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Although recent medical studies have found a significant correlation between betel quid chewing and oral cancer, some Taiwanese aboriginal people continue the traditional betel quid culture. Using the transtheoretical model framework, we conducted a qualitative study to examine the stages of behavioral change in betel quid chewing in the Paiwan sociocultural context. We conducted in-depth interviews with 20 aboriginal chewers of betel quid. Results of a content analysis showed significant patterns in the precontemplation, contemplation, action, and maintenance stages, but none in the preparation stage. Relapse was most likely to occur between the contemplation and action stages. In the precontemplation stage, interviewees showed no motivation to change their chewing behavior due to shared positive attitudes of psychosocial benefits and cultural identity. In the contemplation stage, dependent-type chewers were aware of oral damage and pain caused by chewing betel quid but could not resist their cravings; social-type chewers showed approach–avoidance conflicts between social needs and cessation. Chewers entered the action stage once they decided to quit; "to stop immediately" or "reduce quantity" were the most frequent strategies reported. In this stage, chewers endured withdrawal symptoms and refused betel quid from others but tended to relapse easily. Participants entering the maintenance stage were not affected by withdrawal symptoms and did not have ulcers or pain. Future research should identify ways to preserve traditional aboriginal culture while encouraging aboriginal people to quit betel quid chewing to promote the prevention and treatment of oral cancer. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore how hemodialysis patients' quality of life is related to sociodemographic data and depression as predicting variables, and how it is affected by fatigue as a mediating variable. Participants were 405 patients who has been receiving hemodialysis treatment regularly. SPSS Amos path analysis was used to explore the causal relationship and the mediating effect of fatigue among the variables of sociodemographic characteristics, depression, and quality of life. Unstandardized estimates determined that while sociodemographic characteristics were a significant predictor of fatigue, they were not directly related to quality of life. The results showed that depression and fatigue in patients receiving hemodialysis are important factors that affect patients' quality of life to a greater (fatigue) or lesser (depression) extent. Depression can affect patients' quality of life either directly or indirectly via fatigue. In this study, we demonstrated that fatigue plays an important role in the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis. The results of the study further suggest that comprehensive management programs should be applied with patients to reduce their fatigue, and ultimately to improve their quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Background: Preoperative testing is commonly performed in patients undergoing surgery for hip fractures. The purpose of this study was to determine the appropriate preoperative tests after implementation of the case-payment reimbursement system and clinical pathway. Methods: We analysed 242 patients admitted to a regional hospital for hip fracture. Preoperative comorbidities and laboratory test results were measured and evaluated for their association with the occurrence of postoperative adverse outcomes. Results: Univariate analysis showed that abnormal chest X-ray, haemoglobin, albumin, and total protein were associated with concomitant pulmonary diseases. Abnormal electrocardiogram (ECG), Na, creatinine, and aspirate aminotransferase (AST) levels were associated with heart disease. On the base of the univariate analysis, the significant preoperative variables for increased postoperative complications at 30 days included abnormal chest X-ray (odds ratio, 4.45; 95% confidence interval (CI), 2.24–8.84), ECG (odds ratio, 3.95; 95% CI, 1.96–7.95), Hct (odds ratio, 2.22; 95% CI, 0.96–5.16), Hb (odds ratio, 2.68; 1.29–5.58), blood urine nitrogen (odds ratio, 2.69; 95% CI, 1.34–5.42), creatinine (odds ratio, 4.49; 2.31–8.75), albumin (odds ratio, 9.68; 95% CI, 3.16–29.65), and AST (odds ratio, 2.36; 95% CI, 1.12–4.98). After adjustment for age, sex, and comorbidities, the risk factors that improved the predictability of postoperative complications were found to be abnormal chest X-ray (odds ratio, 6.03; 95% CI, 1.84–19.82) and albumin level (odds ratio, 6.23; 95% CI, 1.90–20.42). Conclusion: Serum albumin level and preoperative chest X-rays should be included in the preoperative routine tests recommended for elderly patient with hip fracture. [Copyright &y& Elsevier]

Abstract: The aim of the study was to examine the predisposing and precipitating factors in the development of hyperventilation syndrome in males during military training in Taiwan. The participants included 110 young males who visited the emergency room of a teaching hospital in southern Taiwan because of an episode of acute hyperventilation during military training. Another 53 males, who had the same military training, and who did not experience hyperventilation or any psychiatric symptoms, were recruited as the control group. The risk of hyperventilation syndrome was increased by the following factors: greater neuroticism, less extraversion, parental overprotection, and less parental caring. A final parsimonious structural equation model showed a cause–effect relationship between the direct effects of maternal overprotection and introversion and the individual''s neurotic characteristics, which contributed to the individual''s current mental health status and the development of hyperventilation syndrome. Military training could be a precipitating factor in the development of hyperventilation syndrome in young males. The elucidation of these factors may contribute to the understanding and treatment of hyperventilation syndrome. The determination of competing risk factors and mediating effects in males with hyperventilation syndrome should be considered in future studies. [Copyright &y& Elsevier]

Cardiac valve calcification (CVC), characterized by the accumulation of calcium in the heart valves, is highly prevalent among patients undergoing dialysis. This meta-analysis aimed to provide an updated summary of recent studies on the prognostic value of CVC in patients undergoing dialysis. We conducted a search of PubMed, Embase, and Web of Science to identify observational studies investigating cardiovascular or all-cause mortality associated with CVC in dialysis patients until March 2023. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated for the meta-analysis, and the strength and significance of the associations between CVC and mortality outcomes in dialysis patients were assessed. From 6218 initially identified studies, we included 10 critical studies with a total of 3376 dialysis patients in a further meta-analysis. Pooled analyses demonstrated a significant association between CVC and an elevated risk of all-cause and cardiovascular mortality in dialysis patients. In our study, we discovered HRs of 1.592 (95% CI 1.410–1.797) for all-cause mortality and 2.444 (95% CI 1.632–3.659) for cardiovascular mortality. Furthermore, subgroup analysis revealed elevated all-cause mortality among patients with mitral valve calcification (HR 1.572; 95% CI 1.200–2.060) compared to those with aortic valve calcification (HR 1.456; 95% CI 1.105–1.917). Similarly, patients undergoing peritoneal dialysis faced a greater risk for all-cause mortality (HR 2.094; 95% CI 1.374–3.191) than those on hemodialysis (HR 1.553; 95% CI 1.369–1.763). This highlights the possibility of CVC being an independent risk factor for dialysis patients, particularly in relation to mitral valve calcification or peritoneal dialysis. [ABSTRACT FROM AUTHOR]

Objective. To explore the involvement of variable number tandem repeat (VNTR) polymorphisms in the monoamine oxidase A (MAOA) promoter and exon 3 of the dopamine D4 receptor (DRD4) gene in heroin addiction modulate the vulnerability of individuals to heroin addiction. Methods. Eight hundred and ninety-four male heroin addicts without other psychiatric disorders, were recruited as subjects. Another community 180 males were selected randomly as controls. Results. The geno-distribution of the DRD4 exon 3 VNTR polymorphism in controls was in Hardy-Weinberg equilibrium (HWEχ2=0.925), but the distribution in heroin addicts was not (HWEχ2=28.35). The long-repeat alleles of the DRD4 exon 3 VNTR polymorphism were found more frequently in the heroin addicts ( P=0.019). However, the long-repeat alleles of the MAOA promoter VNTR polymorphism were not ( P=0.828). No interaction between these two VNTR polymorphisms was found by using multiple logistic regression analysis ( P=0.261). Conclusion. The long-repeat allelic variants (>4-repeats) and 2-repeat allele of the DRD4 exon 3 VNTR polymorphism might be risk alleles for individual vulnerability to heroin addiction in Chinese men, but the MAOA promoter VNTR polymorphism does not mean that the partial dominant inherited mode might involved in the genetics of heroin dependence. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This aim of this study was to investigate depression and related factors in elderly patients (⩾65 years) with type 2 diabetics. Methods: The study utilized a descriptive-correlational design. Convenience sampling was applied to enroll 156 subjects, aged ⩾65 years from diabetic outpatient clinics at three hospitals in Kaohsiung. This study applied the Personal Resource Questionnaire 2000 (PRQ 2000), Taiwan Geriatric Depression Scale (TGDS), and a form for demographic data. Results: (1) The mean index score for depression level was 26, indicating that study subjects had a low level of depression. The social support index score was 76. (2) Significant differences in TGDS scores existed for diabetes duration, diabetes complications, and treatment type. (3) Social support and regular exercise were significantly and negatively correlated with depression. (4) Social support and diabetes complications were significant correlates of depression and accounted for 25.9% of variance in depression. Conclusion: Analytical results may assist nurses in understanding depression and related factors for diabetic patients aged ⩾65. Therefore, this study could form a basis for caring older people with diabetes, and provide a reference for further research. [Copyright &y& Elsevier]

The psychoactive effects of using areca nut and its potential for dependence have been observed. However, the factors that create barriers to or promote chewing cessation are not well understood. This study aims to explore the behavioral changes of betel quid chewers who have been diagnosed with oral cancer within a transtheoretical model framework. Thirty oral cancer patients with betel quid chewing history were chosen for in-depth interviews. Qualitative content analysis was used to analyze the data and identify themes that described the behavioral changes of betel quid cessation. Our research showed that betel quid chewers with oral cancer typically experience four significant stages of behavior: pre-contemplation, contemplation, action, and maintenance. Each stage change was marked by specific characteristics. At first, chewers showed positive attitudes toward the psychoactive or social effects of betel quid. They then realized the negative effects of betel quid, such as dental or other physical problems. Some also realized that they were addicted to betel quid. When they decided to quit, most chewers reported going “cold turkey.” Some chewers successfully quit betel quid and attributed it to willpower. Those quitting because of the loss of oral functions were unable to chew anymore, though some chewers had experienced a relapse. In the maintenance stage, ex-chewers reported overcoming their addiction; however, relapse was possible. In this study, those who quit betel quid because of oral cancer usually quit tobacco and alcohol as well, with a lesser chance of recurrence. As the maintenance of chewing betel quid is multifactorial, this study provides information for betel quid cessation and oral cancer prevention. [ABSTRACT FROM AUTHOR]

Background: There are few published studies addressing multiple substance uses and their effects on subsequent cessation of betel quid (BQ) chewing in the Asia Pacific region. Objectives: This study aims to investigate the usage patterns of BQ chewing, cigarette smoking, and alcohol drinking, and their correlates with subsequent BQ cessation among a male inmate population. Methods: Data from 473 male inmates with a history of BQ use who were incarcerated in Taiwan Kaohsiung Prison was used for this analysis. Participants were asked to report their lifetime usage patterns of cigarette, alcohol, and BQ, and their cessation status of each substance. A stepwise logistic regression analysis was performed to identify predictors of voluntary BQ cessation. Results: Seventy-five percent of all participants reported habitual use of all three substances. A total of 185 (39%) participants reported voluntary cessation of BQ prior to incarceration, and 288 (61%) reported cessation because of incarceration. Inmates who quit smoking before incarceration were more likely to voluntarily quit BQ. Inmates who had drinking habits were less likely to quit BQ, but those who quit drinking before incarceration were more likely to quit BQ. Inmates who preferred the type of BQ known as lao-hwa quid were more likely to quit BQ, and a longer chewing history correlated with a lower likelihood of quitting BQ. Conclusions Importance: Our data suggest that coexisting habitual use of cigarette, alcohol, and BQ is very common in this inmate population. BQ cessation is significantly associated with not only inmates' usage patterns of cigarette and alcohol, but also their cessation status of these substances. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the fatigue levels and important fatigue predictors for patients undergoing haemodialysis. Background Fatigue is a common symptom for haemodialysis patients. With its debilitating and distressing effects, it impacts patients in terms of their quality of life while also increasing their mortality rate. Design A descriptive correlational study. Methods Convenience sampling was conducted at six chosen haemodialysis centres in Southern Taiwan. Data were collected via a structured questionnaire from 193 haemodialysis patients. The scales involved in this study were socio-demographic details, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Scale for haemodialysis patients. Data analysis included percentages, means, standard deviations and hierarchical multiple regression analysis. Results The fatigue level for haemodialysis patients was in the moderate range. Results from the hierarchical multiple regression analysis indicated that age, employment status, types of medications, physical activity and depression were significant. Of those variables, depression had the greatest impact on the patients' fatigue level, accounting for up to 30·6% of the explanatory power. The total explanatory power of the regression model was 64·2%. Conclusion This study determined that for haemodialysis patients, unemployment, increased age, taking more medications or lower exercise frequencies resulted in more severe depression, which translated in turn to higher levels of fatigue. Among all these factors, depression had the greatest impact on the patients' fatigue levels. Relevance to clinical practice Not only is this finding beneficial to future studies on fatigue as a source of reference, it is also helpful in our understanding of important predictors relating to fatigue in the everyday lives of haemodialysis patients. It is recommended that when caring for fatigued patients, more care should be dedicated to their psychological states, and assistance should be provided in a timely way so as to reduce the amount of fatigue suffered. [ABSTRACT FROM AUTHOR]

Abstract: Background: Betel quid is a substance that commonly used among male labor in Taiwan, and the dependence potential has been reported in some studies, but no instrument has been developed specifically to assess areca/betel quid dependence. Objective: To develop a reliable and valid research instrument/screening tool for the measurement of betel quid dependence. Methods: There were 223 male prisoners with a history of betel quid chewing behavior before they were incarcerated in Kaohsiung Prison enrolled in this study. The items of the Betel Quid Dependence Scale (BQDS) were developed by the authors and were designed referring to previous research findings and the diagnostic criteria of Substance Dependence in DSM-IV. Results: The BQDS has high internal consistency (Cronbach''s α =0.921), and a three-factor structure consisting of “physical and psychological urgent need,” “increasing dose” and “maladaptive use,” which accounted for 61.2% of the total variance. There were 94 (42.2%) male-prisoners who satisfied DSM-IV criteria for dependent use, and the receiver operating characteristic (ROC) curve showed that the BQDS had an optimal cut-off score of 4, the optimal sensitivity was 0.926 and the specificity was 0.977, with the predictive accuracy up to 99.3%. Conclusions: The BQDS has good internal consistency and construct validity, and was proved to have optimal reliability and criterion validity in this special sample. Further investigation is suggested in different samples such as the general population or oral submucous fibrosis (OSF) patients to test the generalization of this instrument. [Copyright &y& Elsevier]

The main aims of this study were to develop norms for the Wisconsin Card Sorting Test in 6- to 11-yearold children in Taiwan; to explore the effect of sex, age, birth order, number of siblings, and parental education on WCST performance in 6- to 11-year-old children; and to make a comparison of WCST performance between children in Taiwan and the USA. The results of this comparison of developmental norms of school children in Taiwan and the United States may facilitate the WCST as a clinical or research instrument in combination with other test procedures to assess aspects of cognitive and neuropsychological functioning of school children. [ABSTRACT FROM AUTHOR]