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Holland-Winkler AM, Greene DR, Oberther TJ. The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review. J Clin Med 2024; 13:2169. [PMID: 38673442 PMCID: PMC11050272 DOI: 10.3390/jcm13082169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
The occupational requirements of full-time non-administrative firefighters include shift-work schedules and chronic exposure to alerting emergency alarms, hazardous working conditions, and psychologically traumatic events that they must attend and respond to. These compiling and enduring aspects of the career increase the firefighter's risk for insomnia and mental health conditions compared to the general population. Poor sleep quality and mental health impairments are known to coincide with and contribute to the symptom severity of one another. Thus, it is important to determine approaches that may improve sleep and/or mental health specifically for firefighters, as their occupation varies in many aspects from any other occupation. This review will discuss symptoms of insomnia and mental health conditions such as PTSD, anxiety, depression, substance abuse, and suicide in firefighters. The influencing factors of sleep and mental health will be examined including anxiety sensitivity, emotional regulation, and distress tolerance. Current sleep and mental health interventions specific to full-time firefighters are limited in number; however, the existing experimental studies will be outlined. Lastly, this review will provide support for exploring exercise as a possible intervention that may benefit the sleep and mental health of this population.
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Affiliation(s)
- Angelia M. Holland-Winkler
- Department of Kinesiology, Augusta University, 3109 Wrightsboro Road, Augusta, GA 30909, USA; (D.R.G.); (T.J.O.)
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Ha J, Youn I, Han Y, Kim J, Kim S, Jin H, Kang JW, Leem J. Firefighters' medical use and Korean Medicine experience in Korea: A qualitative study protocol. PLoS One 2024; 19:e0300532. [PMID: 38527034 PMCID: PMC10962829 DOI: 10.1371/journal.pone.0300532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Firefighters, compared to other occupational groups, are exposed more frequently in their working environment not only to physical issues, such as musculoskeletal disease, respiratory disease, and burns but also to mental health issues, such as PTSD and depression. Specifically, Korean firefighters experience significantly higher rates of work-related injuries compared to those in other countries. Recent statistics from the Korea National Fire Agency indicate a steady increase in the number of firefighting work-related injuries. However, there is a shortage of measures in place to address these issues. This study aims to investigate the health needs, overall healthcare usage, and unmet needs of firefighters in Korea. We also aim to investigate, through in-depth interviews, perceptions and hindering factors for integrative medicine approaches to fulfilling unmet needs. METHOD This study was conducted in accordance with the consolidated criteria for reporting qualitative research. Convenience and snowball sampling methods will be used to recruit firefighters to participate in the study, and interviews will be conducted using a semi-structured interview guide. The data will be analyzed in four stages using the qualitative analysis method of Krippendorff. DISCUSSION In this study, we examine the state of health issues and healthcare usage among Korean firefighters and investigate their perceptions of and needs for integrative medicine. In this way, we aim to explore how integrative medicine and Korean medicine approaches could improve and assist healthcare services for firefighters. Furthermore, our findings will provide policymakers and healthcare providers with the necessary basic information to develop integrative medicine systems suited to firefighters.
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Affiliation(s)
- Jisu Ha
- Department of Acupuncture and Moxibustion, National Medical Center, Seoul, Republic of Korea
| | - Inae Youn
- Department of Acupuncture and Moxibustion, National Medical Center, Seoul, Republic of Korea
| | - Yuri Han
- College of AI convergence, Donggkuk University, Seoul, Republic of Korea
| | - Jinwon Kim
- Department of Internal Medicine of Korean Medicine, National Medical Center, Seoul, Republic of Korea
| | - Sunjoong Kim
- Department of Acupuncture and Moxibustion, National Medical Center, Seoul, Republic of Korea
| | - Hanbit Jin
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, Republic of Korea
| | - Jung Won Kang
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jungtae Leem
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, Republic of Korea
- Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, Republic of Korea
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Hershey MS, Bouziani E, Chen XY(M, Lidoriki I, Hadkhale K, Huang YC, Filippou T, López-Gil JF, Gribble AK, Lan FY, Sotos-Prieto M, Kales SN. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol. Front Endocrinol (Lausanne) 2023; 14:1250041. [PMID: 37908746 PMCID: PMC10614295 DOI: 10.3389/fendo.2023.1250041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
In the United States (US), new firefighters' fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, "Surviving & Thriving", tailored towards young US firefighters. "Surviving & Thriving" will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta 'usability' testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app's efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters' perceived "health cultures" scores (ratings of each fire station's/fire department's environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Eleni Bouziani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xin Yu (Maggie) Chen
- Harvard Faculty of Arts and Sciences, William James Hall, Cambridge, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Irene Lidoriki
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Ya-Chin Huang
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - José Francisco López-Gil
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Anne Katherine Gribble
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW, Australia
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP) [Consorcio Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health], Madrid, Spain
- Madrid Institute for Advanced Studies (IMDEA)-Food Institute, The Campus of International Excellence (CEI), The Spanish National Research Council (CSIC), The Autonomous University of Madrid (UAM), Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Yang LL, Guo C, Li GY, Gan KP, Luo JH. Mobile phone addiction and mental health: the roles of sleep quality and perceived social support. Front Psychol 2023; 14:1265400. [PMID: 37809316 PMCID: PMC10556235 DOI: 10.3389/fpsyg.2023.1265400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
As a global phenomenon, mobile phone addiction has become an increasingly common issue among Chinese university students. Although previous research explored the link between mobile phone addiction and mental health, the possible mechanism underlying the above association is unclear. We administered a cross-sectional survey to 585 participants from two universities in Kunming, southwest China, from October 2021 to January 2022. Our results suggested that mobile phone addiction was negatively associated with mental health, and sleep quality partially mediated the relationship between mobile phone addiction and mental health. Furthermore, perceived social support positively moderated the direct effect of sleep quality on mental health, as well as the indirect effect of mobile phone addiction on mental health. These findings provide a new insight into the underlying mechanism by which mobile phone addiction affects university students' mental health. The results emphasize a necessary task for administrators, health workers, and family members to attach importance to the overuse of mobile phones among university students.
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Affiliation(s)
- Lin-Lin Yang
- School of Law and Political Science, Yunnan University of Finance and Economics, Kunming, Yunnan, China
| | - Chen Guo
- School of Law and Political Science, Yunnan University of Finance and Economics, Kunming, Yunnan, China
| | - Geng-Yin Li
- School of Law and Political Science, Yunnan University of Finance and Economics, Kunming, Yunnan, China
| | - Kai-Peng Gan
- School of Law and Political Science, Yunnan University of Finance and Economics, Kunming, Yunnan, China
| | - Jin-Huan Luo
- School of Physics and Electronic Engineering, Yuxi Normal University, Yuxi, Yunnan, China
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Khoshakhlagh AH, Al Sulaie S, Yazdanirad S, Orr RM, Dehdarirad H, Milajerdi A. Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis. Heliyon 2023; 9:e13250. [PMID: 36798763 PMCID: PMC9925976 DOI: 10.1016/j.heliyon.2023.e13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
Lack of sleep can affect the health and performance of firefighters. This systematic review and meta-analysis estimated the global prevalence of sleep disorders and poor sleep quality among firefighters and reported associated factors. Four academic databases (Scopus, PubMed, Web of Science, and Embase) were systematically searched from January 1, 2000 to January 24, 2022. These databases were selected as they are known to index studies in this field. The search algorithm included two groups of keywords and all possible combinations of these words. The first group included keywords related to sleep and the second group keywords related to the firefighting profession. The relevant Joanna Briggs Institute checklist was used to evaluate study quality. Data from eligible studies were included in a meta-analysis. In total, 47 articles informed this review. The pooled prevalence of sleep disorders and poor sleep quality in firefighters were determined as 30.49% (95% CI [25.90, 35.06]) and 51.43% (95% CI [42.76, 60.10]), respectively. The results of a subgroup analysis showed that individuals in low- and middle-income countries (LMICs) had a higher prevalence of sleep disorders than those in high-income countries (HICs) but HICs had a higher prevalence of poor sleep quality than LMICs. Various factors, including shift work, mental health, injuries and pain, and body mass index were associated with sleep health. The findings of this review highlight the need for sleep health promotion programs in firefighters.
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Affiliation(s)
- Amir Hossein Khoshakhlagh
- Department of Occupational Health, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Saleh Al Sulaie
- Department of Industrial Engineering, College of Engineering in Al-Qunfudah, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Saeid Yazdanirad
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran,School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran,Corresponding author. Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Robin Marc Orr
- Tactical Research Unit, Bond University, Gold Coast, Australia
| | - Hossein Dehdarirad
- Medical Library & Information Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Milajerdi
- Research Center of Biochemistry and Nutrition in Metabolic Diseases, Institude for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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Zhang S, Jiang J, Hao L, Yu Y, Zhang Q, Meng H. What matters most? Network analysis of mental health, recovery experiences, sleep, and fatigue among career firefighters. Stress Health 2022. [PMID: 36538510 DOI: 10.1002/smi.3215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Firefighters exhibit a higher prevalence of mental health issues than other occupations because they often directly or indirectly experience potentially traumatic events. Previous research has suggested that recovery experiences, sleep, and fatigue may be protective or risk factors for firefighters' mental health. This study conducted regularised partial correlation network analysis to investigate and visualise the complex relationships between these variables. We collected data through an online survey, and 3144 career firefighters from a large east-coast city in China, were included in the analyses. The results of the network analysis showed that: (1) only relaxation and mastery experiences directly correlated with one dimension of the mental health scale, namely, life/social functioning; (2) sleep quality had stronger correlations with mental health issues than sleep quantity; and (3) mental health issues were central nodes of the network. These results indicated that firefighters' mental health was close to other variables in the network and acted as a bridge linking other variables. Therefore, more attention should be paid to the mental health of firefighters to prevent comorbidities. The study's results also indicated that recovery experiences and sleep may be protective factors for firefighters' mental health.
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Affiliation(s)
- Shu Zhang
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,Institute of Brain and Education Innovation, East China Normal University, Shanghai, China
| | - Junying Jiang
- Shanghai General Fire and Rescue Brigade, Shanghai, China
| | - Leilei Hao
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yu Yu
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Qi Zhang
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Hui Meng
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,Institute of Brain and Education Innovation, East China Normal University, Shanghai, China
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Kim M, Lee D, Kim W, Eun Lee J, Lee J, Tae Kim Y, Lee SK, Soo Oh S, Soo Park K, Baek Koh S, Kim C, Jung YC. Associations between altered functional connectivity of attentional networks and sleep quality among firefighters. Neurosci Lett 2022; 791:136924. [DOI: 10.1016/j.neulet.2022.136924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 10/31/2022]
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Huang G, Lee TY, Banda KJ, Pien LC, Jen HJ, Chen R, Liu D, Hsiao STS, Chou KR. Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis. J Glob Health 2022; 12:04092. [PMID: 36269052 PMCID: PMC9585923 DOI: 10.7189/jogh.12.04092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Shift work and irregular work schedules among first responders have been associated with physical and psychological problems such as sleep disorders. We conducted the first meta-analysis to explore and estimate the prevalence of sleep disorders among first responders for medical emergencies. Methods We searched four databases: Web of Science, Psych Info, CINAHL, and PubMed. The Generalized Linear Mixed model (GLMM) was used to estimate the prevalence estimates of sleep disorders in R software and the DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis was used to explore associated comorbidities for OSA and insomnia, presented as odds ratios (ORs) and confidence intervals (CIs). The Cochran's Q, τ2, and the statistics were used to assess heterogeneity and the moderator analysis was conducted to identify moderator variables. Results Twenty-eight studies with 100 080 first responders were included from the total of 1119 studies retrieved from the databases. The prevalence rates for sleep disorders were 31% (95% CI = 15%-53%) for shift work disorder (SWD), 30% (95% CI = 18%-46%) for obstructive sleep apnea (OSA), 28% (95% CI = 19%-39%) for insomnia, 28% (95% CI = 24%-33%) for excessive daytime sleepiness (EDS), 2% (95% CI = 1%-4%) for restless leg syndrome, and 1% (95% CI = 0%-5%) for narcolepsy. Anxiety (OR = 2.46; 95% CI = 1.99%-3.03%), cardiovascular disease (CVD) (OR = 2.03; 95% CI = 1.43-2.88), diabetes mellitus (DM) (OR = 1.93; 95% CI = 1.41-2.65), depression (OR = 1.89; 95% CI = 1.01-3.56), gastroesophageal reflux disease (GERD) (OR = 1.83; 95% CI = 150-2.22), and post-traumatic stress disorder (PTSD) (OR = 1.78; 95% CI = 1.33-2.39) were associated with OSA. Depression (OR = 9.74; 95% CI = 4.67-20.3), anxiety (OR = 9.22; 95% CI = 3.81-22.3), and PTSD (OR = 7.13; 95% CI = 6.27-8.10) were associated with insomnia. Age, gender, first responders, continent, study quality, study design, and assessment tool were significant moderator variables for OSA, insomnia, and EDS. Conclusions This meta-analysis found a substantially high prevalence of sleep disorders including SWD, OSA, insomnia, and EDS among first responders for medical emergencies. Early assessment and management of sleep disorders among first responders is necessary to promote good, quality sleep to help prevent anxiety, depression, CVD, DM, GERD, and PTSD.
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Affiliation(s)
- Garry Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Australasian College of Paramedicine, Australia.,Australian Institute of Project Management, Australia
| | - Tso-Ying Lee
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Superintendent Office, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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