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Type 2 diabetes mellitus (T2DM), common in older people, is an important reason for muscle loss in Japanese and Taiwanese populations. However, little is known about the association between lifestyle behaviours and muscle quality. We aimed to compare the lifestyle behaviours of Japanese and Taiwanese older adults with T2DM and to the identify lifestyle factors associated with muscle quality.This cross-sectional study was conducted among community-dwelling individuals with T2DM aged ≥65 years in Taiwan and Japan. Totally, 114 Japanese and 226 Taiwanese participants were enrolled in the study. Outcomes were measured by blood biochemical examinations, body composition analyses and structured self-reported questionnaires to assess lifestyle behaviours and muscle quality. Linear regression models were used to examine the relationship between lifestyle factors and muscle quality using SPSS version 27.0 with a statistical significance level of P 0.05.Japanese subjects were more likely to be smokers and alcohol consumers, and they were less likely to have well-balanced diets and engage in more physical activity as compared to Taiwanese subjects. The muscle quality in the Japanese subjects was significantly poorer than that in the Taiwanese subjects. Physical activity, dietary habits and smoking were associated with muscle quality, after adjusting for age, gender and body mass index.Physical activity of insufficient intensity, unhealthy dietary habits and smoking could be risk factors for poor muscle quality. These findings can contribute to the development of effective strategies to improve muscle quality in community-dwelling older Asian people with T2DM.

A recent increase in screen time during early childhood has adversely affected the sleep and psychosocial health of children; however, limited information is available regarding effective interventions to reduce the screen time among them. This study aimed to investigate the effect of a parental educational program on screen use, sleep quality, and psychosocial adaptation among preschoolers.A clustered randomized controlled study with a parallel-group design was conducted. Preschoolers with a screen time of ≥2 h/day and their parents were recruited. In total, 14 kindergartens containing 129 parent-child dyads were randomly allocated to either the experimental group (receiving parental education, N = 63 dyads) or the control group (daily activities, N = 66 dyads). Data were collected before and after the intervention. A screen time questionnaire, the Children's Sleep Habits Questionnaire, and the Pediatric Symptom checklist-17 were provided to the participants. A linear mixed-model analysis was performed to examine the efficacy of the intervention.After the intervention, the screen time of children in the experimental group was significantly reduced (effect size: 0.83, p .001), and they presented improved sleep quality (effect size: 0.57, p = .01) and attention score (effect size: 0.77, p = .02) for psychosocial adaptation.Parental education is an effective intervention for reducing screen time and improving sleep quality and attention among preschoolers.Healthcare professionals should consider implementing parental educational programs to reduce screen time, and thus improve the sleep quality and psychosocial health of preschoolers.

Objectives The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents. Methods A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants’ knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention. Results After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of Conclusions An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents. Practice implications In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Aims (a) To identify the frequencies and reasons for missed care by nursing aides in long-term care facilities and (b) to clarify the correlation between missed care and the characteristics of nursing aides and facilities. Background Missed care by nursing aides in long-term care facilities affects the resident's quality of care and, therefore, requires attention. Methods A cross-sectional study was conducted, wherein 184 nursing aides and 80 registered nurses were recruited from 10 long-term care facilities. Results (a) The most frequently missed item of care by nursing aides was assistance with body cleaning (30.4%). (b) Among all participants, 90.2%, 89.8% and 64% indicated poor communication, labour shortages and material resource insufficiencies, respectively, as the reason for missed care. (c) Participants who perceived staff to be insufficient missed care tasks more frequently than those who perceived staff to be sufficient (p Conclusions Missed handover and insufficient nursing aides on duty were identified as the primary reasons for missed care. Implications for nursing management Handover as a nursing process should be improved to promote accuracy and continuity. Flexibility in human resources should be maintained to respond adequately to resident's emergencies, thereby ensuring effective completion of the job.

Purpose The objective of this study was to conduct a systematic review and meta-analysis to examine the effects of aromatherapy on sleep improvements. Methods A search of randomized controlled trials was conducted in four English and two Chinese medical electronic databases. Two authors independently performed the search, assessed the methodological quality, and extracted data. Then, final studies were selected after consensus with the third author. Results In total, 31 trials met the inclusion criteria, of which four had low risk, while the overall bias in 26 was uncertain in terms of methodological quality. The heterogeneity was high among the trials (Q = 341.544, p Conclusions The results showed that aromatherapy can be applied by clinical staff to effectively improve sleep quality. However, because there was a high degree of heterogeneity among studies, the inferences of the results need to be applied with caution.

The aim of this study was to explore predictors of nurses' willingness to handle abuse of older people.Abuse of older people is a long-discussed healthcare issue worldwide. Although nurses are considered capable of identifying and reporting cases of abuse of older people, no study has been conducted in Taiwan on nurses' willingness to handle abuse of older people.A cross-sectional design was used.The study was conducted from May to June 2019. A convenience sampling was adopted to survey 555 nurses from a medical center in Taiwan. Data were collected using the Knowledge of Abuse of Older People Scale, Attitudes Towards Older People Scale, Attitudes Towards Handling Abuse of Older People Scale, Willingness to Handle Abuse of Older People Scale, and personal characteristics. Pearson correlation coefficient analysis, independent sample t-test, one-way analysis of variance, and multiple linear regression were performed.Participants scored an average of 2.98 out of 4 on the Willingness to Handle Abuse of Older People Scale, indicating that they were inclined to do so. Attitudes towards older people, knowledge, attitudes towards handling abuse of older people, awareness of the hospital's reporting procedure and dissemination of information related to abuse of older people, sex, age, and clinical work experience explained 41.4% of the variance of willingness. Participants' attitudes toward handling abuse of older people was the most important predictor of their willingness to do so.To improve nurses' willingness to handle cases of abuse of older people, particularly that of male nurses, hospital authorities should provide in-service training and education and disseminate information on the subject matter. Nursing schools should prioritize offering gerontological nursing courses to foster nursing students' positive attitudes toward older adults and handling abuse of older people.Nurses' attitudes toward handling abuse of older people were the most important predictor of their willingness to handle abuse of older people.

To evaluate the effects of an integrated childbirth education intervention on reducing childbirth fear, anxiety, and depression, and improving dispositional mindfulness.A two-arm parallel, single-blind randomised controlled trial.A teaching hospital in Northern Taiwan.Pregnant women ≥ 20 years of age with a singleton pregnancy (12-24 weeks gestation) and their support partners were recruited. All women included in the study had a score of ≥ 7 points on a fear of childbirth visual analogue scale.The intervention group (n = 53) received an 8-week course in a childbirth education programme, which included (1) childbirth education using simulation-based learning that highlighted coping with labour pain and (2) instruction in mindfulness breathing, body scans, stretching, sitting meditation, and mindfulness walking. Support partners were invited to participate. The control group (n = 53) received the usual standard prenatal care.The primary outcome of fear of childbirth was assessed using the Wijma Delivery Expectancy/Experience Questionnaire. The secondary outcomes of anxiety, depression, and dispositional mindfulness were assessed with the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory Scale, and the Mindful Attention Awareness Scale, respectively. Repeated data were collected at baseline, 36 weeks gestation, and 1 week postpartum.Ninety-one mothers completed the study, with a mean age of 33.9 years (SD = 4.4), and most were primipara (n = 83). The baseline measurements did not differ between the groups. Compared with the control group, there were significant differences in all measures from baseline for the intervention group: the scores were significantly lower for fear of childbirth (mean difference (MD) =-14.8 ∼ -23.7, p.01), symptoms of anxiety (MD =-7.4 ∼ -6.4, p.01), and depression (MD =-3.7 ∼ -3.5, p.01); the levels of dispositional mindfulness were significantly higher (MD =4.9 ∼ 5.7, p.01) at 36 weeks gestation, and 1 week postpartum.The 8-week integrated childbirth education intervention was effective in reducing the fear of childbirth in pregnant women. The mindfulness techniques were easily learnt and applied by the participants. Using these techniques during pregnancy and labour enhanced participants' mental health and coping. The integrated childbirth education which includes pregnant women and their support partners could be easily taught by midwives in other contexts.

This study applied the Theory of Planned Behavior to predict exercise behaviors and intentions of teenagers and analyzed sex differences.A prospective study design was employed to survey tenth-grade students in Taipei, Taiwan. The 951 participants reported their exercise attitudes, subjective norms, perceived behavioral control (PBC), and intentions, and their exercise behaviors were tracked 6 months later.Results revealed that 22.1% of all students and more male students than female students exercised for ≥30 min/day on 5 or more days/week. Hierarchical multiple regression analyses demonstrated that intentions, PBC, attitudes, and subjective norms explained 32.5% of the variation in exercise behavior (p.001). Intentions, attitudes, and PBC were related to exercise behavior regardless of sex. Attitudes, subjective norms, and PBC explained 67.0% of the variation in intentions (p.001). Attitudes and PBC were related to intentions regardless of sex.The findings support that the main constructs of the Theory of Planned Behavior can effectively predict regular exercise intentions and behaviors among adolescents.The results can serve as a reference for nurses and other healthcare professionals when formulating effective strategies to encourage adolescents to engage in exercise practices.

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age &gt, 85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

The current study was a single-blind clinical trial that evaluated the effect of auricular acupressure on older adults' depression and anxiety. Forty-seven older adults in long-term care institutions were randomly divided into two groups using block randomization. In the experimental group, patches with magnetic beads were pasted onto the auricular Shenmen acupoints for 14 days. In the control group, blank patches were used. Among the older adults in the study institutions, 82.09% scored ≥5 points on the Geriatric Depression Scale (GDS). Significant differences in GDS scores were observed between the two groups after both 7 and 14 days of treatment (p 0.05). There was no significant difference (p 0.05) in anxiety scores between the two groups at 7 days, but there was a significant difference after 14 days of the intervention (p 0.05). Our results suggest that acupressure can reduce depression and anxiety among older adults in long-term care institutions.

Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes.A single-blind, randomised controlled trial.A prenatal clinic of a teaching hospital.First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group.A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months.Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p.001), and postpartum at 1-week (p.001), 1-month (p.001) and 3-months (p.01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p.001) and 6-months postpartum (MD: 7.0, p.05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p.05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p.02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05).The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.Registered with www.clinicaltrials.gov (NCT03807726).

AIMS To examine the effects of work-family conflicts and sleep quality on the self-perceived health status and the mediating effect of sleep quality on the relationship between work-family conflicts and self-perceived health status among hospital nurses. BACKGROUND Studies related to hospital nurses' work-family conflicts, sleep quality and health status are noteworthy but limited. METHODS A total of 575 hospital nurses in Taiwan were recruited. Data were collected using the work-family conflicts Scale, Chinese Pittsburgh Sleep Quality Index and Chinese Health Questionnaire. Independent t-tests, chi-squared tests, multivariate linear regression analyses and the Sobel test were used for analysis. RESULTS Fifty-six per cent of all subjects reported having good health. Significantly more nurses with good sleep reported good health than those with poor sleep (84.2% vs. 44.9%, p

BACKGROUND Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships. METHODS This study adopted a cross-sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent. RESULTS Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions. CONCLUSION Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction.

Summary Aims Brisk walking may be a measure for reducing impacts of chronic diseases in middle-aged and older people. Understanding the perceptions of regular brisk walkers would be valuable for healthcare providers endeavoring to cultivate and promote regular brisk walking in middle-aged and older people. Therefore, the aim of this study was to explore and understand perceptions of regular brisk walking by middle-aged and older persons. Methods A qualitative method was employed in this study. Both purposive and snowball sampling techniques were applied to recruit middle-aged and older persons who have experience doing regular brisk walking in the community. Six focus groups were conducted with a total of 48 people aged 48–81 years in April and May 2011. An interview guide with five open-ended questions was used in the focus groups. Data were analyzed using a content analysis. Results Five themes were identified from the data: (a) health promotion and maintenance; (b) relationship building and social interactions; (c) leaders' enthusiasm and peer pressure; (d) the nature of brisk walking; and (e) becoming part of one's daily life. Conclusions Middle-aged and older persons thought that regular brisk walking could promote and maintain their health and was a good way to have social contact with others. Enthusiastic community leaders and pressure from peers encouraged them to continue exercising, and eventually, it became part of their lives. The results provide information to healthcare professionals, community leaders, and policy-makers for developing appropriate brisk walking programs in the future for middle-aged and older persons in the community.

The aim of this study was to investigate the prevalence of sarcopenia and its associated risk factors among elderly with diabetes in Japan and Taiwan. A cross-sectional study was conducted through convenience sampling. This study was approved by the institutional review boards of Kobe University Graduate School of Health Sciences (No. 543) and Taipei Medical University (No. N201905065). Of the 114 Japanese participants (24.9% females) and 226 Taiwanese participants (75.1% females), the mean age were 73.7±6.9 years and 74.2±6.6 years, respectively. Sarcopenia was found in 10.6% in Japan and 11.1% in Taiwan with no significant difference between both countries. Older age, poor relationships with neighbors, and poor consciousness for health management were significantly associated with sarcopenia in both countries. Additionally, Japanese participants with sarcopenia had significantly longer duration of diabetes, higher level of emotional distress assessed by the Problem Areas In Diabetes (PAID) scale, and lower level of total protein, but no significant differences were shown in Taiwanese participants. Binomial logistic regression analyses were performed to detect risk factors related to sarcopenia. After adjusting for age, sarcopenia was found to be significantly associated with poor consciousness for health management in Japanese participants (OR:0.12 P=0.02) and significantly associated with poor relationships with neighbors and poor consciousness for health management in Taiwanese participants (OR:0.18 P=0.008 and OR:0.45 P=0.04, respectively). These findings are expected to contribute to the development of effective strategies for preventing sarcopenia among elderly with diabetes in Japan and Taiwan.

To examine the effectiveness of extracorporeal magnetic stimulation for treatment of stress urinary incontinence.Systematic review and meta-analysis.Four electronic databases from inception to 18 May 2019.Two authors independently performed the search, assessed the methodological quality, and extracted data. The final studies included in the analysis were selected after reaching consensus with the third author.A total of 20 studies were included in the systematic review and 12 of these in the meta-analysis. Quality assessment indicated that only 8 of 17 randomized controlled trials had low risk in overall risk of bias, whereas all controlled trials had serious risk of bias. The weighted mean effect size of magnetic stimulation on quality of life, number of leakages, pad test outcomes, and number of incontinence events was 1.045 (95% CI: 0.409-1.681), -0.411 (95% CI: 0.178-0.643), -0.290 (95% CI: 0.025-0.556), and -0.747 (95% CI: -1.122 to -0.372), respectively. Subgroup analysis revealed a significant difference in the type of quality of life measurement used. Sensitivity analyses revealed that a high degree of heterogeneity persisted even after omitting studies individually.Extracorporeal magnetic stimulation may be effective in treating urinary incontinence and improving quality of life without major safety concerns. However, because of a high degree of heterogeneity among studies, inferences from the results must be made with caution.We recommend that clinical nurses apply extracorporeal magnetic stimulation to treat stress urinary incontinence among female patients and encourage researchers to conduct further qualitative and quantitative studies to develop consistent content and dosage for the intervention.The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.york.ac.uk/Prospero with the registration number #CRD42019138835).目的: 探讨体外磁刺激治疗压力性尿失禁的疗效。 设计: 系统评估和荟萃分析 数据来源: 从研究开始到2019年5月18日的四个电子数据库。 评估方法: 两位作者独立展开检索,评估了方法质量,并提取了数据。在与第三位作者达成共识后,选择了最终纳入分析的研究。 结果: 系统评估中共纳入20项研究,其中12项纳入荟萃分析。质量评估显示,17项随机对照试验中只有8项总体偏倚风险较低,而所有对照试验均存在严重偏倚风险。磁刺激对生活质量、漏尿次数、护垫试验结果和尿失禁事件次数的加权平均效应量分别为1.045(95% CI:0.409˜1.681)、−0.411 (95% CI: 0.178-0.643)、-0.290(95% CI:0.025˜0.556)和-0.747(95% CI:-1.122˜-0.372)。子组分析显示,所使用的生活质量衡量指标类型存在显著差异。 敏感性分析显示,即使省略个别研究后,仍存在高度异质性。 结论: 体外磁刺激可有效治疗尿失禁,提高生活质量,且无重大安全隐患。然而,由于研究之间的高度异质性,必须谨慎地从结果中作出推断。 影响: 我们建议临床护士应用体外磁刺激治疗女性患者压力性尿失禁,并鼓励研究人员进一步开展定性和定量研究,以确定一致性干预内容和剂量。 研究登记: 评估方案已事先登记,并在PROSPERO系统性评估数据库中在线发布(www.crd.york.ac.uk/Prospero,登记号为#CRD42019138835)。.

The primary purpose of this study was to investigate changes in exercise intentions and behaviors among children across time. Then, we investigated how determinants in the Theory of Planned Behavior (TPB) predicted exercise intentions and behaviors, and explored if demographic predictors contributed to predicting behaviors.A three-wave, 12-month longitudinal study was conducted. A proportional stratified random sampling method was adopted, and 1997 children from 11 elementary schools in Taipei City were recruited. Numbers of participants were 1074, 1064, and 995 at times 1, 2, and 3, respectively.Children's exercise intentions and behaviors significantly changed (both p .05) during a 6-month interval. Attitudes, subjective norms, and perceived behavioral control (PBC) at time 1 could respectively explain 51.0% and 17.1% of the variance in time 1 and 2 intentions (FThe findings support the TPB model being suitable for use in longitudinal studies; its core constructs significantly predicted children's exercise intentions and behaviors.This study highlights that clinical practitioners and school nurses working with children can help youth engage in regular exercise by enhancing their intentions and perceived behavioral control, and cultivating positive attitudes and subjective norms when planning exercise intervention programs.

Background Single- and five-item measures have been used prevalently to assess exercise stages of change. Few studies have investigated the development of instruments that are able to continuously measure exercise stages of change and have conducted associated psychometric analyses. Purpose This study aimed to translate the original, English-language version of the University of Rhode Island Change Assessment-Exercise 2 (URICA-E2), a continuous exercise stages of change assessment instrument, into Chinese and then to test the validity and reliability of the translated version. Methods A cross-sectional descriptive study was conducted. Participants consisted of 325 adults from Taipei, Taiwan. The URICA-E2 was translated into Chinese using a standardized procedure. Psychometric analyses, including validity, reliability, and cluster analysis, of the Chinese-version instrument were conducted. Results The content validity index was .987. Confirmatory factor analysis confirmed that the overall model fit was standardized, as the factor loadings of all of the items and the composite reliability and average variance extracted for the six exercise stages of change satisfied the convergent validity criteria. The average variance extracted for each construct of the stages of behavior change satisfied the discriminatory validity criteria. Values of Cronbach's α for the six exercise stages ranged from .80 to .94. The intraclass correlation coefficients for test-retest reliability after 2 weeks ranged between .74 and .87. Conclusions The Chinese-language version of the URICA-E2 developed in this study exhibited excellent validity and reliability. This instrument may be used by healthcare professionals and the academic community to effectively and continuously measure the intentions and attitudes of adults at various exercise stages of change and to guide the provision of appropriate interventions.

Purpose Osteosarcopenic adiposity (OSA), which is described as the concurrent occurrence of osteopenia, sarcopenia, and adiposity, can lead to frailty and increase the risk of physical disability in elderly women. Progressive elastic band resistance exercise training (peRET) is considered a safe and feasible exercise intervention for elderly women with sarcopenic obesity. This study investigated the effects of elastic band resistance exercise on the physical capacity and body composition of elderly women with osteosarcopenic adiposity. Method A total of 15 and 12 women were randomly assigned to the experimental (12 weeks of resistance exercise) and control groups (no exercise intervention), respectively. Lean mass (measured using a dual-energy X-ray absorptiometer) and physical capacity assessments (such as timed up and go test and single leg stance tests) were conducted at baseline, 12 weeks (end of intervention), and 6 months after the intervention. Outcome differences within the study and control groups were analyzed using repeated-measures analysis of variance with a post-hoc test. The Mann–Whitney U test was used to examine differences between groups at different time points. Results After the intervention, no body composition changes in muscle mass and fat were observed between the study and control groups. Moreover, muscle mass and fat body composition did not significantly differ at different time points. The bone density was higher in the study group, with a higher T-score than their baseline values, but did not significantly differ compared with the control group. The study group exhibited more improved physical function than the control group, but the effect did not last after 6 months of follow-up. Conclusions A 12-week progressive elastic band resistance training program effectively increased the physical capacity and improved the bone density; however, without persistent training, the positive effect diminished at 6-month follow-up.

Aging poses a high risk of lean mass loss, which can be effectively improved through resistance exercise training (RET), or multicomponent exercise training (MET) as well as nutrition supplementation, such as protein supplementation (PS). This study investigated the effects of PS plus exercise training on frail older individuals. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) that reported the efficacy of PS combined with RET or MET in frail older individuals. The included RCTs were analyzed through a meta-analysis and risk-of-bias assessment. We finally included 22 RCTs in the meta-analysis, with a mean (range/total) Physiotherapy Evidence Database score of 6.7 (4⁻9/10). PS plus exercise training significantly improved the frailty status (odds ratio = 2.77; p = 0.006), lean mass (standard mean difference (SMD) = 0.52; p < 0.00001), leg strength (SMD = 0.37; p < 0.00001), and walking speed (SMD = 0.32; p = 0.002). Subgroup analyses revealed that PS plus MET exert significant effects on frailty indices, whereas PS plus RET further improves lean mass. Our findings suggest that PS plus RET as well as MET is effective in improving frailty status, lean mass, muscle strength, and physical mobility in frail older individuals.

The purpose of this study was to investigate the effects that listening and not listening to music had on pain relief, heart rate variability (HRV), and knee range of motion in total knee replacement (TKR) patients who underwent continuous passive motion (CPM) rehabilitation. We adopted a single-group quasi-experimental design. A sample of 49 TKR patients listened to music for 25 min during one session of CPM and no music during another session of CPM the same day for a total of 2 days. Results indicated that during CPM, patients exhibited a significant decrease in the pain level ( p < .05), an increase in the CPM knee flexion angle ( p < .05), a decrease in the low-frequency/high-frequency ratio (LF/HF) and normalized LF (nLF) of the HRV ( p < .01), and an increase in the normalized HF (nHF) and standard deviation of all normal-to-normal intervals (SDNN; p < .01) when listening to music compared with no music. This study demonstrated that listening to music can effectively decrease pain during CPM rehabilitation and improve the joint range of motion in patients who underwent TKR surgery.

Purpose This study aims to evaluate the executive function and learning attention in children with internet addiction (IA). Design and methods Children aged 10-12 were screened by Chinese Internet Addiction Scale to compose the IA group and internet nonaddiction group. Their executive functions were evaluated by Stroop color and word test, Wisconsin card sorting test, and Wechsler digit span test. Learning attention was evaluated by Chinese concentration questionnaire. Findings Executive function and learning attention were lower in the IA group than in the internet nonaddiction group. Practice implications Executive function and learning attention are compromised by IA in children. Early interventions into the IA should be planned to maintain the normal development of executive function and learning attention in childhood.

The self-care behaviors of patients with diabetes represent the most important part of diabetic healthcare. However, few studies have investigated the self-care behaviors of diabetes patients in the context of diabetes shared care networks.The present study applied a health belief model to determine the self-care behaviors of diabetes patients and the related factors affecting those behaviors.A cross-sectional approach and convenience sampling were employed. A questionnaire survey was completed by 165 patients with type 2 diabetes in a diabetes shared care network of a teaching hospital in Yilan County, Taiwan. The questionnaire comprised scales including knowledge, health beliefs, cues to action, self-efficacy, and self-care behavior for diabetes. The collected data were analyzed using the Pearson product-moment correlation and multiple regression analysis.The percentage of accomplishment of diabetes self-care behavior was 62.93%, with taking medication achieving the highest rate of compliance and monitoring blood sugar achieving the lowest rate of compliance. On the diabetes health belief scale, the perceived benefits of taking action scored the highest and the perceived barriers to taking action scored the lowest. Medical treatment, duration of joining the diabetes shared care network, cues to action, age, and self-efficacy were the most important factors of influence in self-care behavior, accounting for 20.2% of total variance.Diabetes health educators should pay attention to factors that affect the self-care behaviors of patients receiving diabetes shared care. The results of the present study provide healthcare professionals with information that may be used to develop better healthcare and suggests further research on diabetes interventions.糖尿病病人自我照護行為及相關因素研究.糖尿病自我照護行為是糖尿病醫療照護中最重要的一環，然而，糖尿病共同照護網之糖尿病病人執行自我照護行為的研究却很少見。.以健康信念模式瞭解糖尿病病人執行自我照護行為與相關因素。.採橫斷式研究設計，以方便取樣，選取宜蘭縣某區域教學醫院165位糖尿病共同照護網之第2型糖尿病病人為研究對象。以糖尿病知識量表、糖尿病健康信念量表、糖尿病行動線索量表、糖尿病自我效能量表、糖尿病自我照護行為量表進行問卷調查。以皮爾森積差相關、複迴歸分析等進行統計分析。.糖尿病自我照護行為的得分百分比為62.93%，其中以藥物行為最好、血糖監測行為最差。糖尿病健康信念以行動利益性認知得分最高、行動障礙性認知得分最低。藥物治療方式、加入糖尿病共同照護網時間、糖尿病行動線索、年齡及糖尿病自我效能，是影響糖尿病自我照護行為的重要因素，解釋變異量為20.2%。.糖尿病衛教人員宜重視糖尿病共同照護網病人之自我照護行為及相關因素，本研究結果可提供醫護人員日後擬定糖尿病健康照護計畫及介入研究之參考。.

Despite the fact that regular physical activity is known to improve physical health and reduce absenteeism and perceived job strain, healthcare professionals currently perform inadequate physical activity.To understand and compare the differences in stages of physical activity among nurses, physicians, and allied healthcare professionals.A cross-sectional questionnaire was used to survey nurses, physicians, and allied healthcare professionals who worked at four branches of a hospital in Taiwan. Data were collected using the physical activity stage of change questionnire. Data were analyzed using descriptive analysis, Chi-square test of homogeneity of proportions and a posteriori comaparisons, and multinominal logistic regression analysis.Of the 3,260 questionnaires administrated, 2,001 valid questionnaires were returned for an effective response rate of 61.4%. In total, 1,497 (74.8%) of the nurses, 241 (12.0%) of the physicians, and 263 (13.1%) of the allied healthcare professionals completed the questionnaire. The results revealed that most of the physicans and allied healthcare professionals were in the preparation stage, while most of the nurses were in the precontemplation stage. Multinominal logistic regression analyses showed that, using the precontemplation stage as a reference value, the odds of being in the contemplation stage were lower among participants who were nurses or male or who had a master's or doctoral degree (p.05). Further, the odds of being in the preparation stage were lower among nurses (p.01). The odds of being in the maintenance stage were higher among participants that: lived in the Taitung area, were male, or were single (p.01).The findings provide valuable references for future hospital leaders to develop effective individual physical activity programs for healthcare professionals.比較護理人員、醫師及其他醫事人員身體活動階段之差異.規律的身體活動雖然可促進醫事人員的健康、降低曠班及工作緊張感，但大部分醫事人員的活動量是不足的。.瞭解與比較護理人員、醫師及其他醫事人員之身體活動階段的差異。.本研究設計採橫斷式問卷調查法，以臺灣某醫院四院區之護理人員、醫師及其他醫事人員為研究對象。以身體活動階段問卷表為研究工具。資料統計分析方法包含：描述性統計分析、卡方百分比同質性考驗及事後比較、多項式邏輯斯迴歸分析。.本研究共發出問卷3,260份，有效回收問卷2,001份，有效問卷回收率為61.4%。本研究共收集1,497名（74.8%）護理人員、241名（12.0%）醫師及263名（13.1%）其他醫事人員。研究結果顯示，醫師與其他醫事人員的身體活動階段均以準備期居多；而護理人員身體活動階段則以無意圖期居多。以無意圖期為參考值，多項式邏輯斯迴歸分析醫事人員身體活動階段傾向之可能因素顯示，護理人員、男性、具碩博士學歷者，其身體活動階段處於意圖期的勝算較低（p.05）；護理人員處於準備期的勝算較低（p.01）。臺東院區、男性及未婚者處於維持期的勝算較高（p.01）。.本研究結果可作為未來醫院領導者發展醫事人員個別化身體活動計畫方案之參考，以促進其健康。.

The number of people living with dementia is growing as the average age of the population rises. Eating difficulties are a common problem for dementia patients and their caregivers. The etiology of these difficulties is often complicated. Weight loss, poor nutrition, aspiration pneumonia, and associated medical admissions or even mortality may occur as soon as an eating difficulty develops. This paper presents a literature review of the eating difficulties of dementia patients. The process of eating involves four stages: recognizing food, taking food into the mouth, chewing, and swallowing. We discuss the causes and clinical manifestations of eating difficulties at each of these stages and introduce an intervention for overcoming eating difficulties, aiming at providing choices of methods to improve eating behavior. The author hopes that this review will help medical personnel / caregivers enhance their understanding of the etiology and the clinical manifestation of eating difficulties in dementia patients, evaluate the overall condition of their patient(s), and provide an appropriate intervention in order to help these patients experience the most comfortable and non-invasive ways of eating or feeding, improve their quality of eating, and realize with their family improved spiritual well-being.失智患者進食困難探討.失智症人數隨著人口老化亦逐年增加，而隨著失智症疾病進展，有一半以上的患者會面臨進食困難的問題，這也是造成家屬困擾的問題之一。病因大多是錯綜複雜，一旦病患有進食困難問題，緊接而來的是體重下降、營養不良、吸入性肺炎住院增加，甚至死亡。本文藉由失智症進食困難文獻回顧，將進食過程分為四個階段，如：辨識食物、拿取食物放入口中、咀嚼、吞嚥的過程，分別探討患者在各階段出現進食困難可能的因素及可能出現行為徵象，進而介紹改善進食困難問題的方法，提供給有進食困難問題的失智症患者或照顧者多項選擇方法。希望除了提升醫療人員及照顧者對失智症進食困難原因及呈現徵象更加了解外，更期待醫療團隊應該更謹慎評估病患整體狀況，提供最適切介入措施，讓病患獲得最舒適及最非侵入性的進食方式，改善病患進食品質，也使病患與家屬可獲得心靈安適。.

Aims To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Background Although NAs require multifaceted managerial competencies, research related to NAs’ managerial competencies is limited. Method A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. Results All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. Conclusion The present study provides recommendations for future administrative training programmes to increase NAs’ managerial competency in fulfilling their management roles and functions. Implications for Nursing Management The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

shen h.-c., chiu h.-t., lee p.-h., hu y.-c. & chang w.-y. (2011) Hospital environment, nurse–physician relationships, and quality of care: questionnaire survey. Journal of Advanced Nursing 67(2), 349–358. Abstract Aim. This paper is a report of a study conducted to (a) to compare hospitalized patients’ and nurses’ perceptions of the hospital environment, nurse–physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables. Background. Quality of care is a function of many factors and includes elements of the hospital environment and nurse–physician relationships. However, comparisons between patients’ and nurses’ perceptions are relatively limited. Methods. This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis. Results. Overall, patients’ mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse–physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P

Title. Job satisfaction and perceptions of quality of patient care, collaboration and teamwork in acute care hospitals. Aim. This paper is a report of a study conducted to compare levels of job satisfaction and perceptions of the quality of patient care, collaboration and teamwork among healthcare professionals in four acute care hospitals and to determine the factors associated with job satisfaction for physicians, nurses and other healthcare professionals. Background. Positive inter-professional relationships improve quality of patient care and staff job satisfaction. Understanding how healthcare professionals perceive their relationships with each other, and identifying factors that affect their job satisfaction and perceptions of the quality patient care, inform quality improvements. Method. This cross-sectional survey study was conducted in four hospitals in Taiwan. Data were collected in 2007 and analysed using descriptive statistics, one-way anova with the Games-Howell post hoc test and stepwise regression analysis. Results. The survey was completed by 1475 respondent, giving a response rate of 52·2% (180 physicians, 1019 nurses and 276 other healthcare professionals). Physicians were more satisfied with their jobs (F = 26·75, P

The purpose of this study was to investigate the demographics, training, and practice patterns of folk medicine practitioners, their opinions toward statutory regulation of folk medicine, and the formal education and credentialing for folk medicine providers in the metropolitan Taipei area.A cross-sectional survey design was used.Included in the survey were 200 folk medicine practitioners in Taipei city and 200 folk medicine practitioners in Taipei county.The survey questionnaire consisted of 3 domains including demographics and training; practice patterns; and opinions toward statutory regulation of folk medicine and formal education and credentialing for Tuina, Ba Guan, Gua Sha, and reflexology providers.The response rates ranged from 86.3% to 99.5%. A typical folk medicine provider in the Taipei metropolitan area was a middle-aged man with a high school degree who worked about 50 hours a week. The majority of the providers in the Taipei metropolitan area received their training through apprenticeship. Years of training and experience varied widely among these practitioners. About 80% had received more than one year of training prior to starting their practice. Adult men and women were their major clientele. The major treatment modalities they offered were Tuina, Gua Sha, Ba Guan, reflexology, and meridian massage. The majority of the respondents agreed that practitioners should receive formal education and training and agreed that certifying the qualifications of folk medicine practitioners is necessary.Findings from the present survey provide an understanding of the training and practice patterns of Taiwanese folk medicine practitioners, highlight folk medicine practitioners' needs for formal education and training, and stress the importance of statutory regulation of folk medicine in Taiwan.

Aims and objectives. This study performed a meta-analysis of seven parallel-group comparison studies evaluating the efficacy of tuina in treating cervical spondylosis. Background. Tuina is a form of Chinese manipulative therapy. It has been used as a modality for the treatment of symptoms associated with such a musculoskeletal condition as cervical spondylosis. However, evidence regarding the efficacy of tuina for cervical spondylosis has yet to be determined. Design. Systematic review. Methods. Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: tuina, tuinaology, manual medicine, massotherapy, cervical spondylopathy, cervical spondylosis and cervical vertebrae. Chinese research papers were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996–2007. Studies were selected if they were written in English or Chinese, used tuina as a stand-alone modality, used a parallel-group comparison design and explicated raw data regarding symptoms relief. Two independent reviewers reviewed the selected studies based on the evidence rating system of the US Preventive Services Task Force. Studies with an evidence rating of II-2 fair or above were included in this review. Results. The direction of the effect size for the improvement of blood flow velocity of vertebral artery and basilar artery was not consistent across studies. Moreover, the pooled effect size was negligible. No evidence supported that tuina could improve headache and vertigo. A small effect of tuina on the viscosity of blood and plasma was found. Conclusion. Based on the results of this systematic review, a definitive conclusion regarding the effects of tuina on cervical spondylosis remains to be determined. Relevance to clinical practice. The efficacy of tuina is not supported by parallel-group comparison studies.

Summary Objective To describe the Instructional System Design Processes (analysis, design, development, implementation, and evaluation) used to develop an e-learning education programme for staff nurses at a 700-bed teaching medical center in Taiwan. Background Evidence has shown that education via e-learning improves knowledge and skills; however, with cost constraints and limited resources, finding effective alternatives is critical for health professionals. Methods Five courses required for N2 to N3 level nurses were designed for both e-learning and traditional in-classroom programmes. Multiple-choice written test questions and a satisfaction questionnaire were used to compare outcomes between programmes. Nursing care skills were rated as pass or fail. Both programmes were begun at the same time and completed within a 3-month period. Results Forty-two staff nurses participated in this study. All nurses’ knowledge scores were >70 points (out of 100) and all passed nursing care skills. In five courses, only teaching and learning and communication were statistically significantly different ( p = 0.001). Nearly all nurses (97.6%) felt satisfied or very satisfied with the programmes. Conclusions Instructional System Design Processes provide an alternative delivery system for in-service nursing education which allows for individualized leaning.

Aims This 3-year longitudinal study examined changes in patterns of risk factors and protective factors of smoking initiation and cessation among vocational high school students in Taipei, Taiwan. Design and setting In 2000, a total of 2151 10th grade students from 16 vocational high schools were assessed and followed up in the 11th and 12th grades. Self-administered questionnaires were collected in each year to assess the pattern of changes in smoking behaviors, and risk and protective factors. Findings Of the 1654 non-smokers in the 10th grade, 227 students initiated smoking by the 12th grade. Higher risk factors such as peer smoking, peers offering cigarettes, alcohol use and lower protective factors, such as refusal self-efficacy, antismoking attitude and belief in the 10th grade predicted youth initiation by grade 12. Increases in risk factors and decreases in protective factors during the years from 10th to 12th grades were associated significantly with youth smoking initiation. Of the 494 smokers in the 10th grade, 76 students quit smoking by the 12th grade. Lower risk factors and higher protective factors in 10th grade smokers predict youth smoking cessation by grade 12. Decreases in risk factors and increases in protective factors were associated significantly with youth smoking cessation. Conclusions The risk factors (i.e. social influences) and protective factors (i.e. self-efficacy) examined in this study predict both youth smoking initiation and youth smoking cessation.

Aim. This paper reports a study whose main aim was to understand the correlation between stages of exercise and health-related qualities of life among overweight and obese adults in Taiwan. Background. Regular exercise has been shown to improve health-related quality of life in the general population and among patients with chronic diseases. Nevertheless, systematic investigations of the correlation between exercise stages and the health-related quality of life among overweight and obese adults are lacking in Taiwan. Method. A cross-section of people from the weight loss clinics of a medical centre in Taipei was recruited to the study. The Chinese version of the Stages of Exercise and the Taiwanese version of Short Form 36 questionnaires were used to collect data from those whose body mass indexes were equal to or >24 kg/m2. The data were collected in 2003. Results. In total, 212 overweight and obese adults participated in the study. The majority were in the preparation (38·2%) or contemplation (31·6%) stages of exercise; relatively few were in the action (14·2%) or maintenance (11·3%) stages, and the smallest number (4·7%) were in the precontemplation stage. Although over 70% of respondents were not in the habit of taking regular exercise, their motivations were very high. For the Short Form 36 scales, the highest scores were for physical functioning (84·5 ± 17·3), while the lowest were for general health (55·5 ± 20·9), vitality (59·8 ± 18·1), and mental health (MH) (66·0 ± 17·9). Different stages of exercise showed statistically significant differences within the eight domains of Short Form 36 (Wilks = 0·733, P = 0·001); a statistically significant difference was also found for physical functioning (P ≤ 0·001), general health (P = 0·003), and vitality (P = 0·005). Conclusion. Since stages of exercise are correlated with health-related quality of life among overweight and obese adults, healthcare providers need to understand what stages people are at in order to educate them to achieve a better quality of life and to motivate those who are inactive to do more exercise on a regular basis.

This is a cross-sectional study that purposely selected healthy community centers (HCC) in Taipei City to explore factors affecting volunteers' health training program participation (HTPP). The major objectives were to: (1) examine volunteer's HTPP; (2) explore relationships among volunteers' HTPP, self-efficacy (SE) in healthy community building, and community activities participation (CAP); and (3) identify key factors affecting volunteers' HTPP. A self-developed instrument with validity (content validity index > .91) and reliability (alpha = .63-.87) was used. A total of 250 participants were recruited. Study results revealed that a majority of the volunteers were middle-aged women who held at least a high school education, worked part-time, held Buddhist religious beliefs, were married and were middle class in terms of income. The average HTPP value was 19, with Xin Yi, Zhong Zhen and Bei Tou HCCs exhibiting higher HTPP values. Those not currently employed and housewives volunteers had lower HTPP values. 66.4% of volunteers participated at community activities after training and contributed 60-120 service hours a year. Volunteers' SE in healthy community building was low (M = 2.01, SD = 1.01), which, however, could explain 21% variance of HTPP. Factors affecting HTPP included HCC site, SE and CAP, which accounted for 57% of variance. Study results indicated that SE and CAP could serve as training evaluation indicators and a well-organized training program could increase volunteers' SE. Standard health training programs should incorporate three programs, including volunteerism perception, health promotion, and middle aged and elderly care to thus further improve volunteers' participation in community health activities.

BACKGROUND The Internet has been gaining worldwide popularity in recent years, but a loss of control over Internet use might lead to negative impacts on our daily lives. OBJECTIVES This study explored the effects of Internet addiction on autonomic nervous system function through heart rate variability (HRV) analysis. METHODS This was a cross-sectional design. Data were collected from 240 school-aged children who completed the Chinese Internet Addiction Scale and Pittsburgh Sleep Quality Index questionnaires. Spectral analysis was used to measure HRV. Independent t test was used to compare differences in characteristics and HRV between groups. A 2-way analysis of variance was used to examine group differences in HRV. RESULTS Internet addicts had significantly lower high frequency (HF) percentage, logarithmically transformed HF, and logarithmically transformed total power and significantly higher low frequency percentage than did nonaddicts. Internet addicts who had insomnia had higher low frequency percentage and lower HF percentage, logarithmically transformed HF, and logarithmically transformed total power compared with nonaddicts who did not have insomnia. CONCLUSIONS Internet addiction is associated with higher sympathetic activity and lower parasympathetic activity. The autonomic dysregulation associated with Internet addiction might partly result from insomnia, but the mechanism still needs to be further studied.

Background: Increased media viewing such as watching television and videos and playing on/using computers has been associated with childhood obesity. Guidelines from the American Academy of Pediatrics recommend limiting children’s total media time to no more than 2 hours per day. Information about media usage and school-aged obesity in Taiwan is lacking.Purpose: The purpose of this study was to investigate whether media viewing after school is associated with the total and central obesity in school-aged children in Taipei, Taiwan’s capital and largest city.Methods: A case-control study was designed, and a control approach was used to recruit participants. Two hundred seventyfive obese and 275 normal-weight children currently in the fourth grade were enrolled from 29 elementary schools in Taipei City. Media viewing after school was measured using a 3-day selfreported physical activity log and the daily sedentary activity component of the National Health Interview Survey in Taiwan. The latter was completed by the participants’ parents.Results: Participants with total obesity had significantly more television watching time (60.24 minutes vs. 43.50 minutes, p G .05) and total media watching time (73.61 minutes vs. 52.67 minutes, p G .001) than normal-weight participants. Similar results were found for participants with central obesity. Total television and total media watching durations greater than 2 hours a day correlated significantly with total and central obesity. Time spent using computers did not differ significantly between obese and normalweight control participants on weekdays.Conclusions/Implications for Practice: Childhood obesity may be multifactorial in origin. Excessive sedentary activity such as watching television may have a variety of consequences beyond the putative effect on body habitus. School nurses should promote health programs targeted to prevent excessiveweight and obesity in children, recommend reducing media viewing, and encourage patient participation in extracurricular outdoor activities.

BACKGROUND A good classroom environment can promote students' learning motivation and affect their academic efficacy and adaptation. This study compares the perceptions of Taiwanese middle school students regarding actual and preferred classroom environments and explores the association with sex and grade level. METHODS Data were collected using cross-sectional research design from a national sample of 1932 middle school students. Data of 1897 valid questionnaires from the Chinese Elementary and Middle School Inventory of Classroom Environment were analyzed. RESULTS The actual and preferred classroom environments perceived by students differed significantly (p

To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs.Although NAs require multifaceted managerial competencies, research related to NAs' managerial competencies is limited.A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011.All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies.The present study provides recommendations for future administrative training programmes to increase NAs' managerial competency in fulfilling their management roles and functions.The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

This paper is a report of a study conducted to (a) to compare hospitalized patients' and nurses' perceptions of the hospital environment, nurse-physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables.Quality of care is a function of many factors and includes elements of the hospital environment and nurse-physician relationships. However, comparisons between patients' and nurses' perceptions are relatively limited.This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis.Overall, patients' mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse-physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P0·001). Both the hospital environment and nurse-physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse-physician relationships and years of education for patients (P0·05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse-physician relationships (P0·05).These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients' and nurses' expectations.

Background: Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited. Purpose: This study aimed to explore perceptions of exercise held by obese school-aged children. Methods: This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1, 714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes. Results: Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise. Conclusions/Implications for Practice: Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.

The issue of active and passive cigarette smoking among pregnant women at home has become a major source of debate. The purpose of this study was to explore the knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke and related factors among pregnant women in Taiwan.A cross-sectional research design was used. Women (n = 281) visiting the outpatient antenatal clinics of one regional hospital and two medical centers in Taipei for routine obstetrical care volunteered to fill out questionnaires.Participants on average had little knowledge of this issue and felt less than "very confident" in resisting environmental tobacco smoke and indicated that it was only "usually true" that they practiced avoidance behaviors. The knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke were all related to both the woman and her partner's educational levels. There were significant differences in mean knowledge, self-efficacy, and avoidance of environmental tobacco smoke scores among different household smoking groups. A multiple regression revealed that overall avoidance of environmental tobacco smoke was positively associated with self-efficacy, with a no-smoking policy at home, and with both a woman and her partner's educational levels.The high prevalence of subjects suffering from active (6.05%) and passive smoking (58.72%) suggests that clinicians can target interventions designed to increase pregnant women's self-efficacy and to advise them to try to set up their own smoking policy at home.

This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension.Participants in the active biofeedback group (n=20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group (n=18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training.The decreases in systolic (12.6 +/- 8.8 versus 4.1 +/- 5.7) and mean BP (8.2 +/- 6.9 versus 3.3 +/- 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group (p=0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP (p=0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group (p=0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged.BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress.

Background This study aimed at exploring the impacts of a school-wide no smoking strategy and a classroom-based smoking prevention curriculum on smoking-related knowledge, attitude, behavior, and skill of junior high school students. Methods Using a pre–post quasi-experimental design, 469 seventh-to ninth-grade students at four junior high schools in Taiwan, were selected and separated into three groups according to class unit. Experimental group A experienced a school-wide no smoking strategy and a six-session smoking prevention curriculum. Experimental group B experienced only the school-wide no smoking strategy. The control group experienced no intervention. The students were tested 1 week before intervention began and 1 week after it ended. Results Experimental group A exhibited a better understanding than either experimental group B or the control group of the dangers of smoking and of techniques for refusing cigarettes; and in fact, group A indicated low smoking intention than experimental group B. Experimental group A also had a better attitudes towards resisting smoking than the control group. However, the intervention had no demonstrable effect on the smoking behavior and on the smoking substitution methods of students. Conclusions To reduce the smoking rates among junior high school students, diversified school-wide no smoking strategies and standardized, diversified instruments should be adopted so that outcomes of smoking prevention work may be assessed more objectively and effectively.