingness to discuss palliative care with patients and their families to facilitate these discussions and protect patients' autonomy. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective To explore the prediction of aerobic exercise and resistance training on incidental metabolic syndrome (MetS) and diabetes in a Taiwanese cohort. Methods The participant underwent annual health examinations and physical fitness tests, including 2-min push-up, 2-min sit-up, and endurance 3000-m none weight-bearing running exercise test from 2013 to 2015, were recruited. The cohort study involved 27,787 participants aged ≥20 years in military services. Multivariate logistic regression odd ratios models were used to explore the associations between the performance of physical fitness and the development of MetS and diabetes. Results The male participants without MetS at baseline with poor performance in aerobic and resistance exercise tests were likely to develop the MetS and diabetes two years later; while the female participants did not show the same results in statistical significance. Additionally, only poor performance measuring by resistance training exercise test was significantly associated with increased risk of metabolic components numbers at follow-up in all subjects without MetS (all P < 0.05). Conclusions The poor performance in aerobic and resistance exercise tests might be predicting tools for MetS and diabetes in Taiwanese men without MetS at baseline. And resistance exercise displayed a substantial predicting ability in development of metabolic abnormality, MetS and diabetes in our study. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The purpose of this study is to identify whether depression and other associated factors in stroke are related to subsequent hip fracture. Background: There are very few studies that focus on depression and demographic impact on subsequent hip fracture after a stroke. Design: This a retrospective cohort study design. Methods: The Taiwan Longitudinal Health Insurance Database between 1997 and 2010 was used. Two stroke patient cohorts were analysed: (1) depression within 1 year after newly diagnosed strokes; (2) without depression within 1 year after newly diagnosed strokes. Demographic characteristics, comorbidities, and hip fracture were compared using the Fine and Gray regression model for subdistribution hazard ratios. Results/Findings: Patients with depression showed a higher risk of hip fracture (95% CI, 0.99‐1.66). Depression was associated with increased risk of hip fracture for patients below 50 years old (95% CI, 1.45‐7.34). Comorbidities and gender showed no significant correlation with hip fracture risk in the depressed or nondepressed groups. Conclusion: Poststroke depression was a significant contributor to hip fracture in patients who suffered strokes and had more negative impact on the younger population, regardless of the gender and presence of comorbidities. [ABSTRACT FROM AUTHOR]

The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS. [ABSTRACT FROM AUTHOR]

Background: In 2010, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed, based on the concept of the International Classification of Functioning, Disability and Health (ICF). The ICF provides a common language and framework for health and health-related status and attempts to integrate the biopsychosocial model as a multidimensional perspective in understanding functioning. Activities and participation (AP) is one salient component of the ICF refers to the execution of a task by an individual, and how such tasks are involved in their daily life. It is essential to examine the gap between the general adult population and adults with disabilities. This gap may be attributed to health status, personal factors, and natural and social environments, which include social and health services and policies. The purposes: (1) To develop a normative activity and participation (AP) value for the adult population and people with disabilities; and (2) to compare the gap in AP normative values between the two groups in Taiwan. Methods: We use the WHODAS 2.0 to survey and develop a normative AP value for the general adult population, and used secondary data from National Disability Eligibility Determination System (NDEDS) of Taiwan to describe the AP functioning distribution of adult with disability. There were 1100 participants, selected by stratified proportional sampling from two cities. There were also 144,850 participants who were adults with disability, selected from the secondary database in Taiwan. Results and conclusions: The AP curve for the disabled population increased rapidly at the beginning. The summary score was 13.21 in the performance at 90 percentile for the general population and 82.61 score for disabled adults that the similar gap in every domain, its means that there are significant functioning difference and health equality in general adults population and adults with disabilities. This presents a substantial challenge for both the government and the whole population of Taiwan, to begin considering how to reduce the gap in AP functioning and promote equality for people with disabilities, using social welfare policy. It is important to make sure disabled people have the same rights to be included in society as anybody else and better access to things in all areas of life that are according to Convention on the Rights of Persons with Disabilities (CRPD). [ABSTRACT FROM AUTHOR]

This study investigates nontraditional students’ of English as a foreign language self-reports of the hypertext learning experience. It determines whether factors such as gender, age, proficiency level, and hypertext learning experience influence predicting hypertext reading achievement. The subjects of this study were 23 nontraditional English majors (9 males and 14 females). Their learning efficiency was rated as low to intermediate. The primary investigation found that students generally perceived that they should have control in operating the designed hypertext system because most did not find it difficult. In addition, students could accomplish the reading tasks more quickly and easily without much mental effort. Females, older adults, and low-proficiency learners expressed more positive feedback and willingness to use the hypertext system in future compared with the other groups, although no significant differences were observed among those variables on hypertext learning experience. Hypertext comprehension performance was significantly influenced only by the factor of proficiency level. Its impact was negative and moderate. Therefore, it is suggested that the use of hypertext system demonstrated the tendency to particularly improve low-proficiency learners’ reading comprehension. Limitations and recommendations for future research are presented and discussed in light of the results of the study. [ABSTRACT FROM AUTHOR]

Background: Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment. The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test. Methods: The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview. Results: The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were "feel still younger" (22.3 %), the second was "there's no sexual experience" (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4). Conclusions: Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women. [ABSTRACT FROM AUTHOR]

Monitoring lifestyle to maintain health is an important issue for breast cancer survivors. No multidimensional instrument has previously been available specifically for assessing overall healthiness of lifestyle among breast cancer survivors. This study aims (i) to establish the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS) and (ii) to examine the reliability and validity of the established scale. A quantitative cross-sectional design was used. This project was conducted in four phases. In phase I, using the Health-Promoting Lifestyle Profile as the core concept, we created 50 preliminary measurement items. In phase II, we invited 10 breast cancer survivors and five professional experts to conduct a content validity assessment. In phases III and IV, a total of 220 breast cancer survivors were enrolled to assess the construct validity and the internal consistency and reliability. The final HLI-BCS contains 20 items across five domains: dietary habits, environment and physiology, health responsibility and stress management, social and interpersonal relations and spiritual growth. Through the information presented in the HLI-BCS, breast cancer survivors can assess their lifestyles on multiple dimensions and subsequently adjust their lifestyles to enhance their recovery and quality of life. [ABSTRACT FROM AUTHOR]

Onion (Allium cepa L.) is widely employed as a food ingredient as well as traditional remedy to treat fever, burns, and scurvy. The present study focused on the modulator efficacy of the quercetin rich onion juice on lipid profile and antioxidant status in mildly hypercholesterolemic subjects. Twenty-four healthy subjects with mild hypercholesterolemia (≧ 200 mg/dL) were recruited and divided into two groups, and they consumed 100 mL of onion juice or placebo every day for 8 weeks. Fasting blood samples were collected at initial, 2nd, 6th, 8th, 10th week for estimating various biochemical assays, as well as anthropometric indices. After 8 weeks of intervention, onion juice greatly decreased (p < 0.05) waist circumference, total cholesterol and LDL-c. In addition, it elevates (p < 0.05) total antioxidation capacity and prolong lag-time of LDL oxidation were also noted. To conclude, drinking onion juice could markedly suppress cholesterol level and elevate total antioxidation capacity. Hence, onion juice was probably recommended for combating various cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background: Certain factors originating from the perinatal and childhood periods are suspected of contributing to the recent increasing trend of childhood type 1 diabetes (T1D) incidence. This study sought to investigate the relationships between various perinatal and childhood risk factors and T1D incidence in young children (<10 years). Methods: We used a nested case-control design based on 1 478 573 live births born in 2000-05 in Taiwan. Cases were 632 incident cases of T1D between 2000 and 2008. Ten matched controls for each case were randomly selected. Information on various perinatal risk factors was also identified from claim data. Multiple conditional logistic regression was employed to estimate odds ratio (OR) and 95 confidence interval (CI) of T1D. Results: Childhood infection was significantly associated with an increased risk of T1D (OR = 1.46, 95% CI = 1.23-1.73). Increased risk of T1D was also noted in children born to younger mothers (<25 years) (OR = 1.94, 95% CI = 1.34-2.81), older fathers (>30 years) (OR = 1.56 (95% CI = 1.16-2.10) to 1.57 (95% CI = 1.19-2.05), mothers with Caesarean section (CS) (OR = 2.35, 95% CI = 1.52-3.64), and mothers with gestational diabetes mellitus (OR = 4.36, 95% CI =2.76-7.77). Fathers with T1D (OR = 7.36, 95% CI = 1.02-57.21) or type 2 diabetes (OR = 1.54, 95% CI = 1.04-2.26) were observed to substantially increase the risk of offspring T1D. Conclusions: Certain modifiable perinatal factors such as infection and CS may predispose incidence of T1D in young children. [ABSTRACT FROM AUTHOR]

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

Objectives: With reference to Phase I of Andersen's Behavioral Model of Health Services Utilization, the researcher investigated emergency department utilization by home-care service recipients with National Health Insurance (NHI) in Taiwan, and examined the predictive factors affecting the risks of morbidity from emergency department utilization. Methods: This design was a retrospective cohort study. Data came from the "home care specific file" in the National Health Insurance Research Database between 1999 and 2008. The subjects were 102,680 newly NHI homecare service users between 2000 and 2008. The Poisson regression model was used to predict the factors affecting emergency department utilization, morbidity from all causes, and major system classifications. Results: The NHI home-care service users experienced the highest incidence of circulatory system diseases (441.41/103 person-year). This study showed that a higher relative risk ratio for emergency department utilization and morbidity from all causes were found in male users, those aged 65 and older, those living in urban areas, Resources Utilization Group Category2-4 home care consumers, major illness/injury and long-term respiratory dependent cases, cases with a Charlson Comorbidity Index score of 3 and above, and cases with tumors, diabetes and congestive heart failure complications. Conclusions: Based on the findings of this study, the top three reasons for emergency department utilization by home-care service recipients were diseases of the circulatory, respiratory, and urinary/reproductive systems. The adjusted relative risk of emergency department utilization increased dramatically among elders, especially for diseases of the circulatory and urinary/reproductive systems. Health care providers should pay close attention to the care needs of home-care service recipients. [ABSTRACT FROM AUTHOR]

Mango is an important fruit crop in Taiwan. Recently, severe fruit rot disease was found frequently on harvested mango fruits. To monitor the incidence of disease and to characterize the causal agent, we performed a field survey in the major mango-producing areas of southern Taiwan, including Guntain, Fanshan, and Yujing, during 2009-2011. The results showed a disease incidence ranging from 18.7% to 58.1%, with those of Guntain significantly greater than the incidence found in Yujing and Fanshan. Based on morphological characteristics and nucleotide sequences of the internal transcribed spacer (ITS), β-tubulin gene (TUB) and elongation factor 1-alpha (EF1-α) gene, we identified four Botryosphaeriaceae species, including Fusicoccum aesculi, Neofusicoccum mangiferae, N. parvum, and Lasiodiplodia theobromae. Pathogenicity tests indicated that all of these fungal species were pathogenic to harvested mango fruits, and L. theobromae was the most aggressive pathogen. Moreover, when attached, immature mango fruits were inoculated with conidia of Botryosphaeriaceae species, disease symptoms characteristic of fruit rot appeared on the fruits after harvest and ripening. These findings indicated that L. theobromae, F. aesculi, N. mangiferae, and N. parvum were all causal agents of the new fruit rot of mango. Furthermore, their conidia may serve as important sources of inocula causing fruit rot disease in mango orchards. [ABSTRACT FROM AUTHOR]

Recently colorectal cancer rates have increased rapidly in Taiwan. The treatment of colorectal cancer includes surgery, radiation therapy and chemotherapy. Mangosteen (Garcinia mangostana) is a famous Asian tropical fruit. γ-Mangostin is a xanthone derivative isolated from the fruit hull. In previous studies, we found evidence of anti-inflammatory and anti-brain tumor activities in γ-mangostin. In this study, we performed further studies to assess the apoptotic effects of γ-mangostin on colorectal adenocarcinoma cells HT29. γ-Mangostin showed concentration and time-dependent cytotoxic effects on HT29 cells. Microscopic observation under Giemsa staining showed that γ-mangostin induced cellular swelling and the appearance of apoptotic bodies, characteristic of apoptosis in HT29 cells. In addition, flow cytometry analysis showed an increase of hypodiploid cells in γ-mangostin-treated HT29 cells, while enhancement of intracellular peroxide production was detected in the same γ-mangostin-treated cells by DCHDA assay and DiOC6(3) staining. In view of the above results, γ-mangostin has demonstrated anticancer activity and induces apoptosis in HT29 colorectal adenocarcinoma cells. The evidence suggests that γ-mangostin could serve as a micronutrient for colon cancer prevention and is a potential lead compound for the development of anti-colon cancer agents. [ABSTRACT FROM AUTHOR]

Background: Weaning ventilator programs include arm exercise training to improve patient respiratory muscle strength. The effectiveness of such training should be evaluated in light of expected results. Purpose: This research evaluated the effectiveness of arm exercise training in a weaning ventilator program. Methods: We adopted a quasi-experiment methodology. Subjects were patients on ventilalors recruited from an ICU (intensive care unit) at o medical center in Taipei, Taiwan. We randomly divided subjects between training and control groups containing a total of 75 subjects each. Training group subjects received arm exercise training: Control group subjects received standard nursing core. Constructive scales used to collect data included a demographics questionnaire, ventilator weaning assessment scale, and subjective perception scale. Result: Results showed that numbers of ICU and ventilator days, medical costs, and RSI (rapid shallow breathing index) were all significantly lower in the training group than the control group: The weaning rate of the training group was higher (100% vs. 68%): The subjective perception scale of the training group was significantly higher than the control group, especially in the positive emotion domain. After arm exercise training, Pimax increased 11.1 cmH2O, Pemax increased 15.8 cmH2O, tidal volume increased 82.7 ml, maximal ventilation increased 112.3 ml, and minute ventilation increased 1L. We constructed a logistic regression model to predict, factors involved in successful ventilator weaning. We found the rate of weaning success increased an average 22.4% for every arm training exercise day. Conclusion: Arm exercise training significantly increased the weaning rate. The training program assisted patients to wean from their ventilator as soon as possible, improved patient quality of life, and effectively reduced medical resource expenditures. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to identify the incidence of frailty and to investigate the relationship between frailty status and health-related quality of life (HRQoL) in the community-dwelling elderly population who utilize preventive health services. Methods: People aged 65 years and older who visited a medical center in Taipei City from March to August in 2011 for an annual routine check-up provided by the National Health Insurance were eligible. A total of 374 eligible elderly adults without cognitive impairment had a mean age of 74.6±6.3 years. Frailty status was determined according to the Fried frailty criteria. HRQoL was measured with Short Form-36 (SF-36). Multiple regression analyses examined the relationship between frailty status and the two summary scales of SF-36. Models were adjusted for the participants' sociodemographic and health status. Results: After adjusting for sociodemographic and health-related covariables, frailty was found to be more significantly associated (p<0.001) with lower scores on both physical and mental health-related quality of life summary scales compared with robustness. For the frailty phenotypes, slowness represented the major contributing factor in the physical component scale of SF-36, and exhaustion was the primary contributing factor in the mental component scale. Conclusion: The status of frailty is closely associated with HRQoL in elderly Taiwanese preventive health service users. The impacts of frailty phenotypes on physical and mental aspects of HRQoL differ. [ABSTRACT FROM AUTHOR]

Introduction As the effectiveness of cytology-based screening programme for cervical cancer in mortality reduction has reached a plateau, various preventive strategies have been considered, including intensive Pap smear screening and the supplemental use of human papillomavirus (HPV) DNA test or HPV vaccination. Cost and effectiveness of these various preventive strategies are therefore of great concern for health policy makers. Objective We intended to assess whether the combination of HPV DNA testing or HPV vaccination with Pap smear screening programme or the sole annual Pap smear screening is more effective and cost-effective in prevention of cervical cancer than the existing triennial Pap smear screening programme. Methods A Markov decision model was constructed to compare total costs and effectiveness between different preventive strategies (including annual Pap smear, HPV DNA testing or HPV vaccination together with Pap smear screening programme) as opposed to the triennial Pap smear screening alone (the comparator). Probabilistic cost-effectiveness (C-E) analysis was adopted to plot a series of simulated incremental C-E ratios scattered over C-E plane and also to yield the acceptability curve for different comparisons of strategies. The threshold of vaccine cost and the influence of attendance rate were also investigated. Results Compared with triennial Pap smear screening programme, most of preventive strategies cost more but gain additional life years (quadrant I of C-E plane) except HPV DNA testing with Pap smear every 5 years dominated by triennial Pap smear screening programme. The most cost-effective strategy was annual Pap smear (incremental C-E ratio = $31 698), followed by HPV DNA testing with Pap smear every 3 years ($36 627), and vaccination programme with triennial Pap smear screening ($44 688) with the corresponding cost-effective probabilities by the acceptability curve being 65.52%, 52.08% and 35.84% given the threshold of $40 000 of willingness to pay. Vaccination combined with triennial Pap smear would be as cost-effective as annual Pap smear provided the cost of vaccination was lowered to $250 per full course of injection. Conclusions Among various preventive strategies annual Pap smear screening programme is still the most cost-effective and additional HPV DNA testing is a cost-effective choice under a reasonable threshold of willingness to pay. Vaccination programme in combination with triennial screening would be cost-effective if vaccine cost can be greatly reduced in a large economic scale. [ABSTRACT FROM AUTHOR]

This paper investigates whether earnings management occurs in non-profit hospitals. Using manually collected financial data of the foundation hospitals in Taiwan over the period from 2006 to 2008, I find non-profit hospitals tend to manage earnings to a range just above zero by examining the distribution of reported income on a sample of 45 hospitals and 133 hospital-year observations. The study further analyzes the characteristics of non-profit hospitals that have reported earnings slightly higher than zero. It shows that the religion- and business-group hospitals and hospitals that receive more donations intend to manage earnings to a range just above zero. In addition, I test the association between discretionary accruals (estimated in aggregate accruals model as well as specific accruals model) and "pre-managed" earnings, the evidence suggests that managers of non-profit hospitals use their managerial discretion over accounting choice to meet earnings target. These results provide evidence consistent with non-profit hospitals similar to for-profit organizations, conduct earnings management. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To assess cost-effectiveness of hepatitis B virus (HBV) vaccination strategies from health care payer and societal perspectives, focusing on the long-term effect, in Taiwan where prevalence of HBV and Hepatitis B e Antigen (HBeAg) is high. Methods: A decision analysis was performed to compare total costs and effectiveness between two vaccination strategies: universal vaccination and no-vaccination. The Markov process was defined as a series of states including acute HBV infection, asymptomatic carrier, chronic hepatitis, compensated and decompensated liver cirrhosis, hepatoma, and death. Direct and indirect costs were also imputed based on estimates. The incremental cost-effectiveness ratio (ICER) per life-year gained and quality-adjusted life years gained were calculated at a 3% discount rate. By assigning a series of specific distributions to each parameter, a probabilistic cost-effective analysis using Monte Carlo simulation was conducted to yield 5000 ICER replicates. Results: The effectiveness of a universal vaccination program for reducing hepatocellular carcinoma cases and deaths was approximately 86%. The average life years gained per subject as a result of such a universal vaccination was 3.9. The vaccination program dominated over a no-vaccination program (less cost and more effectiveness). Conclusions: A universal vaccination program against hepatitis B infection is not only effective for reducing long-term sequelae but is also a cost-saving primary preventive strategy, which supports a universal infant immunization in endemic area with high prevalence of HBV and HBeAg. [Copyright &y& Elsevier]

The purpose of this study was to develop a case management program for patients with chronic obstructive pulmonary disease (COPD) and to test the effects of the developed program on patient length of stay in the hospital, medical costs, disease knowledge and level of satisfaction with nursing care received. This quasi-experimental study focused on a group of 50 COPD patients (24 in the control group and 26 in the experimental one), all treated in one hospital medical ward in northern Taiwan. The control group received routine care, while those in the experimental group received a COPD case management protocol. Data for the control group was collected between September of 2003 and January 2004. Data for the experimental group was collected between April and December 2004. Data collection instruments included medical records, the COPD Knowledge Measurement scale, and the Patient Satisfaction with Nursing Care Questionnaire. Descriptive and inferential statistical analyses were applied to describe demographics, length of stay, medical cost, patient disease-related knowledge, and patient satisfaction with nursing care. Results indicated that, while the study found no significant difference in length of stay and medical cost between the two groups, the use of case management procedures improved patient disease-related knowledge and satisfaction with nursing care. This conclusion supports the premise that case management improves patient care in these two dimensions and is, thus, an effective approach in the management of patients diagnosed with secondary COPD infections. [ABSTRACT FROM AUTHOR]

Latosol soils contaminated with chromium(VI) [Cr(VI)], which is hazardous, can be recycled as raw materials for porcelain and construction sectors if a proper thermal stabilization process is implemented. This study investigates how thermal treatment affects Cr behavior during the sintering of latosol and deorganic latosol samples; both samples are artificially contaminated with CrO3. Approaches including X-ray absorption spectroscopy, scanning electron microscopy, N2-based Brunauer Emmett Teller surface analyzer, thermogravimetric analyzer/differential scanning calorimeter, and the toxicity characteristic leaching procedure promulgated by Taiwan Environmental Protection Administration are used in this study. After drying the Cr(VI)-contaminated latosol (i.e., containing 37,120 mg of Cr/kg sample) at 105 °C, ~80% of the doped CrO3 is chemically reduced to Cr(OH)3 by a humic substance naturally existing in the soil. In contrast, in the organics-free CrO3-contaminated latosol dried at 105 °C, only 9% of the doped CrO3 is reduced to Cr(OH)3. Heating the samples at 500 and 1100 °C transforms hazardous Cr(VI) into Cr(III) that is negligibly toxic; Cr2O3, which is insoluble, is detected as the most abundant Cr species. Moreover, formation of Cr2SiO5, which is suggested to relate to low Cr leaching, is only detected in the sample heated at 1100 °C. Surface morphology, surface area, and thermogravimetric analyzer/differential scanning calorimeter results demonstrate that thermal treatment at 1100 °C can incur considerable soil sintering/ melting if the humic substance in the soil has been heated off previously. Finally, Cr concentrations in the toxicity characteristic leaching procedure leachates collected from the samples thermally treated at 1100 °C for 4 hr are ≤0.21 mg of Cr L-1 that are much less than the Taiwan Environmental Protection Administration regulatory limit (<5 mg of Cr L-1); consequently, these two samples are nonhazardous, and they have the potential for resource recycling. Conversely, Cr concentrations in the leachates from all 500 °C and 105 °C samples are in the 25.6-1279 mg L-1 range. [ABSTRACT FROM AUTHOR]

The use of virtual simulation methods in nursing education offers potential advantages for students to experience and learn in a safe and realistic environment by acquiring skills and attitudes to prepare for clinical experiences. The study's aim was to test the hypothesis that nursing students who used a mobile learning app would have significantly (1) higher levels of knowledge about medication administration and nasotracheal suctioning, (2) better development of skill performances on medication administration and nasotracheal suctioning, (3) higher satisfaction, and (4) lower cognitive load than a control group. A randomized experimental study with pretest and posttest design. One hundred nursing students were randomly assigned to an experimental or control group at a Southern Taiwan university's school of nursing. The experimental group received the virtual simulation-based mobile learning app and the control group used traditional paper materials. Participants were assessed on knowledge before and after the intervention. Skill performance and intrinsic and extraneous cognitive load were measured after the intervention. The experimental group who used the mobile app had significantly higher knowledge scores, significantly lower intrinsic and extraneous cognitive load, better skill performance, and higher satisfaction than the control group. The implementation of a mobile app for simulation learning had a positive impact on nursing students' knowledge and skill performances as well as the reduction of learning cognitive loading. Nurse educators and researchers should collaborate in developing virtual learning resources to support clinical nursing education. Tweetable abstract: The mobile app for learning achieved higher knowledge and satisfaction scores, demonstrated better skill performance without increasing cognitive load. [ABSTRACT FROM AUTHOR]

OBJECTIVE--We retrospectively assessed the age- and sex-specific incidence and relative risk of Parkinson disease (PD) in Taiwan's diabetic population. RESEARCH DESIGN AND METHODS--Study cohort included 603,416 diabetic patients and 472,188 nondiabetic control subjects. Incidence rate and relative risk of PD (ICD-9-CM 332.0) were evaluated. RESULTS--The incidence of PD was 3.59 and 2.15 per 10,000 person-years for the diabetic and control group, respectively, representing a covariate adjusted hazard ratio (HR) of 1.61 (95% CI 1.56-1.66), which was substantially reduced to 1.37 (1.32-1.41) after adjusting for medical visits. Diabetes was associated with a significantly elevated risk of PD in all sex and age stratifications except in young women, with the highest HR noted for young men aged 21-40 years (2.10 [1.01-4.42]), followed by women aged 41-60 (2.05 [1.82-2.30]) and >60 years (1.65 [1.58-1.73]). CONCLUSIONS--Diabetes is associated with an increased risk of PD onset in a Chinese population, and the relation is stronger in women and younger patients. [ABSTRACT FROM AUTHOR]

This study was aimed to explore the antioxidant and anti‐inflammatory activity of various pine needle products (non‐fermented, fermented, and commercial) extracted with different solvents (hexane, ethyl acetate, and water) in lipopolysaccharide (LPS) induced RAW 264.7 cells. The phenolic/flavonoid contents of ethyl acetate extract of fermented pine needle (EAE‐FPN) is higher than other pine product extracts (hexane/water). The levels of antioxidant indices (TEAC, DPPH) as well as free radical scavenging activity (H2O2) were significantly improved in EAE‐FPN than other pine needle product extracts. The levels of ROS and various inflammatory markers (NO, PGE2, TNF‐α, and IL‐1β/6) were considerably abolished by EAE‐FPN in a dose‐dependent manner (50–200 μg/ml). Moreover, the protein expressions of inducible NO synthase (iNOS), cyclooxygenase 2 (COX‐2), and nuclear factor Kappa B (NF‐κB) p65 subunit were also markedly downregulated by EAE‐FPN. Collectively, EAE‐FPN with phenolic/flavonoid content showed excellent antioxidant and anti‐inflammatory properties via modulating NF‐κB signaling pathway. Practical applications: Pine needle drink (Pinus morrisonicola Hay) has been used as a functional beverage for many years due to its various biological properties in Asia especially in Taiwan, China, and Korea. Many researchers hinted various biological activity of fermented pine needle product but none of them explored the in‐depth mechanism underpinning its antioxidant and anti‐inflammatory properties in LPS‐induced RAW 264.7 cell model. Hence, the current cell line study was designed to assess the underlying mechanism behind the antioxidant and anti‐inflammatory activity of Pine needles extract (both non‐fermented and fermented) in LPS‐induced RAW 264.7 cells (macrophage). The outcome of this study distinctly showed that EAE‐FPN displayed potent antioxidant and anti‐inflammatory activities by regulating NF‐κB signaling pathway. Therefore, pine needle could be developed into functional drink to abolish the progression of inflammatory responses in various disease condition. [ABSTRACT FROM AUTHOR]

Background: The postpartum period is a physiologically and psychologically crucial transition phase for every woman who gives birth. Aromatherapy may improve mood and alleviate sleep challenges. However, few randomized controlled clinical trials have focused on the effect of aromatherapy in postpartum women. Purpose: This study was designed to explore the effect of a bergamot essential oil aromatherapy intervention on depressive mood and sleep quality in postpartum women. Methods : This randomized controlled trial used consecutive sampling. The participants were all women in a postpartum care center in eastern Taiwan and were randomly assigned to either the experimental (n = 29) or control (n = 31) group. Bergamot essential oil aroma was used in the experimental group, and pure water aroma was used in the control group. The experimental and control interventions were both performed while the participants were residents at the postpartum care center in the afternoon for 15 minutes each day. Before the aroma intervention, pretests were conducted using the Edinburgh Postnatal Depression Scale and the Postpartum Sleep Quality Scale. The first and second posttests were conducted using the same two scales at 2 and 4 weeks after the intervention, respectively. Results : At both the first and second posttests, depressive mood was significantly lower (p <.001) in the experimental group than in the control group, supporting the positive effect of the bergamot essential oil aroma intervention on depressive mood in postpartum women. No significant intergroup difference in sleep quality (p >.05) was observed at either the first or second posttest, indicating an uncertain effect of the bergamot essential oil aroma intervention on sleep quality. Conclusions/Implications for Practice: The results of this study support the effectiveness of bergamot essential oil aromatherapy in alleviating depressive mood in postpartum women. In addition, the results provide a practical reference for clinical postpartum nursing care. [ABSTRACT FROM AUTHOR]

• Gender, employment, marital status, injury area, and facial burns affect QoL. • Patients' simple abilities had the best recovery, improving significantly over time. • Employment and body image showed no significant improvement over three years. • Patients with more severe symptoms had lower QoL and higher risk of PTSD. Nearly 500 people were injured in the dust explosion at the Formosa Fun Coast water park in 2015, making it the accident with the largest number of burn victims in Taiwan. Severe burn injuries are often accompanied by long-term impacts on physical, psychological, social, occupational, and aesthetic wellness. Survivors usually require several years or even decades of medical rehabilitation and psychological counseling, which inevitably affect their quality of life (QoL). The purpose of this study was to assess the changes in the QoL and the risk of posttraumatic stress disorder (PTSD) among the survivors of the 2015 dust explosion at the Formosa Fun Coast water park and discuss the potential influencing factors. Data were collected from the burn victims using a self-administered sociodemographic and injury characteristics questionnaire, the adapted Chinese version of the Burn Specific Health Scale-Brief (ACV BSHS-B), and the Impact of Event Scale for Burns (IESB). IBM-SPSS (Version 21.0) was used for the statistical analysis of the data. A total of 81 patients were enrolled in this study from July 2016 to August 2018. The study results revealed that gender, employment status after the burn injury, marital status, injury area, and the presence of facial burns greatly affected survivors' QoL three years following the injury. Survivors' simple abilities (Mean: 3.91 out of 4 on average, SD:.21) showed the best recovery and improved significantly over time. Employment (Mean: 2.33, SD:.98) and body image (Mean: 1.94, SD:.95) were considered the most influential factors on QoL, with no significant improvement over the three years. Moderate to severe pain, itching, and sleep problems caused by the dust explosion still affected 29.2%, 46.6%, and 58.1% of survivors after three years, respectively. Survivors with more severe symptoms had worse QoL and a higher risk of PTSD. The burn accident affected not only the injured individuals but also their entire families. In order to help injured individuals reintegrate into society and maintain better overall health, our study suggested providing family-based healthcare plans and necessary follow-up visits in a timely manner. [ABSTRACT FROM AUTHOR]

Cervical cancer (CC), compared with other gynecological cancers, has critical implications for women's sexual lives. For most Asian people, the issue of sexual dysfunction (SD) is treated as a taboo especially in a conservative culture. As a result, little is known about the prevalence of SD among CC patients. The purpose of this study was to investigate the prevalence of SD and associated factors among CC patients. We used a cross-sectional correlation design with the purposive sampling to recruit 105 CC patients from a hospital in Northern Taiwan. A structured questionnaire was used in this study to collect demographic data, disease characteristics, and information provided by the Chinese version of the Female Sexual Function Index scale. Data were analyzed by descriptive statistics, independent t-test, chi-square test, and multiple logistic regression. The prevalence of SD and the main predictors for SD were determined. The crude prevalence and age-standardized prevalence of SD were 66.67% and 55%, respectively. CC patients with a lower level of education (≤9th grade) (adjusted odds ratio [AOR]: 3.14; 95% confidence interval [CI]: 1.51-10.37), who were older (AOR: 1.16; 95% CI: 1.07-1.25), who had received no sexual-counseling services prior to therapy or later (AOR: 4.98; 95% CI: 2.31-9.71), or were stage II or above (AOR: 4.34; 95% CI: 1.65-19.09) showed a significantly higher risk of SD compared with those without these conditions. Our findings are beneficial to health-care providers by identifying the prevalence of SD and by pinpointing those groups with a higher predisposition of having SD, which will allow the provision of appropriate rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: Group B streptococci (GBS) are Gram-positive bacteria that are a leading cause of neonatal infections. Most invasive isolates are β-hemolytic, and hemolytic activity is critical for GBS virulence. Although nonhemolytic GBS strains are occasionally isolated, they are often thought to be attenuated in virulence. Recent studies have observed that many nonhemolytic and nonpigmented (NH/NP) strains originated from invasive infections, including bacteremia and meningitis, in neonates or adults. The mutations causing the NH/NP phenotype are predominantly localized in the cyl operon and abx1 gene. Previous studies on group B streptococci in Taiwan have focused on the serotype and genotype distribution. In this study, we investigated the serotype distribution of the NH/NP strains and detected the mutations of abx1., Methods: One hundred clinical GBS strains from non-invasive (vaginal and rectal swabs, 69) and invasive infections (blood, urine and abscess, 31), including 10 NH/NP isolates, were collected during 2019-2021 at Fooyin University Hospital. To confirm GBS isolates, we have developed a multiplex PCR method that detects GBS isolates, virulent strain ST-17 and virulent factor Srr1 simultaneously. Molecular serotyping was performed by multiplex PCR assay using serotype specific primer sets. The genomic region containing abx1 was amplified from DNA extracts by PCR and the amplicons were directly sequenced and analyzed on an ABI prism 3730 DNA analyzer., Results: The capsular serotypes III and VI were the most abundant in both the non-invasive specimens and invasive specimens. The ST-17 isolates were more frequently associated with invasive infections (16.1%, 5/31) than non-invasive diseases or colonization (7.2%, 5/69). The association of NH/NP strains between noninvasive diseases or colonization (10.1, 7/69) and invasive infection (9.7%, 3/31) is nearly compatible. The NH/NP strains were isolated from various serotypes (Ia, III, V and VI) and five NH/NP isolates were serotype III. The virulence factor Srr1was detected in most of the NH/NP isolates (8/10) and one NH/NP isolate was ST-17. Abx1 mutations, including transitions, transversions and deletions, were observed in some NH/NP isolates, but some mutations also observed in hemolytic isolates. Five NH/NP isolates were erythromycin and clindamycin resistant., Conclusion: These results indicate NH/NP GBS strains may have the potential for invasive infections and may show higher tendency to get mutated., Competing Interests: Declaration. Compliance with ethical standards: Conflict of interest The authors declare that they have no conflict of interest. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This study aimed to evaluate the differences in nurses' willingness to discuss palliative care with terminally ill patients and their family members., Methods: The participants were randomly recruited from registered staff nurses ≥20 years of age who were responsible for clinical inpatient care in a tertiary hospital in northern Taiwan. A semi-structured questionnaire was administered to evaluate nurses' experiences of discussing do-not-resuscitate (DNR) decisions and their willingness to discuss palliative care with terminal patients and their family members. The differences in nurses' experiences regarding DNR and willingness to discuss palliative care with terminally ill patients and their family members were compared using the Chi-square test. Logistic regressions were used to analyze factors associated with nurses' willingness to discuss palliative care with patients and their families., Results: More participants had experienced initiating discussions about DNR with patients' families than with patients (72.2% vs 61.9%, p < 0.001). Unadjusted logistic regression analysis showed that the experiences of actively initiating DNR discussions with patients were a significant factor associated with palliative care discussion with patients (odds ratio [OR] = 2.91, 95% confidence interval [CI]: 1.09-7.79). On the other hand, the experiences of actively initiating DNR discussions with patients and with patients' families were significant factors associated with palliative care discussion with patients' families (OR = 3.84, 95% CI: 1.22-12.06 and OR = 3.60, 95% CI: 1.19-10.90, respectively). After adjusting for covariates, no significant factors were found to be independently associated with nurses' willingness to discuss palliative care with patients and their family members., Conclusion: There are significant differences in nurses' willingness to discuss palliative care with patients and their family members. Further research is needed to evaluate factors associated with nurses' willingness to discuss palliative care with patients and their families to facilitate these discussions and protect patients' autonomy., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2021, the Chinese Medical Association.)

Accumulating evidence indicates the association between obesity and lung function. However, no previous study has examined whether obesity affects lung function in normal weight participants with high body fat. We hypothesized that subjects with normal weight obesity (NWO) were inversely associated with lung function in Taiwan. The study sample was composed of participants who attended health examinations at the Tri-Service General Hospital from 2010 to 2016. A total of 7801 eligible participants who were classified as NWO were divided into quartiles by percentage body fat (PBF), which was measured by bioelectrical impedance analysis (BIA). A multivariable linear regression was performed to assess the association between PBF quartiles and pulmonary function. The relationship between PBF and the presence of obstructive and restrictive lung diseases was analyzed by a logistic regression. PBF quartiles were closely associated with reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in all adjusted models. This relationship remained significant in the male population, and a dose-dependent effect was observed. Increased PBF was associated with increased risks for the presence of restrictive lung diseases. These results presented a novel finding that body fat exhibited an inverse association with pulmonary function in NWO subjects. More comprehensive management of subjects with normal weight but high body fat, which might contribute to metabolic dysfunction and impaired pulmonary function, is needed.