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The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (β = −.29) and indirect negative effects (β = −.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Orthokeratology (Ortho-k) is an effective method for slowing the progression of myopia and correcting refractive error in school children. Although parents of children aged10 years play a major role in Ortho-k lens care, they have a generally low level of compliance in performing regular follow-up visits.This study was developed to analyze the associations between follow-up visits by parents of Ortho-k lens wearers aged10 years and, respectively, the Ortho-k-related knowledge of these parents and information resources promoting Ortho-k use.A cross-sectional study design was used. Parents of children who wear Ortho-k lenses were recruited through a private Facebook group with 3,500 members in 2020 that was created in 2018 for information sharing and exchange among parents of these children. The following data were collected: demographics of the parents and their children, four-item Ortho-k-related knowledge, information resources that prompted the decision to use Ortho-k, and the regularity of follow-up visits. These data were presented in terms of means, standard deviations, and percentages. Logistic regression was performed to compute the odds ratios ( OR s) and 95% confidence intervals (CIs).The study showed that 83.11% had regular follow-up visits. The correct response rate on Ortho-k-related knowledge was80%. However, 15.51% of the participants did not recognize axial length as an indicator for monitoring myopia progress, and 10.76% did not know that at least 6 hours of nighttime sleep is required for myopia control with Ortho-k. The most common information resource leading to Ortho-k use was self-acquisition from Internet sources. The spherical equivalent refraction of-2.0 D was 2.58 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 2.58, 95% CI [0.22, 5.63]). In addition, acknowledgment of "There is no need to change the Ortho-k lenses regularly as long as there is no discomfort" was 7.19 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 7.19, 95% CI [1.26, 13.93]). However, participants with regular follow-up visits did not receive Internet ophthalmology advertisements prompting their decision to use Ortho-k 2.62 times higher than their peers with irregular follow-up visits ( OR = 2.62, 95% CI [0.04, 4.29]).The results support that both information sources and knowledge of Ortho-k use influence the frequency of follow-up visits among parents of Ortho-k lens wearers aged10 years. Related support from health professionals in terms of providing appropriate information and guidance is recommended to promote higher rates of regular follow-up visit attendance.

To investigate the change in the prevalence of reduced visual acuity (VA) in Taiwanese school children after a policy intervention promoting increased time outdoors.Prospective cohort study based on the Taiwan School Student Visual Acuity Screen (TSVAS) by the Ministry of Education in Taiwan.All school children from grades 1 through 6 were enrolled in the TSVAS from 2001 through 2015.The TSVAS requires each school in Taiwan to perform measurements of uncorrected VA (UCVA) on all students in grades 1 through 6 every half year using a Tumbling E chart. Reduced VA was defined as UCVA of 20/25 or less. Data from 1.2 to 1.9 million primary school children each year were collected from 2001 through 2015. A policy program named Tian-Tian 120 encouraged schools to take students outdoors for 120 minutes every day for myopia prevention. It was instituted in September 2010. To investigate the impact of the intervention, a segmented regression analysis of interrupted time series was performed.Prevalence of reduced VA.From 2001 to 2011, the prevalence of reduced VA of school children from grades 1 through 6 increased from 34.8% (95% confidence interval [CI], 34.7%-34.9%) to 50.0% (95% CI, 49.9%-50.1%). After the implementation of the Tian-Tian 120 outdoor program, the prevalence decreased continuously from 49.4% (95% CI, 49.3%-49.5%) in 2012 to 46.1% (95% CI, 46.0%-46.2%) in 2015, reversing the previous long-term trend. For the segmented regression analysis controlling for gender and grade, a significant constant upward trend before the intervention in the mean annual change of prevalence was found (+1.58%; standard error [SE], 0.08; P0.001). After the intervention, the trend changed significantly, with a constant decrease by -2.34% annually (SE, 0.23; P0.001).Policy intervention to promote increased time outdoors in schools was followed by a reversal of the long-term trend toward increased low VA in school children in Taiwan. Because randomized trials have demonstrated outdoor exposure slowing myopia onset, interventions to promote increased time outdoors may be useful in other areas affected by an epidemic of myopia.

Objective:The objective of this study was to examine the relationships between students’ perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity.Design:Cross-sectional study.Setting:Primary, middle and high schools in Taiwan.Participants:A nationally representative sample of 2433 primary school (5th–6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018.Results:Multivariate analysis results showed that after controlling for school level, gender and age, the students’ perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools’ campaigns promoting the eating of vegetables and fruit were positively associated with students’ consumption of vegetables. In addition, schools’ initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students’ engagement in outdoor physical activities and daily moderate-to-vigorous physical activity.Conclusions:Students’ perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

College students experience new pressures and choices as they transition to independent living and can easily develop unhealthy eating habits, resulting in obesity and obesity-related chronic diseases in later life. This study aimed to test the hypothesis that nutrition literacy (NL) mediated the relationship between multi-level factors influencing healthy eating behavior identified from the social-ecological model and healthy eating behavior of college students. A four-part questionnaire was completed by 412 participants recruited from six different four-year universities in Taiwan (effective response rate = 85.8%). Data were analyzed using descriptive statistics, an independent samples t-test, hierarchical multiple regression, and mediation analysis. The results indicated that the students’ mean nutrition literacy score was 4.32 (SD = 0.78, range = 1–6). In the social-ecological framework, nutrition literacy significantly predicted healthy eating behavior (β = 0.28, p &lt, 0.001, ΔF = 32.54, p &lt, ΔR2 = 0.05) with control variables of background, intrapersonal, interpersonal, environmental, and macrosystem factors. Nutrition literacy mediated the effects of seven factors on healthy eating behavior across four levels. These findings suggested that strengthening influential multi-level factors associated with healthy eating behavior not only enhanced NL, but also improved individuals’ healthy eating behavior.

Orthokeratology (OK) lens wear is an effective modality to inhibit axial elongation in myopic children. Willingness for commitment from both parents and children contributes to the success of OK treatment. We aimed to develop and assess the usability of a mobile application on OK lens wear by quantitatively and qualitatively evaluating parents with myopic children and eye care professionals (ECPs). Moreover, the preliminary outcome was also evaluated in this study. The app was developed and tested using a co-design approach involving key stakeholders. Two prototype tests were conducted during the feasibility and utility assessment. The app features include self-reported compliance documentation, analytics, and personalized and generalized messages for compliance behaviors of OK lenses. After the trial period, the full usage of app functions ranged from 40% to 60% among the enrolled parents. After app implementation, the compliance with follow-up visits substantially improved. Qualitative data show that the high-satisfaction app functions reported by parents were the app’s reminder and axial length recording, although it was recommended that the number of compliance questions should be reduced to minimize the survey completion time. Additionally, who should complete the recording of the axial length data as well as the management and reminder for the follow-up visit remained controversial. This is the first app developed to improve parents of myopic children’s compliance with OK lens wear and to assist ECPs and parents in collaboratively monitoring and managing the use and care of OK lenses among myopic children. This study highlights the importance of interdisciplinary collaboration in the design, development, and validation of such an app.

For the present study, we developed a television (TV) drama-based media literacy program for Taiwanese adolescents. A quasi-experimental design was used to determine the effects of the program on their media literacy and gender role attitudes. Participants were ninth-graders (aged 14 and 15 years, 50.6% male) from eight classes at one school which were randomly divided into two groups (four classes each). The experimental group (n = 126) received a three-unit media literacy program based on the constructs of the Message Interpretation Process Model and utilizing popular TV idol dramas as the material. The control group (n = 122) did not receive any gender or media education. A repeated measures analysis of variance was used to examine mean changes in participants’ media literacy and gender role attitudes at pre-test, immediate post-test, and at one-month lagged post-test. We found that the experimental group showed significantly better media literacy abilities and more positive gender role attitudes at post-intervention compared to the control group. At the one-month lagged post-test, compared to pre-test, the experimental group had significantly better performance in media literacy and gender role attitudes. The intervention in the present study could be used as the reference for school educators to guide adolescents into breaking gender stereotypes on TV dramas and to reducing their frequency of watching them.

Objective:This study aimed to investigate the nutrition literacy status of Taiwanese college students and to assess the relationship between nutrition literacy and healthy-eating behaviours.Design:Cross-sectional design with convenience sampling.Setting:Six universities in northern, central and southern Taiwan; both national and private universities were included in each region.Method:A maximum of 220 students was recruited from each university with no more than 45 students from one department. Data were collected using a self-rated nutrition literacy scale and questions about frequency of practising healthy-eating behaviours and demographic information.Results:The mean score for self-rated nutrition literacy was 2.8 (out of 4), and the mean score for healthy-eating behaviours was 3.07 (out of 5). Results of hierarchical regression showed that nutrition literacy explained 17.2% of the total variance of healthy-eating behaviours of college students, controlling for confounding variables.Conclusion:The findings of this study showed that nutrition literacy among college students was not optimal, and there was a positive association between higher levels of nutrition literacy and healthier dietary behaviours. Therefore, identifying methods to increase nutrition literacy among college students is essential to promote healthy-eating behaviours.

健康素養對健康狀態、健康不平等、醫療支出、醫療照護可近性、健康資訊的理解及醫療場域中的決定行為皆有重要影響。然而，目前健康素養的相關研究卻仍存在以醫療場域為背景及以成人為對象的問題，因此，本研究旨在以健康促進觀點建構青少年健康素養之定義與能力指標。本研究以國中三年級學生及高中職三年級學生為指標發展之目標對象，為能建立青少年健康生活情境之基礎資料，故訪談青少年及與其生活情境相關之重要他人，共 85 名青少年、23 名家長與 34 名教師，並同步參酌國中與高中職健康教育教學相關能力指標，發展青少年健康素養之定義與能力指標，由八位健康教育相關背景之專家學者及八位資深的健康教育教師，進行兩回合的德懷術後定稿。本研究發展出青少年功能性、互動性及批判性健康素養之定義，並依其定義發展出青少年健康素養能力指標共 56 項；在個別指標部分，適用國中階段之指標 13 項，適用高中職階段之指標 18 項，共用指標部分共 25 項，指標內容共涵蓋10 個健康議題。由於本研究之健康素養定義與能力指標之發展乃依據青少年之真實生活情境，也同步考量國家健康教育課程綱要，故可作為健康素養測量工具發展及教學介入策略之重要參考依據。 Research has demonstrated that health literacy significantly affects health status, health inequality, medical expenses, accessibility of medical care, understanding of health information, and decision-making behavior. However, most studies on the topic of health literacy have focused on adults and are based on a medical perspective. This study proposed a definition of health literacy and an ability indicator for adolescents. The target study population were students in their third year of junior and senior high school. Thirty-four teachers, 23 parents, and 85 adolescents were interviewed to collect data concerning the real-life context of adolescents. The collected data and national health education curriculum guildines were used as a reference to develop health literacy definitions and abilities. Eight health education experts and eight senior teachers were invited to conduct a two-round Delphi survey. Based on the 3 types of adolescent health literacy (functional, interactive, and critical health literacy), this study developed health literacy definitions and 56 abilities (10 for the junior high indicator, 18 for the senior high indicator, and 28 for the junior and senior high indicator) covering 10 issues. The definitions and ability indicators in this study were developed on the basis of real-life adolescent contexts and considered Taiwan’s health education guildines. Therefore, the results can serve as a valuable reference for developing health literacy measurement instruments or intervention programs.

BACKGROUND Myopia is an underappreciated but profound public health problem. Orthokeratology (OK) lens wear is an effective modality to inhibit axial elongation in children with myopia. Willingness for a commitment from both parents and children contributes significantly to the success of the OK treatment and decreases the chance of complications due to non-compliance behaviors. OBJECTIVE The aim of this pilot study was to develop and assess the usability of a mobile application of OK lens by quantitatively and qualitatively evaluating parents with myopic children and eye care professionals (ECPs). We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for parents and ECPs to collaboratively manage myopic children wearing OK lens. METHODS The app was developed and tested in 2020 using a co-design approach involving target users (parents with 7-13 myopic children), ECPs, designers, and app developers. A total of 36 parents with children who were given OK lens in an ophthalmology clinic were admitted to the study. Subsequently, prototype tests, two System Usability Scale (SUS) questionnaire surveys, and app engagement and app experience interviews were conducted during the three-month feasibility and utility assessment. RESULTS The app features include self-reported compliance documentation, analytics, personalized and generalized messages for compliance behaviors of orthokeratology lens. After the three-month trial period, the app demonstrated a usage rate of approximately 40 – 60 % among the 30 enrolled parents and was most often used prior to the follow-up visit. Although after the implementation of the app, there was no significant difference in compliance of wear and care, the incidence of comorbidities as well as the compliance with follow-up visits substantially improved. The average SUS scores at the first week and the third month were 54.6 and 82.0, respectively. Qualitative data suggested that parents were most satisfied with the app’s reminder and axial length recording functions, although it was recommended that the number of compliance behavior questions should be reduced to minimize the time required to complete the survey. In addition, whether the recording of the axial length data as well as the management and reminder for the follow-up visit should be completed by parents or ECPs remained controversial. CONCLUSIONS This is the first app developed to improve the parents’ compliance of myopic children with OK lens and assist ECPs and parents to collaboratively monitor and manage the wearing and caring of OK lens among myopic children as well as their follow-up visits. The study also highlighted the importance of interdisciplinary collaboration in the design, development, and validation of such an app. CLINICALTRIAL Nil

Delay discounting, time perspective, and self-schemas are well-known predictors of health risk behaviors among adolescents. However, the associations between these constructs and their influence on such behaviors are yet to be examined. This study aimed to determine the relationships among three cognitive constructs, namely, delay discounting, time perspective, and self-schemas, and determine the associations of these constructs with alcohol drinking (alcohol use and alcohol problems) and disordered eating behaviors in adolescents. Participants were 436 eighth-graders from three public junior high schools in southern Taiwan, who answered an anonymous questionnaire assessing self-schema, delay discounting, time perspective, and health risk behaviors. Generalized linear models with robust estimation were performed to estimate the effects; gender was the covariate. Delay discounting was associated with alcohol use (OR = 1.15), but not alcohol problems and disordered eating behaviors. Present-Hedonistic time perspective was associated with alcohol use (OR = 2.01), alcohol problems (IRR = 2.23), and disordered eating behaviors (Exp(b) = 1.38); while Future time perspective was associated with alcohol problems (IRR = 2.18). Drinker self-schema was associated with alcohol use (OR = 1.62) and alcohol problems (IRR = 1.71). Fat/overweight self-schema was associated with overall disordered eating (Exp(b) = 1.03). Thus, the findings suggest that each of the three constructs is independently associated with drinking and disordered eating behaviors, and these associations vary according to the specific type of behavior. Future research identifying the underlying mechanisms linking these constructs to the abovementioned behaviors can be useful for developing targeted intervention strategies.

Objectives To evaluate compliance with orthokeratology (Ortho-K) care and its influencing factors among parents of 6–13-year-old myopic children in Taiwan. Methods Parents who are responsible for the care of the Ortho-K lenses of their myopic children were recruited through a closed Facebook peer support group to answer an online compliance questionnaire, including the wear and care behaviours and follow-up visits of Ortho-K. Results A total of 253 online questionnaires were analysed after excluding those with wrong information. Most participants (89.7%) were mothers and had university-level or higher education (72.3%); 67.6% of them could achieve a score equal or higher than 60% correct rate on knowledge items. In addition, 39.3% of participants had high myopia (spherical equivalent ≦ 6.0 diopters). The mean age at onset of myopia was 7.75 years for children, and 57.4% wore Ortho-K lenses for less than a year. Full compliance rate was 22.8%, as reported by fathers or mothers. The compliance rate for follow-up visits significantly increased with provision of axial length information in follow-up visits, knowledge of axial length changes as an effect of myopia control, and Ortho-K use for less than 6 months. The compliance rate for wear and care was significantly associated with high myopia in one of parents, high education level, early onset of myopia in children, knowledge of Ortho-K and myopia control, and Ortho-K use for less than 6 months. Conclusion These results indicate the need for a comprehensive education programme for parents with young myopic children to ensure strict adherence to fitting and wear protocols and good follow-up of Ortho-K lenses.

Background Achieving and improving cultural competence in nursing is an ongoing process, beginning in the student period and continuing through the professional career. Objectives The present study aims to compare pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors in Taiwan in terms of their respective levels of cultural competence, and to determine associated influencing factors. Design A comparative cross-sectional study. Settings Three universities and three hospitals (one regional hospital and two teaching hospitals) in Taiwan. Participants A total of 756 nurses/students (103 pre-graduate nurses, 321 newly graduated nurses, 101 registered nurses, and 231 nurse mentors). Methods The Cultural Competence Scale for Pre-Graduated Students to Licensed Professionals was used to measure the cultural competence level. One-way analysis of variance and hierarchical regression analysis were used for statistical analysis. Results For overall cultural competence and the subscales of knowledge, awareness, and skills, the pre-graduate students scored lower than the other three groups. Experience of caring for patients from diverse cultures and countries significantly influenced the cultural competence of all four groups. Ability to speak fluent English and receiving cultural competence education during nursing education only significantly influenced the cultural competence of the pre-graduate and new graduate nurses. Current job position and primary practice setting significantly influenced the cultural competence of the registered nurses and nurse mentors. Conclusion Pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors have differing levels of cultural competence and differing influencing factors. Cultural competence education that accords with the influencing factors for each nursing position would continuously cultivate nursing staff's cultural competence.

Purpose To assess the visual acuity and compliance with the use of orthokeratology lenses (OrthoK) in school children. Methods A retrospective study was conducted to determine the education-related factors influencing the improvement in visual acuity in myopic students using OrthoK in five primary schools in Taiwan. Results Of the 5,173 eligible students from five primary schools, 1906 (36.8%) students were diagnosed with myopia. Among 201 (10.6%) students wearing OrthoK, 69.7% had used them for at least 1 year, 53.2% achieved visual acuity greater than 0.8 (6/7.5, log of minimal angle of resolution 0.1) in school, and 49.8% had received health education related to OrthoK care. Multiple logistic regression analysis showed that a higher possibility to achieve visual acuity greater than 0.8 was associated with more than 1-year use of OrthoK, good compliance, and receiving health education from an ophthalmologist. Conclusion It is important that children wearing OrthoK receive education and comply with the use of OrthoK for visual acuity improvement.

Objective: This study assessed school principals’ understanding, attitudes and willingness to influence the implementation of the health-promoting schools (HPS) programme in Taiwan and teachers’ willingness to sustain it. Method: In 2014, a total of 1,140 school principals and 1,110 teachers (HPS coordinators) completed questionnaires concerning their perspectives on implementation and sustainability. Results: Compared with teachers, school principals reported higher levels of willingness to sustain HPS implementation. School principals’ levels of understanding of HPS and willingness to sustain it were significantly associated with higher levels of HPS implementation and an increase in teachers’ willingness to sustain HPS implementation. Conclusion: School principals’ understanding and willingness to support are central to the effective implementation and sustainability of initiatives such as HPS.

Unhealthy eating behaviors contribute to obesity and chronic illness. This study examined the relative contributions of a healthy-eater self-schema (a self-conception as a healthy eater) and nutrition literacy on healthy-eating behaviors and whether nutrition literacy was a mediator among Taiwanese college students. A total of 1216 undergraduate students from six universities in Taiwan participated in the study from April to June 2016. Healthy-eating behaviors, nutrition literacy, healthy-eater self-schema and known determinants of eating behaviors (e.g. nutrition-related information, health status, nutrition knowledge needs, sex, year in college and residence) were measured by a self-report questionnaire. A hierarchical multiple regression and mediation analysis were conducted with the known determinants of eating behaviors as covariates. Results showed that a healthy-eater self-schema and nutrition literacy explained 9% and 12% of the variance in healthy-eating behaviors, respectively, and both had unique effects on healthy-eating behaviors. The effect of a healthy-eater self-schema on healthy-eating behaviors was partially mediated through nutrition literacy. Findings suggest that both a healthy-eater self-schema and nutrition literacy should be considered when promoting healthy-eating behaviors. Additionally, nutrition literacy interventions should be tailored to the healthy-eater self-schema status and emphasize the personal relevance of being a healthy-eater to improve the intervention's effectiveness.

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator&ndash, student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.

Background: Currently, health literacy (HL) worldwide is measured primarily among adults from a medical perspective. A children’s HL test from a health promotion perspective is needed. This study develops the Taiwan Children’s Health Literacy Test (TCHL) targeted at Taiwanese sixth-graders. Methods: HL indicators were identified through interviews of sixth-grade teachers, primary caregivers, and sixth-graders. They were used to develop a 25-item online test, which was finalized after pretesting and administered to a stratified random sample of 671 students across 29 sixth-grade classes. Results: The response rate was 87.2% (585 participants). Cronbach’s α was 0.60–0.78 for the HL subtests and 0.79 for the overall HL test. Correlation coefficients among subtests ranged from 0.49 to 0.87. The average proportion correct was 0.80 for overall HL. In item response theory analysis, the difficulty level ranged from −2.77 to −0.40, while the degree of discrimination was 0.44–2.65. Item information peaked when the ability value was approximately −1.8. Furthermore, HL scores had a significant positive correlation with health behaviors. Conclusions: Overall, the test was found to be reliable and valid, with a low level of difficulty for basic HL ability. The present results can be used as a reference by government health education units to investigate national HL in children.

Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising.

Significance This study set out to illustrate the trajectories of myopia control in time sequence and explore orthokeratology compliance for parents with myopic children in the first fitting within one year. Profiling these results is crucial to improving myopia control and orthokeratology care. Purpose To obtain a better understanding of myopia control and orthokeratology care that could promote compliance with orthokeratology (ortho-K) lenses for parents with myopic children. Methods We conducted semi-structured qualitative interviews and pre-interview questionnaire surveys of the parent who is mainly responsible for complying to ortho-K lens care for their myopic children aged 7–12 years, including 16 mothers and 4 fathers. A framework analytical approach that involved gaining familiarity with the data to identify a thematic framework was used for data analysis. It was written in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results Five themes and twelve subthemes depicted the parents’ trajectory during myopia diagnosis, treatment, and compliance with ortho- K for their children in the first fitting within one year. Myopia control and the convenience of outdoor activities were important reasons for parents to actively ask for ortho-K lenses for their children. Parents have non-compliance behaviors after the children wore the lenses for three months, including not scheduling follow-up visits, simplifying cleaning procedures, not replacing accessories. The degree of parents’ non-compliance differed based on the uncomfortable feelings of their child’s eyes. In general, clear, unaided vision (visual acuity > 0.9) during the day was an indicator of ortho-K’s effectiveness, according to parents. Conclusions Although parents play a passive role when a child is diagnosed with myopia, they take on a proactive role when deciding on ortho-K treatment. Myopia treatment for children is a long-term process. Understanding the course of treatment and non-compliance helps eye care professionals provide parents with the necessary assistance and resources, and enables myopia treatment to yield maximum effects.

Purpose The objective of this study was to empirically test a theoretical model to determine the cognitive mechanisms that are associated with adolescent alcohol use and alcohol problems. We posited that alcohol outcome expectancies would affect alcohol-refusal self-efficacy through the drinker self-schema. We also posited that alcohol outcome expectancies and the drinker self-schema would affect alcohol use and problems through alcohol-refusal self-efficacy. Methods A survey was administered to 225 adolescents in a public junior high school in Taiwan at two-time points, six months apart. Path analysis was used to determine the mechanisms underlying the alcohol-related cognitive constructs on the alcohol use and alcohol problems separately, controlling for appropriate alcohol-related personal and environmental factors. Indirect effects were estimated using the bootstrapping method. Results Higher positive alcohol outcome expectancies and lower negative alcohol outcome expectancies predicted higher drinker self-schema scores. Higher positive alcohol outcome expectancies and drinker self-schema scores predicted lower alcohol-refusal self-efficacy. Lower alcohol-refusal self-efficacy was associated with a history of drinking and alcohol problems in the past six months. Effects of alcohol outcome expectancies on alcohol use and alcohol problems were partially mediated through the drinker self-schema and alcohol-refusal self-efficacy. Conclusions Findings support the proposed theoretical cognitive mechanisms underlying alcohol use and alcohol problems in a sample of Taiwanese adolescents. Given that alcohol-related cognitive constructs are modifiable, the findings also provide a foundation to suggest that interventions to reduce positive alcohol outcome expectations and prevent the formation of a drinker self-schema may facilitate alcohol-refusal self-efficacy and mitigate drinking behaviors in this adolescent population.

Warpage has always been an important issue in electronic packaging, especially for fan-out and flip-chip chip scale packages (fcCSP). The molded underfill for encapsulation plays a key role in warpage control. It is critical to establish a fundamental understanding of the properties of cure-induced shrinkage and viscoelasticity, and the effects of pressure, temperature, volume variation, and degree of cure on package warpage.In this study, the cure-dependent shrinkage and cure-dependent viscoelasticity of a molded underfill are carefully characterized during in-molding and post molding cure (PMC) thermal processes. A plunger dilatometer is used for shrinkage characterization, and the volume change is described by pressure, volume change, temperature, and degree of cure relations. In addition, the cure-dependent properties are characterized by other two techniques, including cure kinetics by differential scanning calorimetry (DSC), and dynamic mechanical analysis (DMA). It was found that the volume change after the gel point is the dominant factor for package warpage. The package warpage evolution was modeled by finite element analysis. Our predictive models are not only in good agreement with the experimental thermal shadow moire result, but also effectively evaluate the effect for shrinkage and CTE/modulus. The results indicate that warpage at high temperature is highly sensitive to the CTE/Modulus of MUF.

Background Cultural competency has been identified as an essential curricular element in undergraduate and graduate nursing programmes. Supporting successful transition to practice is essential for retaining graduate nurses in the workforce and meeting the demand for cultural diversity in health care services. Objectives This study aimed to explore the teaching and learning interactions of transition cultural competence from the perspective of mentors of newly graduated nurses in a Taiwanese postgraduate nursing programme. Design A qualitative design that utilised focus group interviews was adopted for this study. A framework approach—a content and thematic analysis strategy—was used to analyse the interviews. Setting The study setting consisted of two hospitals in northern Taiwan. Participants The study participants consisted of 24 new graduate nurse mentors. Methods Three focus group sessions were conducted (two at a medical centre and one at a district hospital), where the participants were interviewed. Results Four themes were derived from the data—transition process, teaching strategies according to the transition stage, learning after overcoming clinical stress, and awareness of cultural diversity among new graduate nurses. The clinical routine and physical stress of caring for patients did not allow the newly graduated nurses to appropriately demonstrate cultural competence in the first three months. Mentors were only able to provide resources for new graduate nurses when they first started to care for patients in cultural groups. The point of catalysis was when learners finally gained awareness of cultural differences, and, consequently, they could encounter the teaching and learning process. Conclusion The different learning stages and teaching strategies illustrated the interactive process between new nurses and educators. Facilitating the cultural awareness of learners is a challenge for teachers who provide cultural competence training. This model could serve as a reference for curriculum and clinical training programmes.

Myopia, the most common refractive error, is the most common cause of avoidable visual impairment among children and has reached epidemic proportions among children and young adults in urban areas of East and Southeast Asia that contain populations of Chinese ancestry. Moreover, vision health is an important theme of the health-promoting school program issued by the Ministry of Education in Taiwan. The aim of this study is to assess the impact of pre- and post-intervention proposed by the health-promoting school (HPS) model. The objectives are to understand whether the HPS model influenced the vision screening results and the attitude, knowledge level, and vision care behavior of the students involved. A prospective cohort study design was used to evaluate a vision health program. Four elementary schools, local education authorities, and one university in northern Taiwan established a coalition partnership to design a six-month program to combat myopia among students. The target population was 6668 school children from local elementary schools. For the purpose of this study, the outcome of visual acuity testing (in logMAR) was analyzed with a sampling of 373 school children (aged 11–12 years old) who were chosen from high prevalence of poor vision classes. After the HPS program, the attitudes, behaviors, and knowledge levels of the school children regarding vision health were significantly improved. The pre-intervention mean logMAR of all participating students ( N = 373) was –.10, which increased to –.19 after the intervention. Analysis using the Wilcoxon signed-rank test showed that the logMAR value was significantly improved after the intervention ( t = 2.13, p < 0.05). Our findings highlight the relevance and effectiveness of the coalition’s efforts, which reinforces the usefulness of co-operatively implementing the HPS program.

BACKGROUND: Taiwan has advocated health-promoting schools (HPS) since 2001 and established the Health-Promoting School Supporting Network (HPSSN) in 2005 to offer administrative support and consultation. Respondents' opinions about HPSSN and the relationship between these perceptions and HPS implementation were examined. METHODS: In 2011, 800 primary and middle schools were selected through stratified random sampling. School staff members (N = 656) in charge of HPS programs reported their impressions of the HPSSN's support. RESULTS: Respondents were most satisfied with consultants and schools' recognition of responsibilities and rules and their interactions with HPSSN administrators. They were least satisfied with the extent of their HPSSN consultant interaction and believed HPSSN provided insufficient resources to establish HPS. Respondents' consultant partnerships and satisfaction with HPSSN administration significantly predicted HPS implementation. Additionally, the predictive values of healthy policies and school-community relationships were greater than the other 6 HPS components. CONCLUSIONS: HPSSN positively influenced HPS implementation; however, consultant/school partnerships and school resource allocations must be improved. Language: en

Few studies have focused on premenstrual symptoms in employees. This study explored the prevalence of premenstrual symptoms in 7,193 female employees aged 18-55 years in a large electronics manufacturer in Taiwan from August 2014 to December 2014 and examined whether regular exercise was associated with premenstrual symptoms. Information was collected on demographics, lifestyle, menstrual history, menstrual pain, and premenstrual symptoms. Half of the participants reported irregular menstruation; 79.4% reported a moderate menstruation amount, and half reported little impact of menstrual pain at work. In order of prevalence, symptoms were "easy to fatigue" (24%), "backache" (21.2%), and "abdominal bloating" (17.4%). Participants who engaged in regular exercise reported fewer backaches (adjusted odds ratio [aOR] = 0.79, 95% confidence interval [CI] = 0.68-0.91), somatic discomfort (aOR = 0.78, 95% CI = 0.63-0.96), headache (OR = 0.82, 95% CI = 0.69-0.98), diarrhea (aOR = 0.76, 95% CI = 0.60-0.96), constipation (aaOR = 0.59, 95% CI = 0.44-0.78), less irritability (aOR = 0.78, 95% CI = 0.65-0.94), feeling morose and depressed (aOR = 0.75, 95% CI = 0.58-0.95), crying (aOR = 0.51, 95% CI = 0.27-0.87), and emotional lability (aOR = 0.73, 95% CI = 0.58-0.91). Regular exercise was associated with decreased menstrual pain (aOR = 0.85, 95% CI = 0.76-0.96). Our findings provide a better understanding of premenstrual symptoms in female workers, allowing for the development of premenstrual health programs to improve their health and quality of life.

In this investigation, a system-in-package (SiP) that consists of a very low-cost interposer with through-silicon holes (TSHs) and with chips on its top and bottom sides (a real 3-D IC integration) is studied. Emphasis is placed on the fabrication of a test vehicle to demonstrate the feasibility of this SiP technology. The design, materials, and process of the top chip, bottom chip, TSH interposer, and final assembly will be presented. Shock and thermal cycling tests will be performed to demonstrate the integrity of the SiP structure.

As a three-terminal power semiconductor device, an insulated gate bipolar transistor (IGBT) chip is characterized by its fast switching and low switching loss, explaining its extensive use in high-power electrical products. However, Joule heating may be induced during high current conditions, subsequently raising the temperature of the power module. Correspondingly, an uneven temperature distribution may decrease reliability and diminish the life of a power module in long-term operations. Therefore, this study investigates the temperature effect of current crowding and corresponding Joule heating on the IGBT chip. The electro-thermal finite element (FE) behavior of the power module is also investigated, based on a numerical analysis. The current densities of solder, IGBT chip, and aluminum pad are also examined to observe the current crowding effect. Analysis results indicate that the maximum current density occurs at the interface between aluminum pad and the aluminum wire. Additionally, the maximum current density may induce electromigration or failure behavior in long-term operations. These characteristics and temperature distribution can be analyzed during an electrical loading, based on electro-thermal FE analysis. Additionally, the test sample is designed to validate the temperature distribution in the simulation and experimental results. Moreover, the steady temperature of the test sample under electrical loading is determined using an infrared-detecting camera and T3ster. Comparing the simulation and experimental results demonstrates the reliability of the temperature validation method. Furthermore, the temperature from the electro-thermal FE analysis is treated as temperature loading in the thermo-mechanical FE analysis. Efforts are underway in our laboratory to investigate the temperature induced thermal stress. Results of this study demonstrate that numerical analysis can replace and reduce the number of experiments, as well as forecast the electrical, thermal, and mechanical behaviors of the power module efficiently.

Energy recycling is an important research topic worldwide. Thermoelectric generators (TEGs) are used to recycle energy. TEGs are suitable for small and medium-sized applications and industrial waste heat harvesting in medium to high temperatures. Traditional lead-free soldering cannot be applied at temperatures above 200 °C. The joint may melt and fail at exceedingly high temperatures. Therefore, determining the suitable bonding material to apply during TEG assembly is necessary. Ni/Sn/Ag was adopted as the joint material for TEG packaging in this study. The joints were bonded and transformed into a full intermetallic compound (IMC) through solid–liquid interdiffusion bonding (SLID) and solid–solid interdiffusion reaction. The IMC has a high melting point and can be utilized at temperatures above 200 °C. The mechanical strength of the joints was examined through shear test at different thermal treatment times. Shear strength declined with the increase in thermal treatment time. The TEG was assembled with 12 pairs of thermoelectric (TE) pillars, and its performance was measured through the slope method. The TE characteristics do not significantly vary before and after thermal treatment. With the established finite element (FE) model, temperature and output power were estimated at specific temperature loading through thermo-electrical FE analysis.

In this paper, a 3-D finite-element (FE) model was established based on real test samples. Coupled electrothermal and thermal-mechanical FE analyses were conducted to analyze the mechanical behavior of bonding wire under cyclic power loading. The current crowding phenomenon may be improved by increasing the wire number. The junction temperature can be decreased by decreasing the joule heat from the current crowding around the bonding wire. The findings suggest that the power module with wire configuration design shall be operated in a higher power load; meanwhile, the identical reliability can be guaranteed. The temperature predicted by the simulation was consistent with the experimental data. Incremental equivalent plastic strain was not observed when the current loading was low. However, the plastic ratio progressively enhanced with the current load. With a high current load, the yielding effect should be considered. Plastic strain dominated the failure mechanism. The concepts of high- and low-cycle fatigue should be incorporated into the life prediction model for modules subjected to low and high current loadings, respectively. After the simulation results were validated with the experimental data, two models for the design of power modules were proposed.

Solid liquid interdiffusion technique is employed to attach N type Bi2(Te0·92Se0·08)3 thermoelectric material to alumina substrate. The surface finishes of the bonding surfaces for Bi2(Te0·92Se0·08)3 and alumina are Ni and Ag respectively. The bonding layer is pure Sn. The growth kinetic of intermetallic compounds and their microstructure evolution during aging at 200°C was established. The success of this bonding technique provides a cost effective way to assemble thermoelectric modules at a low temperature for higher temperature applications.

Because of a lack of appropriate methods and the difficulties of sample preparation, few direct measurements of the thermal conductivity of thermoelectric materials in thin films have been reported. We prepared thermoelectric thin films of four types containing Bi–Te and Sb–Te by electrodeposition from aqueous solutions with and without added surfactant, and evaluated their intrinsic thermal conductivity with a modified parallel-strip technique. Three thermoelectric materials showed values 0.2–0.5 W m −1 K −1 of intrinsic thermal conductivity; for the other type problems of sample preparation precluded measurement. According to observations with a scanning electron microscope, the existence of grain boundaries in the thermoelectric thin films is likely the cause of the small values, and their fragile structure causes difficulty in preparation of a test sample.

Objectives To achieve consensus on a set of competencies in health literacy practice based on a literature review and expert consultation. Setting Hospitals and community health centres in Taiwan. Method A 2-stage modified Delphi study involving a literature review was conducted, followed by qualitative interviews and 3 rounds of email-based data collection over a 3-month period in 2011. Participants 15 Chinese healthcare practitioners with more than 6 months’ experience in patient education were interviewed to collect data on health literacy practice. 24 experts (12 academic scholars in health literacy and 12 professionals with training related to health literacy practice) were invited to participate in the Delphi process. Results Qualitative data from the interviews were analysed and summarised to form 99 competency items for health literacy practice, which were categorised into 5 domains of health literacy practice including those pertaining to knowledge and skills. Consensus was reached on 92 of 99 competencies, using a modified Delphi technique. Conclusions The 92 competencies in health literacy practice embraced core components of patient education in the Chinese healthcare profession.

We designed a school-based, nationwide program called the 'New Era in Eye Health' to strengthen teacher training and to examine whether the existence of a government vision care policy influenced teachers' vision care knowledge and students' behavior. Baseline data and 3-month follow-up data were compared. A random sample of teachers (n = 660) from school vision health clusters in 22 cities/counties in Taiwan were invited to participate in our study and 436 agreed to participate (response rate = 66.1%). The mean age of participant teachers was 41.2 years, while the length of service mean was 14.6 years. For monitoring teacher outcomes, five cities/counties were selected as the intensely monitored group based on certain criteria. Sunlight diaries (n = 5434) were distributed and 3342 (61.5%) were returned. Teachers showed significant improvements in knowledge and behavior on the school vision health questionnaire. At the 3-month follow-up, the number of recesses as recorded by students' 'sunlight diary' increased. When teachers had better knowledge and behavior, recesses also increased. This study provided valuable insights to guide dissemination efforts for school vision health interventions and to help teachers implement research into their school vision health activities.

Power module with high power density and high heat dissipation structure has been developed because of increasing requirement for high-power electric products. Power cycling test (PCT) was often adopted to assess to reliability of power module while the cyclic load was applid in power chip. This study investigates the electro-thermo-mechanical behavior of high-power module by using numerical analysis, and assesses its reliability through PCT. First, the current density, corresponding temperature distribution and mechanical behavior of high-power module are predicted by using electro-thermal coupling and thermo-mechanical analysis. In order to satisfy automotive electronics application, the cycling period of minute-level was chosen and applied in high-power module to conduct the reliability test.

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

A high current load may cause the Joule heating, subsequently raising the chip temperature in a conventional power module. Temperature excursion in power chip may generate thermal stress, induce failure and reduce its reliability. Double-sided power module is a crucial structure to provide another heat dissipation path and efficiently reduce chip temperature. This study estimate the thermal and reliability analysis of double-sided power module by using copper bump as an interconnection under different cooling condition. The connection layout can be designed more flexible by using bump interconnection in double-sided power module. The concept of dummy ball also utilized to reduce the mechanical strain or stress of copper bump and improve its reliability in a power module.

A quantitative structure–property relationship (QSPR) has been found to predict the effectiveness of surface tension reduction by anionic surfactants in aqueous solution, as measured by the maximum surface pressure at their respective critical micelle concentrations Πcmc. Our data set contains 34 values of surface pressure for 20 anionic surfactants at different counterion concentration C at different temperatures T. Besides C and T, the best‐regressed model also contains three molecular structural descriptors of surfactants: the Kier & Hall index of zero order, KH0, of the hydrophobic fragment, the molar heat of formation ΔH f and the molecular dipole moment D. The best QSPR between Πcmc and the descriptors produces a correlation coefficient (of multiple determination) of 0.988.

Complications of myopia have become an important public health issue with serious socio-economic burdens. Prevention and treatment are both important. The Taiwan Student Vision Care Program (TSVCP) promoted by Ministry of Education (MOE) has been carried out for 3 decades in Taiwan. The myopia prevalence has increased rapidly to a high level and therefore myopia prevention has continued to be the most important item in the program. Therefore, TSVCP aims to decrease the prevalence of myopia, in order to decrease the high myopia related blindness in the future. Recently, outdoor activity has been found to be an important protective factor for myopia and was implemented in TSVCP since 2011. Afterwards, the nationwide vision impairment rate (uncorrected vision 20/25 or less) of elementary school students declined unprecedentedly and continuously in recent years. Evidence-based protective and risk factors for myopia are now clearer. Widespread acknowledgement of myopic disease, preventing the onset of myopia, prompt diagnosis, and early treatment to control progression are all important.