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Supplementary Figure Legends 1-2 from Endoplasmic Reticulum Stress Triggers XBP-1–Mediated Up-regulation of an EBV Oncoprotein in Nasopharyngeal Carcinoma

Supplementary Figure 1 from Endoplasmic Reticulum Stress Triggers XBP-1–Mediated Up-regulation of an EBV Oncoprotein in Nasopharyngeal Carcinoma

Endoplasmic reticulum (ER) stress-activated unfolded protein response (UPR) plays multiple roles in cancer development, but its specific roles for virus-associated cancers have not been fully understood. It is still unknown whether ER stress/UPR occurs in and contributes to nasopharyngeal carcinoma (NPC), an epithelial malignancy closely associated with EBV. Here, we report that UPR proteins are frequently detected in NPC biopsies. In addition, we reveal that, in EBV-infected NPC cells, ER stress inducers up-regulate a potent EBV oncoprotein latent membrane protein 1 (LMP1), and the ER stress-induced LMP1 enhances production of interleukin-8. ER stress triggers LMP1 expression at a transcriptional level, activating a distal LMP1 promoter TR-L1. TR-L1 contains an ER stress-responsive element, which is targeted by an UPR protein XBP-1. Ectopic expression of XBP-1 induces LMP1 expression, and knockdown of XBP-1 blocks ER stress-triggered up-regulation of LMP1 in NPC cells. Furthermore, XBP-1 significantly correlates with LMP1 expression in NPC tumor biopsies. Therefore, this study not only provides a novel clue linking ER stress/UPR to EBV-associated NPC but also suggests that ER stress/UPR can promote virus-associated cancer in a unique way by driving expression of a viral oncogene. [Cancer Res 2009;69(10):4461–7]

Supplementary Figure 2 from Endoplasmic Reticulum Stress Triggers XBP-1–Mediated Up-regulation of an EBV Oncoprotein in Nasopharyngeal Carcinoma

Patient and visitor violence (PVV), the most prevalent source of workplace violence, is largely ignored, underreported, and a persistent problem in emergency departments. It is associated with physical injuries, psychological distress, and occupational stress in nurses. A randomized controlled trial was conducted in Taiwan from January to December 2020. This study aimed to test the efficacy of an integrated Workplace Violence Prevention and Management Training Program on PVV in 75 emergency department (ED) nurses from a hospital. Cluster sampling was used because the policy of subdivision strategy was enforced during the COVID-19 pandemic. ED nurses received either the intervention or 1-hour in-service class. Data were collected from questionnaires. Data were analyzed mainly by the repeated measure analysis of variance and generalized estimating equations. The intervention had positive effects on developing stronger goal commitment, improving occupational coping self-efficacy, increasing confidence in ability to deal with violent situations, and modifying attitudes toward the causes and management of PVV in ED nurses (p < 0.05). The marginal R2 of the generalized estimating equation model for goal commitment, occupational coping self-efficacy, confidence, attitudes toward aggression in ED and aggressive behavior variables was high as 0.54 (p < 0.001), 0.45 (p < 0.001), 0.58 (p < 0.001), 0.29 (p < 0.05), and 0.72 (p < 0.001), respectively. These study models could effectively predict changes in the mean values. The benefit was driven by the effect of the intervention in ED nurses. Thus, the intervention, when applied in conjunction with routine in-service class, could exert synergistic improvements on outcomes measured in nurses.

Moral cognition is an important and multidimensional, but often overlooked, determinant of violence. Very few interventions have systematically examined the role of moral reasoning, anger management and problem-solving together in violence. A randomized controlled trial was conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning Development Intervention (MRDI) in the management of repetitive violence in schizophrenia. This study placed special emphasis on essential components related to moral reasoning and violence in patients with schizophrenia. Evaluations, including measures of violence, moral reasoning, ethical valuation and judgement, decision-making, conflict management style, and personality traits, were performed at baseline, end of intervention, and 1-month follow-up after intervention. We found that MRDI was superior to treatment-as-usual, in improving moral reasoning and related variables and violence outcomes (p < 0.05). In comparison with the treatment-as-usual group (n = 22), patients in the MRDI group (n = 21) showed improved levels of moral reasoning, with decreased levels of violent behaviors. The MRDI participants also experienced significantly greater improvements or changes (p < 0.05) in their ethical valuation and judgement, decision-making style and preferences, and conflict management style. Our findings provide important implications for risk assessment and violence management and prevention.

Background: Disturbance of lipid, particularly omega-3 polyunsaturated fatty acid (PUFA), metabolism is associated with the etiology and symptoms of schizophrenia. Numerous clinical studies have tried to evaluate whether omega-3 PUFA supplementation can ameliorate the disorder, but the results are inconclusive. Objectives: This systematic review integrates and refines the research evidence of the effectiveness of omega-3 PUFA nutritional supplementation on schizophrenia during the different developmental phases of the disease (prodromal, first-episode, and chronic phases) and examines whether different developmental stages modulate the efficacy of omega-3 PUFA supplementation. Data Sources: Scientific articles from 2000 to 2020 in PubMed/Medline, Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews guidelines. Methods: A systematic review was performed. We reviewed electronic databases and identified 1,266 clinical studies. Of these, 26 met the inclusion criteria. Results: The effectiveness of omega-3 dietary supplementation on symptoms varies among different phases of illness. Omega-3 supplementation significantly improves positive and negative symptoms at the prodromal phase, improves mainly the negative symptoms in patients with the first-episode, and effects symptoms partly in patients with chronic schizophrenia. Discussion: The effectiveness of omega-3 PUFA dietary supplementation is modulated by age, duration of untreated psychosis and illness, baseline levels of omega-3 fatty acids, and status of antioxidant capacity of patients. The important implications for psychiatric research and clinical practice developments as well as nursing care are presented and discussed.

Patients with schizophrenia and repetitive violence express core impairments that encompass multiple domains. To date, there have been few interventions integrating neurocognition, social cognition, alexithymia, and emotion regulation together as an approach to manage repetitive violence. The aim of this open-label randomized controlled trial was to examine more comprehensively the effectiveness of a novel Integrated Cognitive Based Violence Intervention Program on management of repetitive violence in patients with schizophrenia (vSZ). Sixty recruited patients were aged ≥20 years, diagnosed with schizophrenia for >2 years, had repetitive violent behavior within one year, and were psychiatrically hospitalized. The vSZ patients were randomly allocated to two groups and received either the intervention or treatment as usual. The intervention module, consisting of all defined 11 cognitive and social cognitive domains as well as emotion regulation, which were grouped into four modules. The intervention placed emphasis on the patients’ behavioral problems or intrinsic conflicts in relation to repetitive violence. The results indicate a statistically significant trend toward reducing impulsivity, anger with resentment, physical aggression, suspicion, and hostility (p < 0.05). The intervention significantly alleviated the intensity of cognitive failure, improved the management of alexithymic features and attribution styles and errors, and fostered adequate decision-making styles and emotion regulation capacity (p < 0.05). The intervention, when applied in conjunction with psychiatric standard care, could exert synergistic effects on alexithymia and cognitive, clinical, and neurocognitive features of repetitive violence in schizophrenia. This intervention provided patients a more active role to manage their violent behavior with the involvement of alexithymia.

Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses’ perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses’ experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.

Introduction. This study aimed to examine the effectiveness of a physical activity (PA) program on weight control, physical fitness, occupational stress, job satisfaction and quality of life of ove...

PURPOSE The purpose of this study was to compare the effect of standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care alone on wound healing, markers of inflammation, glycemic control, amputation rate, survival rate of tissue, and health-related quality of life in patients with diabetic foot ulcers (DFUs). DESIGN Prospective, randomized, open-label, controlled study. SUBJECTS AND SETTING The sample comprised 38 patients with nonhealing DFUs who were deemed poor candidates for vascular surgery. Subjects were randomly allocated to an experimental group (standard care plus HBOT, n = 20) or a control group (standard care alone, n = 18). The study setting was a medical center in Kaohsiung City, Taiwan. METHODS Hyperbaric oxygen therapy was administered in a hyperbaric chamber under 2.5 absolute atmospheric pressure for 120 minutes; subjects were treated 5 days a week for 4 consecutive weeks. Both groups received standard wound care including debridement of necrotic tissue, topical therapy for Wagner grade 2 DFUs, dietary control and pharmacotherapy to maintain optimal blood glucose levels. Wound physiological indices were measured and blood tests (eg, markers of inflammation) were undertaken. Health-related quality of life was measured using the Medical Outcomes Study 36-Item Short Form. RESULTS Complete DFU closure was achieved in 5 patients (25%) in the HBOT group (n = 20) versus 1 participant (5.5%) in the routine care group (n = 18) (P = .001). The amputation rate was 5% for the HBOT group and 11% for the routine care group (χ = 15.204, P = .010). The HBOT group showed statistically significant improvements in inflammation index, blood flow, and health-related quality of life from pretreatment to 2 weeks after the last therapy ended (P < .05). Hemoglobin A1c was significantly lower in the HBOT group following treatment (P < .05) but not in the routine care group. CONCLUSIONS Adjunctive HBOT improved wound healing in persons with DFU. Therapy also reduced the risk of amputation of the affected limb. We assert that at least 20 HBOT sessions are required to be effective.

Con A-induced hepatitis in mice is an established model of autoimmune hepatitis (AIH). JKB-122, a toll-like receptor 4 (TLR4) antagonist, was tested for hepatotprotectant activity. Within several hours of Con A challenge (15mg/kg iv), increased production of proinflammatory cytokines with inflammatory infiltrate occurred in the liver. The severity of tissue necrosis and the amount of circulating liver enzymes peak at 24h post Con A challenge. JKB-122 was given 24 and 16h before, then concurrently, and 4 and 8h (× 5 doses) after challenge with Con A. Serum and liver were harvested at 3, 9 and 24h post Con A challenge. JKB-122 at 20 and 50mg/kg po prevented the increase of serum liver enzymes by 47% and 95% respectively vs vehicle control 24h post Con A. JKB-122 significantly inhibited Con A-induced pathological lesions in the liver and the amount of IFN-γ IL-1β, IL-4, IL-5, IL-6, IL-17A and TNF-α starting as early as 3h post Con A. Moreover, JKB-122 given concurrently (× 3 doses) with Con A showed similar effect. Finally, JKB-122 enhanced the therapeutic effects of submaximal dose of prednisolone with improved lesion score. It is concluded that JKB-122 at 20 and 50mg/kg po caused dose-dependent inhibition of elevated liver enzymes in Con A-induced hepatitis in mice, indicating hepatoprotectant activity. The results suggest that JKB-122 as monotherapy or in combination with prednisolone may offer a viable approach to the treatment of AIH.

Background: Persons with schizophrenia are at greater risk of developing subsequent medical conditions. To date, few studies have examined comprehensively the risks, mortality and survival rates in schizophrenia and subsequent dyslipidemia over different time periods. The objective of this study was to evaluate the occurrence of subsequent dyslipidemia after the diagnosis of schizophrenia, and factors associated with mortality and survival rate in patients with schizophrenia. Methods: We used a population-based cohort from Taiwan National Health Insurance Research Database, to investigate in patients whom were first diagnosed with schizophrenia during the period from 1997 through 2009, the risk of subsequent dyslipidemia during follow-up. Cumulative incidences and hazard ratios after adjusting for competing mortality risks were calculated. Results: A total of 20,964 eligible patients were included. Risks (i.e., comorbidity) and protective factors (i.e., statin use) have significant impacts on mortality. The mortality exhibits a U-shaped pattern by age. After 50, the risk of death increases with age. Risk of mortality before 50 increases with a decrease in age. Risks differed by the duration time to subsequent dyslipidemia after schizophrenia. Mean duration was 63.55 months in the survive group, and 43.19 months in the deceased group. The 5-, 10-, and 15-year survival rates for patients with schizophrenia and subsequent dyslipidemia were 97.5, 90, and 79.18%, respectively. Conclusion: Early occurrence of subsequent dyslipidemia is associated with increased overall mortality in patients with schizophrenia.

Child-to-parent violence is an often hidden serious problem for parental caregivers of mentally ill adult children who experience violence toward them. To date, the comprehensive dyadic parent-adult child intervention to manage child-to-parent violence is scarce.To evaluate the effect of Child- and Parent-focused Violence Program, an adjunctive intervention involved with both violent adult children with mental illness and their victimized biological parent (parent-adult child dyads) on violence management.Open-label randomized controlled trial.A psychiatric ward in a teaching hospital and two mental hospitals in Southern Taiwan.Sixty-nine patients aged ≥20 years, with thought or mood disorders, having violent behavior in the past 6 months toward their biological parent of either gender were recruited. The violent patients' victimized biological parents who had a major and ongoing role in provision of care to these patients, living together with and being assaulted by their violent children were also recruited. The parent-adult child dyads were selected.The intervention was carried out from 2011 to 2013. The parent-adult child dyads were randomly assigned to either the experimental group (36 dyads), which received Child- and Parent-focused Violence Intervention Program, or to the control group (33 dyads), which received only routine psychiatric care. The intervention included two individualized sessions for each patient and parent, separately, and 2 conjoint sessions for each parental-child dyad for a total of 6 sessions. Each session lasted for at least 60-min. Data collection was conducted at 3 different time frames: pre-treatment, post-treatment, and treatment follow-up (one month after the completion of the intervention).Occurrence of violence prior to intervention was comparable between two groups: 88.9% (n=32) parents in the experimental group versus 93.9% (n=31) in the control group experienced verbal attack, and 50% (n=18) versus 48.5% (n=16) received body attack and were injured. The intervention significantly reduced violence, improved impulsivity, changed patients' and parents' violence attributions, and fostering active coping processes in the experimental group as compared to the control group (p0.05). No significant reductions were found in verbal aggression, cognitive and social reactions in the parent's reactions to assault, attentional subscale of impulsivity and wishful thinking (p0.05).Child- and Parent-focused Violence Intervention Program is effective on child-to-parent violence management in parent-adult child dyads. Thus, the intervention can be helpful for patients who have just been diagnosed with mental illness and had an episode of violence toward their parents within a narrow time frame.

Schizophrenia is a disabling neurological disorder. Patients with this disease are at higher risk to violence. This paper reviewed the recent literatures with respect to the heterogeneous nature of the abnormalities and pathophysiological and biological risk markers that link to violent behavior in patients with schizophrenia with a particular interest in lipid metabolism. We have focused on altered lipid profile including polyunsaturated fatty acids, which may have attributed to the development of aggressive behavior in patients with schizophrenia. We addressed questions on how aberrant lipid metabolism affects brain structure and function, and how lipids modulate neurotransmission activity during progression of this devastating disease. Many clinical studies have demonstrated that omega-3 fatty acids may reduce transition rate to psychosis and serve as additive to reduce the violence. We postulate that the beneficial effect of omega-3 fatty acid supplementation on violence may act through modulating neuronal membrane lipid structure and neurotransmission. A better understanding of the underlying mechanisms how these pathways modulate aggression may facilitate development of strategies to prevent, ameliorate or reduce the manifestation of violence.

Compelling evidence has yet to be published regarding the positive effect of psychoeducational interventions (PEIs) on psychological distress in patients with breast cancer. The impact of PEIs on self-efficacy, resilience, and quality of life is also unclear.The aim of this study was to assess the effects of a PEI on anxiety, depression, disease-specific care knowledge, self-efficacy, resilience and quality of life in patients with breast cancer during and after chemotherapy. The intervention was administered before and during five rounds of chemotherapy treatment.A randomized controlled trial was conducted. Patients with breast cancer (N = 40) were randomly assigned to either the experimental or control group. The experimental group participated in PEI, a brief and highly structured program consisting of two parts: (a) an educational manual that addressed depression, anxiety, disease-specific care knowledge, self-efficacy, and resilience and (b) a self-assessment of learning. The control group received only traditional pamphlet education. Data were collected at four time points: before the first chemotherapy session (T1), during the third chemotherapy session (T2), during the fifth chemotherapy session (T3), and at 2 weeks after the final chemotherapy session (T4).Anxiety, depression, resilience, and quality of life in the experimental group showed significant differences at T4. Significant differences became apparent at T2 for knowledge and at T3 for self-efficacy. The effects of knowledge, resilience, and quality of life remained significant when group and time interactions were included in the model, showing a positive relationship between PEI and the variables of knowledge, resilience, and quality of life.Face-to-face PEI for patients with breast cancer is potentially effective in improving knowledge, resilience, and quality of life during and after chemotherapy. In the current study, PEI significantly improved disease care techniques, reduced chemotherapy-related discomfort, and improved quality of life for participants in the experimental group.

Background and Purpose μ-Opioid receptors, pro-opiomelanocortin and pro-enkephalin are highly expressed in the nucleus tractus solitarii (NTS) and μ receptor agonists given to the NTS dose-dependently increased BP. However, the molecular mechanisms of this process remain unclear. In vitro, μ receptors heterodimerize with α2A-adrenoceptors. We hypothesized that α2A-adrenoceptor agonists would lose their depressor effects when their receptors heterodimerize in the NTS with μ receptors.

Background & Aims Hepatitis C virus (HCV) infection leads to glucose abnormality. HCV depends on lipid droplets (LDs) and very-low density lipoproteins for assembly/releasing; however, the components and locations for this process remain unidentified. Apolipoprotein J (ApoJ), upregulated by glucose, functions as Golgi chaperone of secreted proteins and resides abundantly in very-low density lipoproteins. This study investigates the interplay between glucose, ApoJ and HCV virion production. Methods The effects of high glucose on ApoJ expression and HCV production were evaluated with cultivated HuH7.5, primary human hepatocytes, and in treatment naive chronic hepatitis C patients. How ApoJ affects HCV lifecycle was assessed using siRNA knockdown strategy in JFH1 infected and subgenomic replicon cells. The interactions and locations of ApoJ with viral and host components were examined by immunoprecipitation, immunofluorescence and subcellular fractionation experiments. Results HCV infection increased ApoJ expression, which in parallel with HCV infectivity was additionally elevated with high glucose treatment. Serum ApoJ correlated positively with fasting blood glucose concentration and HCV-RNA titre in patients. ApoJ silencing reduced intracellular and extracellular HCV infectivity and extracellular HCV-RNA, but accumulated intracellular HCV-RNA in HCV-infected cells. ApoJ interacted with HCV core and NS5A and stabilized the dual protein complex. HCV infection dispersed cytoplasmic ApoJ from the compact zones of the Golgi to encircle LDs, where co-localization of the core, NS5A, HCV-RNA, subcellular markers for LDs, endoplasmic reticulum (ER), Golgi, and membrane contact sites occurred. Conclusions ApoJ facilitates infectious HCV particle production via stabilization of core/NS5A, which might surround LDs at the ER-Golgi membrane contact site.

Background Clinical practice guidelines frequently recommend systematic screening for depression in cancer patients to improve recognition and prompt appropriate management. We aimed to screen major depressive disorder (MDD) in cancer inpatients using a structured tool and explore its applicability. Methods Cancer inpatients were routinely screened by nurses using the Taiwanese Depression Questionnaire (TDQ), and for those screened positive, this was followed by a non-mandated referral to a psychiatrist for clinical evaluation and diagnosis. Patients who completed this two-stage procedure comprised the analysis sample. Results Routine screening of 8800 patients in a period of 27 months yielded 1087 (26.9%) positive first-time screens. Of them, 298 (27.4%) completed the psychiatric consultation. Depressive disorders were diagnosed in 185 patients (62.1%), mainly adjustment disorder (23.8%) and MDD (21.5%). The estimated prevalence of MDD was 21.5%. Area under the curve was 0.72, a result produced by the receiver operating characteristic curve of the TDQ scores relative to the clinical psychiatric diagnoses of MDD. A TDQ cutoff score of ≧26 provided an optimal diagnostic accuracy for MDD. Conclusions This two-stage depression screening and diagnosing strategy is practical for improving recognition of MDD and other depressive disorders in cancer patients and could be routinely applied, rather than selectively, in a comprehensive cancer care system. Copyright © 2014 John Wiley & Sons, Ltd.

Purpose To examine the unique relationships among demographic variables, depressive symptoms scoring ≥16 on the Center for Epidemiological Studies-Depression (CES-D), social support and quality of life (QOL) in breast cancer survivors, and whether social support moderated the effects of depressive symptoms on the outcome of QOL. Specifically, this study aimed to probe more deeply into the nature of causal mechanisms of moderation. Method A model based, descriptive cross-sectional research design was conducted. A total of 150 breast cancer survivors were recruited from two teaching hospitals in Taiwan. All participants completed the CES-D, Interpersonal Support Evaluation List, and the Medical Outcomes Study 36-Item Short Form Health Questionnaire. The moderation models and moderating hypotheses were tested and confirmed by applying structural equations and hierarchical regression analyses. Results Approximately 35% of the participants had depressive symptoms. Findings indicated social support as a moderator of effects of depressive symptoms on QOL. Social support significantly moderated depressive symptoms on QOL. Conclusions Testing for moderating effects provides helpful information regarding the role of social support in buffering the relationship between depressive symptoms and QOL. The moderating effects of social support are adequate in the management of nursing care for breast cancer patients, particularly in the early phase of treatment or in cases of newly diagnosed patients who may not know how to manage their health conditions. These findings may aid in the development of social support interventions to enhance social support for breast cancer survivors.

Purpose The study explored the lived experiences of violence by patients with mood disorders against their biological parents who were the major caregivers (13 parent–adult–child dyads), and sought to gain an understanding of the precipitating factors influencing violence. Design and Methods Data were collected by means of in-depth semi-structured interviews, managed and subjected to hermeneutics-guided thematic networks analysis. Findings The phenomenon was that violence was part of life. The four global themes were that increased irritability and poor impulse control lead to violence; violence causes anxiety; a transition from violence to nonviolence is difficult; and moving from descriptions of violence to analyses of violence is important. Practice Implications A comprehensive dyadic parent–child intervention program and de-escalation techniques are suggested to manage violence substantially.

Background Patients with chronic schizophrenia often show negative emotional responses because of cognitive impairment. Multisensory stimulation therapy has been shown effective in improving cognitive and emotional functions in cognitively impaired patients with dementia. However, very few studies have applied this multisensory intervention to patients with chronic schizophrenia. Furthermore, it is not known whether a dose-response relationship exists between the frequency and efficacy of this intervention. Purpose The objective of this study was to evaluate the relationship between the effects and dose-response of the multisensory intervention on patients with chronic schizophrenia in a mental rehabilitation hospital. Methods A crossover study design with a sample size of 60 was conducted. Participants were divided equally between an experimental group and a control group. The experimental group received the intervention in a multisensory stimulation room. Six sessions of the 30-minute sensory intervention were conducted on experimental group participants, who were allowed to select their preferred stimulants. In contrast, the control group received routine care only. After a 2-week washout period, participants in the experimental group were reassigned to the control group, and those in the control group were reassigned to the experimental group. Standardized questionnaires were applied to evaluate psychotic symptoms, emotional responses, and well-being of all participants. The NeXus-4 model wireless biofeedback system was used to measure the psychological-physiological parameters of participants at baseline and after the first, third, and sixth sessions of the multisensory intervention. A generalized estimating equation model was used to analyze the effects of the intervention RESULTS:: Although multisensory stimulation therapy had no significant effect on psychotic symptoms and well-being, this intervention may improve the negative emotional reactions of patients. In particular, the intervention significantly reduced the subjective anxiety level of participants and stabilized their objective respiratory and heart rates. Moreover, a positive correlation was found between the efficacy of the treatment and the frequency of the intervention. Conclusions/implications for practice Evidence from this study validated the multisensory stimulation therapy protocol. Therefore, this protocol may be incorporated into clinical interventions to improve quality of care and to alleviate the negative emotions of patients with chronic schizophrenia.

Summary Objective Metabolically healthy obesity (MHO) subjects have better metabolic parameters than metabolically abnormal obesity (MAO) subjects, but the possible mechanisms underlying this remain unknown. Our study was designed to investigate the interrelationships among genes, adipokines, body fat and its distribution in MHO and MAO. Methods From 2007 to 2009, 103 males and 131 females aged 18–50 years were enrolled by an intention-to-treat design in a weight management clinic. Participants were divided into MHO and MAO groups. Percent body fat (PBF) was measured by a deuterium oxide dilution method. Four polymorphic variants, including PPARγ2 (Pro12Ala and C1431T) and adiponectin (T45G and G276T) genes, and three adipokines (adiponectin, leptin and resistin) were obtained. Results Of the 234 obese subjects, 130 (55.6%) were MHO. In the univariate analysis, the MAO group has significantly higher anthropometric, metabolic indices and leptin levels than the MHO group. Logistic regression analysis revealed that age, male gender, the T allele of adiponectin T45G polymorphism, leptin and PBF were positively associated with MAO. ANCOVA analysis revealed that the T allele of adiponectin T45G polymorphism was associated with higher fasting and postprandial glucose levels. We further found that TT genotype has a lower high molecular weight (HMW)/low molecular weight (LMW) adiponectin ratio than GG genotype. Conclusions The factors associated with MAO are age, male gender, the T allele of adiponectin T45G polymorphism, leptin, and PBF. The net effects of T45G polymorphism on the MAO phenotype may be achieved by changes in the adiponectin oligomer ratio and glucose levels.

Background: Patients undergoing surgical treatment for obesity are likely to experience changes in their health-related quality of life (HRQOL). The purposes of this study were to investigate HRQOL before and after laparoscopic gastric bypass (LGB) surgery, and to describe the influence of weight loss surgery on HRQOL in morbidly obese patients. Methods: Patients with morbid obesity who underwent weight loss surgery at a hospital in Taiwan were recruited. The standard survey was administered before surgery and again 3 months after LGB to patients with a body mass index (BMI) of >40 kg/m2 or a BMI ≧35 kg/ m2 when combined with diabetes/hypertension. Results: The sample included 40 patients; 62.5% were women and the average age of participants was 30.1 years. Scores on the subscales of the Medical Outcomes Study SF-36 demonstrated significant improvements between baseline and follow-up. The physical health domain was most affected. There were also significant improvements related to physical functioning, ph...

Aims. The aims of this study were to examine the relationships among religion, religious involvement, anxiety, depressive symptoms and quality of life in older adults with psychological problems and whether religious involvement moderated anxiety and depressive symptoms on the outcome of quality of life. Evidence for the mechanism through which religious involvement exerts its moderated effect on anxiety and depressive symptoms was provided. Background. Older adults suffering from stress may consequently have anxiety or depressive symptoms and their quality of life is also influenced. The meanings of religious involvement are well documented but less is known about moderating characteristics that determine which older adults with psychological problems are most likely to benefit. Design. A correlational, cross-sectional study. Methods. The study was conducted in 2007–2008 with a purposive sample of 115 older adults who were 60 years of age or older at a psychiatric centre in Taiwan. Three reliable and valid questionnaires and a demographic sheet were administered. Results. Approximately 75% of older adults had mild to severe anxiety; 76·5% had depressive symptoms; and 67·8% of participants who had depressive symptoms also had comorbid anxiety. Findings indicated that there was a significant moderating effect for religious involvement on the quality of life outcome. Religious involvement significantly moderated anxiety and depressive symptoms on quality of life. Moreover, religious participants had a better quality of life and had lower anxiety and depressive symptoms than non-religious participants. Conclusion. Testing for moderating effects provides important information regarding the benefits of religious involvement. The current study reveals that religious participants have lower levels of depressive symptoms and anxiety and better quality of life than non-religious ones. Religious involvement plays a role in buffering the relationship between psychological problems and quality of life. Relevance to clinical practice. Nurses can encourage individuals with health problems to participate in religious involvement, which may help individuals to experience a feeling of support and enhance their quality of life.

Aims. To determine the effect of music therapy and verbal relaxation on state anxiety and anxiety-induced physiological manifestations among patients with cancer before and after chemotherapy. Background. Cancer and its treatment provoke a series of changes in the emotional sphere of the patient’s anxiety. Music therapy and verbal relaxation had reported the anxiety reduction effect on patients with cancer receiving chemotherapy. Few studies have been undertaken comparing music therapy and verbal relaxation in differentiating high–normal state anxiety subsample. Design. A randomised controlled trial and permuted block design were used. Outpatient chemotherapy clinic operated by a University medical centre in southern Taiwan. Methods. Ninety-eight patients were randomised into three groups: the music therapy group received one-hour single music session; the verbal relaxation group received 30 minutes of guided relaxation; the control group received usual care. Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, three biobehavioural indicators: skin temperature, heart rate and consciousness level were measured during and after chemotherapy. Result. Music therapy had a greater positive effect on postchemotherapy anxiety than verbal relaxation and control groups and a significantly increase in skin temperature. Patients with high state anxiety receiving music therapy had a greater drop in postchemotherapy anxiety than did the normal state anxiety subsample. Conclusions. Both music and verbal relaxation therapy are effective in reducing chemotherapy-induced anxiety. Thirty minutes of intervention initiates anxiety reduction. Patients with high state anxiety receiving chemotherapy obtain the most benefit from music or verbal relaxation. Relevance to clinical practice. Prior to chemotherapy, patients with high state anxiety must be sorted from all patients as they are more responsive to interventions. Oncology nurses can offer music and verbal relaxation as adjuvant interventions to reduce chemotherapy-induced anxiety and enhance the quality of care.

Accessible summary • A supervised volunteer programme can provide safe care for suicide survivors. • Compared with newly trained volunteers, volunteers with at least 1 year of experience are more effective with suicide survivors with greater psychological distress. • Changes in psychological distress of suicide survivors occur after 2 months. Abstract The crisis level in the worldwide suicide rate has revealed a severe suicide problem in Taiwan that is now well above the world average of 16 per 100 000 individuals. Many countries have relied on suicide care volunteers training programmes to conduct suicide prevention programmes. However, there is a dearth of research evaluating the effect of volunteers on psychological distress and the impact of volunteer experience level. An evaluation of the impact of experienced and novice volunteers in alleviating psychological distress of suicide survivors was conducted. A supervised programme trained 15 volunteers at Years 1 and 2. Year 1 volunteers completed 400 h of service with continuing education. Programme evaluation occurred after Year 2 volunteers had completed training. Eighty-two suicide survivors were recruited. With 60 suicide survivors completing 3 month of volunteer care, a significant group difference with time interaction in suicide survivors who exhibited moderate to severe distress between the veteran care and novice care groups was found. Compared with novice volunteers, veteran volunteers with at least 1 year of experience are more effective with suicide survivors reporting higher psychological distress.

Intratumoral cytotoxic T lymphocytes are critical for controlling tumor recurrence, and programmed death-1 (PD-1) is a recognized marker of T-cell dysfunction. We analyzed this marker and its binding ligands in nasopharyngeal tumor tissue and non-cancerous nasopharyngeal control tissue to retrospectively evaluate the correlation between its expression and the post-treatment outcome of nasopharyngeal carcinoma patients. Using double immunofluorescence staining, we found that the expression of PD-1 in CD8 T cells in tumor tissue was significantly higher than in control tissue (mean: 28.4 vs 3.9%, P

Aims. The purposes of this study were to examine the associations among social support, poststroke depression and quality of life among patients with first-time ischemic stroke and to further test the impact of the dimensions of social support on poststroke depression and quality of life. The proposed models included mediation hypotheses to examine the mediating roles of social support. Background. Although considerable attention has recently been devoted to explaining why poststroke depression and poor quality of life are frequent concomitants of stroke, little empirical work has been conducted to test predictions based on these models, especially in Taiwan. Design. A cross-sectional, descriptive correlation design was used. Methods. The 102 patients with first-time ischemic stroke aged 32–90 (mean = 64·5, SD 11·8) were recruited from a large general hospital in Taiwan and through face-to-face survey interviews. The participants were assessed using the Social Support Inventory, Centre for Epidemiologic Studies Depression Scale, Barthel Index, the Instrumental Activities of Daily Living and Quality of Life Index-Stroke Version. The models were tested and confirmed through the application of structural equations with proposed variables. Results. Nearly half of the Taiwanese patients with stroke felt depressed. Social support fully mediated the prediction of quality of life by age and partially mediated the prediction of quality of life by functional ability. Social support partially mediated the prediction of poststroke depression by functional ability. Conclusion. This study provides researchers and nurses with increased understanding of the mediating role of social support between functional ability and poststroke depression/quality of life. Social support may be a promising intervening variable in stroke outcome. Relevance to clinical practice. The results suggest several clinical implications. The inclusion of social support in poststroke depression and quality of life after stroke may help nurses in planning stroke programme development, patient education, effective and efficient use of health care resources and effective rehabilitation, especially in those individuals who lack support or who are involved in stressful situations.

PURPOSE. The purpose of this study was to examine the roles of adherence attitude to antidepressants and patient education as mediators in mediating patients' attitudes toward antidepressant use. DESIGN AND METHODS. A sample of 201 outpatients, 50 years of age or older, with major depressive disorder, completed a drug use questionnaire, attitudes toward and patient education about antidepressants questionnaire, and Adherence Attitude Inventory. FINDINGS. Attitudes toward antidepressants were positively associated to antidepressant use, an association explained by the mediating variable, patient education about antidepressants. Adherence attitudes to antidepressants were a mediator that accounted to a significant degree for the causal relationship between attitudes toward antidepressants and antidepressant use. PRACTICE IMPLICATIONS. Adequate patient education and an understanding of patients' adherence attitude to antidepressant use are needed in nursing practice to reduce patients' uncertainty about treatment and increase successful treatment.

Aims. To explore pivotal moments and changes during the Bonny Method of Guided Imagery and Music from the perspective of patients with depression. Background. Depression has been described as an extremely difficult experience for people and is characterised by emotional distress and suffering. As depression progresses, symptoms increase and gradually influence all aspects of the lives of those affected. Few studies have been undertaken into the essence of inner and pivotal experiences during Guided Imagery and Music in patients with depression. Design. A qualitative research design and discovery-oriented approach were used as the method of both data gathering and textual analysis. Methods. This study conducted semi-structured interviews with five patients with depression after each of eight sessions of the Bonny Method of Guided Imagery and Music. Each session took place in a music therapy laboratory. Forty transcripts were organised into categories and analysed according to the discovery-oriented approach of Mahrer and Boulet, considering the dimensions of the Bonny Method of Guided Imagery and Music. Results. Nine patients with depression were recruited from a medical centre in southern Taiwan from 2004–2005. Five successfully completed eight Bonny Method of Guided Imagery and Music sessions. There were 141 statements coded into 10 subthemes and three themes describing pivotal moments: pushing aside the barrier, gaining new insight, moving forward. Each category was supported by three-four themes. The analysis also yielded three meaningful moments: releasing mind–body rigidity, awareness and inspiration, acceptance and inner transformation. Patients described personal emotional, cognitive and behavioural transformation during the Bonny Method of Guided Imagery and Music experiences. Conclusions. The discovery-oriented approach fulfilled the aim of gaining a valuable understanding of the psychological growth experiences of patients with depression during the Bonny Method of Guided Imagery and Music. Relevance to clinical practice. Patients with depression particularly need comfort and caring. It is important that nurses offer interventions as adjuvants to medication. This study supports the feasibility of incorporating the Bonny Method of Guided Imagery and Music into the nursing management of patients with depression. Future studies are suggested to examine the interactive process of music stimulus and the multidimensional nature of imagery.

Aims. To investigate patients’ attitudes toward complementary and alternative medicine, the education nurses provided about complementary and alternative medicine for treating depression and to test whether such education mediates the effect of complementary and alternative medicine use and attitudes toward complementary and alternative medicine. Background. Although we know that attitudes influence behaviour, very few studies simultaneously explore the relationship between attitudes, education and complementary and alternative medicine use. Design. Survey. Methods. This study was conducted as part of a larger survey, using face-to-face survey interviews with 206 adult patients aged 50 years or over and hospitalised in conventional hospitals in Taiwan for treatment of depression. The attitudes toward complementary and alternative medicine and patient education about complementary and alternative medicine instruments were specially developed for the study. Results. Participants expressed slightly favourable attitudes toward complementary and alternative medicine. Many participants (50%) expressed that they were willing to try any potential treatment for depression. They believed that complementary and alternative medicine helped them to feel better and to live a happier life. However, 66·5% of participants reported that they had inadequate knowledge of complementary and alternative medicine. Participants with a higher monthly income, longer depression duration and religious beliefs hold more positive attitudes toward complementary and alternative medicine. Most participants were not satisfied with the education they received about complementary and alternative medicine. Patient education about complementary and alternative medicine was found to be a mediator for the use of complementary and alternative medicine. Conclusion. Patient education from nurses may predict patients’ attitudes toward complementary and alternative medicine. Continuing nursing education is needed to enable nurses to respond knowledgeably to concerns patients may have about complementary and alternative medicine and treatment options. Relevance to clinical practice. This study highlights the potential role of patient education about complementary and alternative medicine as an effective way of adjusting patients’ attitudes toward complementary and alternative medicine and to link both patients’ preferences for complementary and alternative medicine and health professionals’ concerns about the proper use of complementary and alternative medicine for depression management and adverse drug interactions.

Title. Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis. Aim. This paper is a report of a trial to identify the effect of thermal therapy with far-infrared rays in comparison with non-thermal therapy on uremic pruritus and biochemical parameters. Background. Uremic pruritus remains one of the most frustrating, common, and potentially disabling symptoms in patients undergoing haemodialysis. The mechanism underlying uremic pruritus is poorly understood. Although enough is known to determine a reasonable treatment approach, more research is needed to evaluate more reliable treatments. Methods. A randomized, double-blind, controlled trial was conducted in 2005 using questionnaires and measurement of blood biochemical parameters. A total of 41 uremic patients on maintenance haemodialysis were randomly assigned either to the thermal therapy group or the control group. The thermal therapy group was treated with 40°C thermal therapy with far-infrared rays at the Sanyinjiao acupoint for 15 minutes once a day on two days a week for a total of 18 sessions. The control group received a plain adhesive patch placed on the same acupoint. Findings. Both groups showed statistically significant improvements but there were no differences between groups, while a relatively large decrease in pruritus scores was found in the thermal therapy group (P

Given the potentially important effects that age and gender may have on midazolam premedication, this study aimed at determining if these factors alter anxiety, sedation, and cardiorespiratory outcomes when administering two different doses of i.v. midazolam.After randomization, patients were premedicated 1 h before surgery with either i.v. midazolam 0.02 or 0.06 mg kg(-1) depending on their age and gender group. Levels of anxiety and sedation, heart rate, respiratory rate (RR), mean blood pressure (MBP), and oxygen saturation (Sp(O2)) were measured before and 15 min after midazolam administration.A higher level of preoperative anxiety was more often observed in women than in men, and in young than in older patients. The female or younger patients showed significant anxiolytic benefits from midazolam. A deeper sedation level was found in men compared with women. Forty-two of 45 patients (93.3%) with excessive sedation received midazolam 0.06 mg kg(-1). The elderly patients receiving midazolam 0.06 mg kg(-1) showed significant reductions in MBP, RR, and Sp(O2). Of the patients with an Sp(O2)90%, 72.7% had received midazolam 0.06 mg kg(-1).Age and gender differences in neuropsychological and physiological responses after midazolam premedication were evident. Midazolam is effective for producing sedation and anxiolysis at a dose of 0.02 mg kg(-1), with minimal effects on cardiorespiration and oxygen saturation to patients. Dosage adjustments based on these covariates are, therefore, necessary.

Epstein-Barr virus (EBV)-associated, undifferentiated type of nasopharyngeal carcinoma (NPC) is characterized by intensive leukocyte infiltration. Interaction between the infiltrating cells and the tumor cells has been considered crucial for NPC development. Recruitment of the infiltrates can be directed by certain chemokines present in the NPC tissues. It is unknown whether and how EBV lytic infection regulates expression of the chemokines. Using an antibody array, we first found that several chemokines secreted from EBV-infected NPC cells are increased upon EBV reactivation into the lytic cycle, and interleukin-8 (IL-8) is the chemokine upregulated most significantly and consistently. Further studies showed that the EBV lytic transactivator Zta is a potent inducer of IL-8 in NPC cells, augmenting secreted and intracellular IL-8 proteins, as well as IL-8 RNA. Zta upregulates Egr-1, a cellular transcription factor that has been involved in upregulation of IL-8, but the Zta-induced IL-8 expression is independent of Egr-1. The ability of Zta to transactivate the IL-8 promoter is important for the induction of IL-8, and we have identified two Zta-responsive elements in the promoter. Zta can bind to these two elements in vitro and can also be recruited to the IL-8 promoter in vivo. DNA-binding-defective Zta mutants can neither activate the IL-8 promoter nor induce IL-8 production. In addition, Zta-expressing NPC cells exert enhanced chemotactic activity that is mainly mediated by IL-8. Since IL-8 may contribute to not only leukocyte infiltration but also multiple oncogenic processes, the present study provides a potential link between EBV lytic infection and pathogenesis of NPC.

Aims. The aim of this study was to examine the effect of an Interactive Computerized Psycho-Education System on patients suffering from depression and to compare the use of an Interactive Computerized Psycho-Education System vs. traditional pamphlet education approach. Background. Depression management depends on pharmacological treatment and psychotherapy and on appropriate and timely patient education. Whilst multimedia learning concepts have been applied in areas such as education, this approach has not been widely used in psychiatric outpatient departments. Design and method. A preliminary pre and post quasi-experimental design with patients with depression was employed at an hospital. Participants in the experimental group (n = 19) received an Interactive Computerized Psycho-Education System intervention programme (Interactive Computerized Psycho-Education System and the educational manual). Participants in the control group (n = 13) were exposed only to the traditional pamphlet education approach (consultation from psychiatrists and information sheets). Primary outcome was depression knowledge scores. Secondary outcomes were scores on the Compliance Behaviour Assessment Scale. Results. In the experimental group (n = 19), the time spent working on the Interactive Computerized Psycho-Education System was about 30–180 minutes per session, with an average of 67 minutes. Participants in the experimental group had a considerably decreased incidence of medication non-compliance compared with participants in the control group. Knowledge scores of the experimental group ranged from 30–100, with an average score of 74.7. Conclusion. The Interactive Computerized Psycho-Education System is acceptable and may be as more effective than a traditional education approach to achieve adherence to medications for depression. Relevance to clinical practice. Compared with a traditional approach, the combination of the Interactive Computerized Psycho-Education System and a nursing-consulting clinic may assist patients with depression to achieve and maintain better medication compliance in addition to improving their knowledge of depression.

The purpose of this study was to evaluate the effects of Baduanjin exercise on oxidative stress, antioxidant status and quality of life in middle-aged women. A quasi-experimental design was adopted. Subjects were 31 middle-aged women. Subjects completed a supervised and standardized Baduanjin exercise program 3 times a week for 12 weeks. Malondialdehyde (MDA) level was measured and determined by using a spectrophotometer for oxidative stress. The superoxide dismutase (SOD) was measured for the antioxidant status. A 36-item Short Form Health Survey (SF-36) was used to evaluate changes in quality of life. All outcome measures were collected before intervention and at the end of a 12-week intervention. The results suggest that there are significant differences in serum SOD level with Baduanjin exercise. SOD level was significantly increased after exercise ( p < 0.05). Baduanjin exercise contributed significantly to antioxidant status on these samples. However, a reduction in MDA level was observed. The t-test value was 2.03 with a p-value of 0.052. The changes may be meaningful at a 5% level. There are significant improvements in quality of life after the exercise program. Subjects had greater improvements in 4 dimensions of SF-36, namely physical function, body pain, social function and general mental health ( p < 0.05). In conclusion, Baduanjin exercise has beneficial effects on improving quality of life, increasing antioxidant enzymes and reducing oxidative stress in middle-aged women. Reduction of MDA level may be more attributable to the increase in the antioxidant enzyme SOD.

The purpose of the present study was to explore the self-learning experiences of depression patients on interactive multimedia education program. Qualitative in-depth interviews were employed. Fourteen patients with a first episode of major depression were recruited from a psychiatric outpatient department. Explanations of the purposes of the exercise and on-the-spot teaching were provided by the researcher before the study began. A tape-recorded, semi-structured interview format was employed after two weeks. Data analysis was performed in the framework of line-by-line content, contextual and thematic analysis. Eight subjects successfully completed the entire learning activities. Content analysis revealed 4 main aspects of successful self-learning experiences: the triggering of learning motivation, the enjoyment of self-paced learning, support for the effects of learning materials, and the gaining of self- awareness and changes. The factors influencing learning performance were related to: environmental impact, the degree of familiarity with traditional learning, possession or non-possession of the necessary computer operation skills, and good computer support. However, the findings provide a preliminary understanding of the application of interactive multimedia education programs in terms of self-learning outcomes and recognizing key elements of learning impediments among the study sample. A larger sample size with different clinical contexts is recommended to determine the effect and generalizability for future research. Furthermore, the creation of a computerized learning environment with different educational styles is crucial to patients' success in obtaining depression-related information and understanding effective adaptive skills.

μ-Opioid receptors, pro-opiomelanocortin and pro-enkephalin are highly expressed in the nucleus tractus solitarii (NTS) and μ receptor agonists given to the NTS dose-dependently increased BP. However, the molecular mechanisms of this process remain unclear. In vitro, μ receptors heterodimerize with α2A -adrenoceptors. We hypothesized that α2A -adrenoceptor agonists would lose their depressor effects when their receptors heterodimerize in the NTS with μ receptors.We microinjected μ-opioid agonists and antagonists into the NTS of rats and measured changes in BP. Formation of μ receptor/α2A -adrenoceptor heterodimers was assessed with immunofluorescence and co-immunoprecipitation methods, along with proximity ligation assays.Immunofluorescence staining revealed colocalization of α2A -adrenoceptors and μ receptors in NTS neurons. Co-immunoprecipitation revealed interactions between α2A -adrenoceptors and μ receptors. In situ proximity ligation assays confirmed the presence of μ receptor/α2A -adrenoceptor heterodimers in the NTS. Higher levels of endogenous endomorphin-1 and μ receptor/α2A -adrenoceptor heterodimers were found in the NTS of hypertensive rats, than in normotensive rats. Microinjection of the μ receptor agonist [D-Ala(2) , MePhe(4) , Gly(5) -ol]-enkephalin (DAMGO), but not that of the α2A -adrenoceptor agonist guanfacine, into the NTS of normotensive rats increased μ receptor/α2A -adrenoceptor heterodimer formation and BP elevation. The NO-dependent BP-lowering effect of α2A -adrenoceptor agonists was blunted following increased formation of μ receptor/α2A -adrenoceptor heterodimers in the NTS of hypertensive rats and DAMGO-treated normotensive rats.Increases in endogenous μ receptor agonists in the NTS induced μ receptor/α2A -adrenoceptor heterodimer formation and reduced the NO-dependent depressor effect of α2A -adrenoceptor agonists. This process could contribute to the pathogenesis of hypertension.

AIMS: To describe the lived experiences of aggression and violence among patients with schizophrenia and their victimized biological parent as the major caregiver being aggressed by their child (parent-adult-child dyads), and to gain an understanding of the precipitating factors influencing violence. BACKGROUND: Child-to-parent violence, particularly in the mentally ill adult child, is arguably the most stressful and under-researched issue of family violence. Violence in patients with mental illness is most frequently targeted at family members, and most often takes place at home. Both patients and their parents' experiences of violence are relatively unexplored. DESIGN: Qualitative study design. METHODS: Data were collected using individual in-depth interviews between August 2010-August 2011 in Taiwan. Purposive sample of 14 hospitalized patients with schizophrenia who had aggression and violence in the past year directed towards their biological parent of either gender. FINDINGS: Five main themes were identified: violence occurring beyond control in a particular situation translated into parent and patient's possible endangerment, the repetitive nature of violence, distress, ineffective communication, and management of violence and help-seeking. Repetitive violent episodes and tension made both the parent and patient feel uncontrollable. Parents had a perceived fear of adverse consequences such as being punished by receiving more retribution and they also had concerns related to their parental responsibility. CONCLUSIONS: Health professionals should be aware of the complexity of phenomena and the interplay of factors inducing violence. A comprehensive dyadic parent-child intervention is suggested for violence prevention. Language: en

Aims and objectives To test a hypothetical three-path mediation model evaluating the effects of functional status and depressive symptoms on the relationship between fatigue and quality of life in patients with cancer on the basis of the Theory of Unpleasant Symptoms. Background Patients with cancer often experience two or more concurrent, interrelated, mutually influential symptoms. Multiple unpleasant symptoms that have been proposed as mediating variables affecting quality of life in a model proposed in recent cancer studies are scanty. Design This study was a cross-sectional, descriptive, correlational design. Methods Three hundred and twenty-six patients with cancer from oncology clinics were recruited in Taiwan between 2010–2011. Mediation models were tested and confirmed by applying structural modelling using Analysis of Moment Structures and the joint significance test. Results Fatigue affects patient quality of life directly or indirectly through functional status and depressive symptoms. These two mediating variables exhibited direct effects on quality of life. A path analysis approach revealed that 47·28 and 67·70% of the total effects of functional status and depressive symptoms, respectively, on the quality-of-life mediation models are attributable to 29·6 and 44·7% of the total effects between fatigue and quality of life, which mediated through two mediators, respectively. Conclusion Quality of life may be enhanced by simultaneously improving physiological and psychological factors. Relevance to clinical practice An understanding of mediating effects is valuable in nursing care of patients with cancer, particularly in the early phase of treatment or in newly diagnosed stages I–III or recently treated patients with cancer in different disease stages.

The study explored the lived experiences of violence by patients with mood disorders against their biological parents who were the major caregivers (13 parent-adult-child dyads), and sought to gain an understanding of the precipitating factors influencing violence.Data were collected by means of in-depth semi-structured interviews, managed and subjected to hermeneutics-guided thematic networks analysis.The phenomenon was that violence was part of life. The four global themes were that increased irritability and poor impulse control lead to violence; violence causes anxiety; a transition from violence to nonviolence is difficult; and moving from descriptions of violence to analyses of violence is important.A comprehensive dyadic parent-child intervention program and de-escalation techniques are suggested to manage violence substantially.

The current study evaluated the efficacy and safety of risperidone and haloperidol as an adjunctive agent in combination with divalproate in patients with an episode of acute mania.This 6-week randomized, single-blind study was conducted in psychiatric wards of a mental hospital. A total of 41 patients were randomly assigned to the risperidone (risperidone plus divalproate) or haloperidol groups (haloperidol plus divalproate). Efficacy was assessed by changes in symptom rating scales [Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and Clinical Global Impression (CGI) scores]. Safety and tolerability were assessed by monitoring the Extrapyramidal Symptom Rating Scale (ESRS) and Hamilton Rating Scale for depression.Mean doses at baseline, and at weeks 4 and 6 were 3.77, 4.95 and 5.00 mg/day of risperidone and 5.89, 9.95 and 8.58 mg/day of haloperidol, respectively. Risperidone was shown to have significant anti-manic effects which was observed as early as week 1, following start of treatment. The BPRS scores were in favor of risperidone at week 2. Patients receiving risperidone exhibited significant greater global improvement on the CGI, as early as week 2 and over the entire treatment period, than haloperidol after 4 weeks of treatment. The ESRS at endpoint were significantly higher in the haloperidol patients.Risperidone plus divalproate was more efficacious than haloperidol plus divalproate for treatment of acute mania, and was well tolerated due to its evidence showing rapid anti-manic action, effective and sustained control of manic and psychotic symptoms and a favorable safety and tolerability profile in acute mania.