The effectiveness of a transtheoretical model-based smoking cessation intervention for rural smokers: A quasi-experimental longitudinal study

OBJECTIVE

Cigarette smoking is highly prevalent, despite being a primary preventable cause of disease and mortality. This study examined the effect of a Transtheoretical Model (TTM)-based psychoeducational intervention for smoking cessation (SC) on knowledge, SC-related parameters, and progression through the TTM stages of change among rural smokers.

METHODS

This quasi-experimental study recruited 200 smokers from an outpatient clinic. The comparison group was recruited before the experimental group to address possible self-selection bias. Structured questionnaires were administered pre- and post-intervention (three months) and at follow-up (six months).

RESULTS

A generalised estimation equation model indicated that the TTM-based intervention significantly increased participants' SC-knowledge and improved progression through TTM stages by the six-month follow-up. No significant group differences were found in self-efficacy and nicotine dependence scores or daily cigarette consumption.

CONCLUSIONS

A TTM-based intervention enhances SC-knowledge and fosters progress through change stages. However, it does not directly impact nicotine dependence or cigarette consumption. Outpatient settings may employ TTM-based programmes for SC education and motivation. Detecting anticipated effects may require a longer intervention duration exceeding six months.

PRACTICE IMPLICATIONS

Such TTM-based programmes may facilitate SC-knowledge and motivation in outpatient settings. Further research to comprehend patients' context and experiences during the stages of change is required.

Effects of internet-based digital health interventions on the physical activity and quality of life of colorectal cancer survivors: a systematic review and meta-analysis

PURPOSE

The recent trend of Internet-based digital health interventions has driven researchers to implement them to promote physical activity (PA) and improve patients' health outcomes. This systematic review and meta-analysis aim to evaluate the effects of Internet-based digital health interventions on PA and quality of life (QoL) in colorectal cancer (CRC) survivors.

METHODS

We searched for relevant studies investigating the effects of internet-based digital health interventions published until Dec. 2022 in electronic databases (PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and CEPS) according to PRISMA guidelines. The Joanna Briggs Institute critical appraisal checklist was used to examine the quality of the included studies. We performed the fixed and random effects model for meta-analysis.

RESULTS

Among 746 identified studies, eight published between 2018 and 2022 were included. These covered 991 internet-based digital health interventions and 875 controls. After 6 months of internet-based digital health interventions, CRC survivors' performance in PA (standardized mean difference (SMD) = 0.23, 95% confidence interval [CI] = 0.09-0.38) and QoL (SMD = 0.11, 95% CI = 0.01-0.22) indicators improved significantly.

CONCLUSIONS

Internet-based digital health improved the PA behaviour and QoL of patients with CRC. Because of differences in intervention outcomes, additional randomized controlled trials are warranted to provide suggestions for clinical practice. Internet-based digital health interventions are promising for promoting PA in CRC survivors.

Exposure to incense burning, biomarkers, and the physical health of temple workers in Taiwan

Incense burning releases heavy particulate matter (PM) and nitrogen dioxide (NO2), known to have adverse effects on human health. Long-term exposure to PM and NO2 increases inflammatory cytokine levels and can induce respiratory diseases. This study examined the association between incense burning exposure and the health status, especially inflammatory biomarkers, of temple workers and volunteers in Taiwan. The longitudinal observational study compared adult temple workers and volunteers, with long-term incense burning exposure, to residents from outpatient clinics in the Chiayi area. Forced expiratory volume in 1 s (FEV1) and serum and exhaled breath condensate (EBC) cytokines were assessed. Nonparametric Mann-Whitney U tests were used to compare cytokine levels of the exposure and control groups during the cold and hot weather seasons. FEV1 was significantly more diminished in the exposed group than in the control group during the cold season. Exposure status was associated with greater hot-cold seasonal differences in serum interleukins (IL)-1β (regression coefficient (B) = 6.6, 95% confidence interval (CI) = 5.0 to 8.3, p < .001), IL17-A (B = 2.4, 95% CI = 0.3 to 4.5, p = .03), and plasminogen activator inhibitor [PAI]-1 (B = 5.4, 95% CI = 1.5 to 9.3, p = .009). After adjusting for confounders, the groups' serum levels of IL-1β, IL-17A, and PAI-1 significantly differed. EBC cytokines did not show significant differences. Elevated levels of IL-1β, IL17-A, and PAI-1 have been associated with various autoinflammatory syndromes and diseases. Given the cultural significance of incense burning, culturally sensitive interventions, including education, policy development, and program implementation, are crucial to protect individuals' health, especially temple workers, from the adverse effects of exposure, addressing the manufacture, importation, and sale of incense.

The Associations of Body Mass Index, Body Image, Perceived Stress, and Mental Health among Female Nursing Students: A Cross-Sectional Study in Taiwan

Maintaining a healthy caloric intake and expenditure balance is challenging. The preliminary study examined (a) the associations of Body Mass Index (BMI), body image, perceived stress, mental health, dietary habits, and exercise participation among 310 female college nursing students and (b) the differences in these factors among BMI subgroups. The cutoffs for underweight, normal weight, overweight, and obesity were <18.5 kg/m2, ≥18.5 but <23 kg/m2, ≥23 but <25 kg/m2, and ≥25 kg/m2, respectively. The survey used Multidimensional Body-Self Relations Questionnaire-Appearance Scale, Perceived Stress Scale, and Chinese Health Questionnaire (CHQ). Because of a non-normal distribution, non-parametric statistics were used. The study found that BMI correlated with body image. The lower the BMI, the higher the satisfactory score the participants rated. BMI was irrelated to diet, exercise, stress, and mental health. The participants were unlikely to eat under stress and negative moods. The underweight group (17.1%) had the highest satisfactory score on their appearance evaluation. There was no difference between the overweight (14.2%) and obese (11.0%) groups. Meanwhile, the median of perceived stress was 18 and the prevalence of mental disturbance was 45.2% based on the CHQ. Underweight, overweight, obesity, high perceived stress, and poor mental health among nursing students warrant attention. Nurse educators should strengthen their coping strategies and provide support. A longitudinal study may consider incorporating coping strategies into the study design.

The effect of a multidimensional teaching strategy on the self-efficacy and critical thinking dispositions of nursing students: A quasi-experimental study

BACKGROUND

Internships in pediatric nursing often reveal that nursing students lack critical thinking dispositions and self-confidence, which are important and necessary for nursing practice. Therefore, preparing nursing students to engage in critical thinking is an important goal for educators.

OBJECTIVES

The purpose of this study was to explore whether a teaching model combining the 5E learning model and self-efficacy would be effective in enhancing participants' self-efficacy and critical thinking dispositions in a course on child-friendly care.

DESIGN

The quasi-experimental method was single-blind, as the study was conducted with two parallel and unequal groups to address the research questions.

SETTING

Two campuses of a university located in Northern and Southern Taiwan.

PARTICIPANTS

Fifty-eight participants completed this study.

METHODS

Participants completed the pre-test questionnaire in Week 1, after which participants in the experimental group learned via the teaching strategy that combined the 5E learning model and self-efficacy, while participants in the control group were taught the same course via conventional teaching methods. A post-test questionnaire was completed in Week 18. An independent sample t-test was used to determine any mean differences of outcome variables between groups over time.

RESULTS

Significant improvements were found in self-efficacy, t (56) = 3.93, p < 0.01, but non-significant results for the outcome of critical thinking disposition t (56) = 0.88, p > 0.05. A t-test was also performed on the four subscales of critical thinking disposition for the two groups, showing that the only difference for overall reflective thinking was statistically significant, t (56) = 2.09, p < 0.05).

CONCLUSIONS

The multidimensional teaching strategy introduced in this study is more effective than conventional teaching strategies in improving students' self-efficacy and the overall reflective thinking aspect of critical thinking disposition.

Effectiveness of Smoking Prevention Programs on the Knowledge, Attitudes, and Anti-Smoking Exposure Self-Efficacy among Non-Smoking Rural Seventh-Grade Students in Taiwan

The disproportionate smoking prevalence among adolescents in rural Taiwan may be attributed to insufficient anti-smoking education. Increasing access to such education may help reduce initiation and promote smoking cessation in adolescents, particularly in rural areas. However, effects of these programs require verification. This study determined the effectiveness of a school-based prevention program in enhancing knowledge, attitudes, and anti-smoking exposure self-efficacy among seventh-grade non-smoking students. A quasi-experimental design with convenience sampling was employed, where participants included seventh graders from two junior high schools who completed a questionnaire 1−2 weeks before and after the intervention. Furthermore, the intervention group received four smoking and secondhand smoke (SHS) prevention classes, whereas the control group engaged in scheduled school activities. Knowledge on smoking (B = 4.38, p < 0.001) and SHS (B = 2.35, p < 0.001) were significantly greater in the intervention group. Moreover, the groups differed significantly in avoiding SHS exposure (B = 3.03, p = 0.031). Intervention modifications may be necessary to enhance the program’s effect on smoking exposure-related attitudes and self-efficacy. Additionally, cultural and other aspects (or “urban-rural gap”) might influence these results. Future randomized controlled trials should compare urban to rural adolescents, use longitudinal designs, and assess smoking initiation or cessation.

Effect of buttonhole cannulation versus rope-ladder cannulation in hemodialysis patients with vascular access: A systematic review and meta-analysis of randomized/clinical controlled trials

BACKGROUND

Safe and effective arteriovenous fistula (AVF) puncture techniques must be used to reduce harm to hemodialysis patients. The relative benefits of buttonhole (BH) cannulation over those of rope ladder (RL) cannulation for AVF remain unclear and inconsistent.

METHODS

This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature searches were conducted in June 2020 in multiple scientific databases including Cochrane library, CINAHL, PubMed/ Medline, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, Google scholar, Embase, and ProQuest. We included all randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that explored the efficacy of BH cannulation in hemodialysis patients. These included reports published in either English or Chinese that enrolled adults aged 18 years or older who underwent hemodialysis using an autogenous AVF. Studies that showed poor design, such as use of a self-control group or no control group, were excluded from analysis. The critical appraisal skills program checklist for RCTs were used to assess the quality of the evidence and RevMan software were used to perform the meta-analysis.

RESULTS

Fifteen studies (11 RCTs and 4 CCTs) met the inclusion criteria and were used for the meta-analysis. Meta-analysis showed that BH cannulation significantly reduced aneurysm formation (RR = 0.18, 95% confidence interval [CI] [0.1, 0.32]), stenosis (RR = 0.44, 95% CI [0.25, 0.77]), thrombosis formation (RR = 0.4, 95% CI [0.2, 0.8]), and hematoma (RR = 0.63, 95% CI [0.40, 0.99]) and showed no differences in AVR infection (≦6 months, RR = 2.17, 95% CI [0.76, 6.23]; >6 months, RR = 2.7, 95% CI [0.92, 7.92]) compared to RL cannulation.

CONCLUSIONS

Given the benefits of BH, this meta-analysis found that BH cannulation should be recommended as a routine procedure for hemodialysis but that hospitals and hemodialysis clinics should strengthen staff knowledge and skills of BH cannulation to reduce the risk of AVF infection.

N-acetylcysteine alleviates fine particulate matter (PM2.5)-induced lung injury by attenuation of ROS-mediated recruitment of neutrophils and Ly6Chigh monocytes and lung inflammation

BACKGROUND

Exposure to particulate matter (PM) may contribute to lung inflammation and injury. The therapeutic effect of N-acetylcysteine (NAC), a well-known antioxidant, with regards to the prevention and treatment of fine PM (PM2.5)-induced lung injury is poorly understood. This study aimed to determine the effect of PM2.5 on the recruitment of neutrophils and Ly6C^high monocytes into lung alveoli and the production of proinflammatory proteins by stimulating the generation of reactive oxygen species (ROS), and to investigate the therapeutic effect of NAC on PM2.5-induced lung injury.

METHODS

C57BL/6 mice were exposed to a single administration of PM2.5 (200 μg/100 μl/mouse) or phosphate-buffered saline (control) via intratracheal instillation. The mice were injected intratracheally via a microsprayer aerosolizer with NAC (20 or 40 mg/kg) 1 h before PM2.5 instillation and 24 h after PM2.5 instillation. Total protein, VEGF, IL-6, and TNF-α in bronchoalveolar lavage fluid (BALF) were measured. Oxidative stress was evaluated by determining levels of malondialdehyde (MDA) and nitrite in BALF. Flow cytometric analysis was used to identify and quantify neutrophils and Ly6C^high and Ly6C_low monocyte subsets.

RESULTS

Neutrophil count, total protein, and VEGF content in BALF significantly increased after PM2.5 exposure and reached the highest level on day 2. Increased levels of TNF-alpha, IL-6, nitrite, and MDA in BALF were also noted. Flow cytometric analysis showed increased recruitment of neutrophils and Ly6C^high, but not Ly6C^low monocytes, into lung alveoli. Treatment with NAC via the intratracheal spray significantly attenuated the recruitment of neutrophils and Ly6C^high monocytes into lung alveoli in PM2.5-treated mice in a dose-dependent manner. Furthermore, NAC significantly attenuated the production of total protein, VEGF, nitrite, and MDA in the mice with PM2.5-induced lung injury in a dose-dependent manner.

CONCLUSION

PM2.5-induced lung injury caused by the generation of oxidative stress led to the recruitment of neutrophils and Ly6C^high monocytes, and production of inflammatory proteins. NAC treatment alleviated PM2.5-induced lung injury by attenuating the ROS-mediated recruitment of neutrophils and Ly6C^high monocytes and lung inflammation.

Analysis of COVID-19 rapid antigen and PCR detection policy

After the outbreak of COVID-19, Taiwan has implemented rigorous border control and taken specific measures such as virus detection, contact tracing, and quarantine since 2020. Its epidemic prevention performance has been quite outstanding. Even in May 2021, when the epidemic situation worsens, the people in Taiwan fully cooperate with the government’s control measures so as to successfully alleviate and control the epidemic in less than three months. Among them, the detection policy has played a pivotal role. We analyze and discuss the false positive and false negative problems from rapid antigen and PCR detection in the screening policy as well as the timing of using these two instruments. This paper provides theoretical verification of the appropriateness of screening policy in Taiwan, offering a few feasible suggestions for related policies in other countries or regions at different stages of this and other potential epidemics.

The Adverse Impact of Incense Smoke on Human Health: From Mechanisms to Implications

Incense burning is a very popular activity in daily life among many parts all over the world. A growing body of both epidemiological and experimental evidences has reported the negative effects of incense use on human well-being, posing a potential threat at public significance. This work is a comprehensive review that covers the latest findings regarding the adverse impact of incense smoke on our health, providing a panoramic visualization ranging from mechanisms to implications. The toxicities of incense smoke come directly from its harmful constituents and deposition capacity in the body. Besides, reactive oxygen species-driven oxidative stress and associated inflammation seem to be plausible underlying mechanisms, eliciting various unfavorable responses. Although our current knowledge remains many gaps, this issue still has some important implications.

A Profile of Novice and Senior Nurses' Communication Patterns during the Transition to Practice Period: An Application of the Roter Interaction Analysis System

Novice nurses' successful transition to practice is impacted by their interactions with senior nurses. Ensuring that novice nurses are adequately supported during their transition to practice has wide-ranging and significant implications. The aim of this study is to explore the communication patterns between novice and senior nurses by applying an interaction analysis technique. Trimonthly onboarding evaluations between novice and senior nurses were recorded. The Roter Interaction Analysis System was adapted and deployed to identify communication patterns. In total, twenty-two interactions were analyzed. Senior nurses spoke more (64.5%). Task-focused exchange was predominant amongst senior (79.7%) and novice (59.5%) nurses. Senior nurses' talk was concentrated in clusters of information-giving (45%) and advice or instructions (17.2%), while emotional expression (1.4%) and social talk (0.4%) were rare. Novice nurses' talk was concentrated in clusters-information giving (57%) and positive talk (39.5%). The communication patterns between senior and novice nurses during the onboarding period indicate aspects of novice nurse transition that could be addressed, such as encouraging novice nurses to use these interactions to communicate more, or emphasizing the importance of social talk. These insights can be used to inform mentorship and preceptorship training to ensure that senior nurses are able to adequately support novice nurses through all parts of the transition to practice period.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.

Contributions of burning incense on indoor air pollution levels and on the health status of patients with chronic obstructive pulmonary disease

Background

Among Buddhist or Taoist Taiwanese residents, burning incense is a common source of indoor particulate matter (PM), including PM₁₀ and PM_2.5, and can adversely affect the health status of patients with chronic obstructive pulmonary diseases (COPD). However, few studies have focused on the effects of intermittent burning of incense on PM concentration levels and the health status of patients with COPD. This correlational cohort study aimed to investigate the association between burning incense exposure duration, indoor air pollution levels, and lung function in patients with COPD in Taiwan.

Methods

We assessed 18 outpatients at seven time points with moderate-to-severe COPD using the COPD Assessment Test (CAT), and lung function tests. PM level changes were assessed at seven intervals using generalized estimating equations.

Results

Participants were primarily male (84%), with a mean age of 72.1 (standard deviation (SD)  ± 9.3) years, and with a mean COPD duration of 3.7 (SD  ± 3.1) years. Both PM₁₀ and PM_2.5 levels were the same as the background levels 1 h after incense burning. Burning incense may not influence lung function or symptom severity in patients with COPD in a short-time period. Air quality returned to baseline levels 1 h after burning incense.

Conclusion

Patients with COPD should avoid staying in rooms where incense is burnt, for up to 1 h. The small sample size and short study period may have influenced our results. Future longitudinal studies with larger sample sizes and long-term follow-ups are recommended.

Effects of Particulate Matter Education on Self-Care Knowledge Regarding Air Pollution, Symptom Changes, and Indoor Air Quality among Patients with Chronic Obstructive Pulmonary Disease

The burden of illness resulting from adverse environmental exposure is significant. Numerous studies have examined self-care behaviors among patients with chronic obstructive pulmonary disease (COPD), but seldom assess these behaviors in relation to air pollution. The study aims to examine the effects of particulate matter (PM) education on prevention and self-care knowledge regarding air pollution, symptom changes, and indoor PM concentration levels among patients with COPD. A longitudinal, quasi-experimental design using a generalized estimating equation examined the effectiveness of the education intervention. Participants were 63 patients with COPD, of whom only 25 received intervention. Levels of PM2.5 and PM10 decreased in the first-month follow-up in the experimental group. Improvement of knowledge and prevention regarding PM in the first and third months were also greater in the experimental group compared to the control. Regarding the COPD assessment test and physical domain scores, the experimental group exhibited a greater improvement in the first-month follow-up. Scores on the psychological domain significantly changed in the sixth-month follow-up. The PM education coordinated by nurses improved the health of participants, maintaining six-month effects. Further studies should evaluate the practice barriers and effects of health education on preventive self-care behaviors regarding indoor PM among patients with COPD.

Auricular acupressure for overweight and obese individuals: A systematic review and meta-analysis

BACKGROUND

Auricular acupressure has been used for treating obesity, but inconsistent outcomes have been reported. Moreover, systematic reviews and meta-analyses have seldom addressed the effects of auricular acupressure and duration of treatment in overweight/obese individuals. This study reviewed research articles on auricular acupressure for weight reduction, analyzed the related effects on obesity, and explored the relationships between weight reduction and treatment duration, as well as outcome variables.

METHODS

We searched PubMed, Cochrane Library, CINAHL, MEDLINE with Full Text, National Digital Library of Theses and Dissertation in Taiwan, and Airiti Library for articles up to July 4, 2018. Eight eligible trials were identified for qualitative synthesis, and one of them was excluded from quantitative synthesis. Inclusion criteria were as follows: intervention contained auricular acupressure, study subjects were overweight and/or obese, as defined by published authors, and the study design had 2 or more arms for comparison.

RESULTS

Pooled analysis of the 7 remaining studies revealed that auricular acupressure alone, or with diet and/or exercise, was effective for weight reduction, particularly for decreasing body weight (BW), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), body fat mass (BFM), and body fat percentage (BFP), compared with no treatment, sham treatment, or use of surgical tape with diet and/or exercise. However, there was no effect on hip circumference. A 12-week acupressure intervention was associated with a larger effect on lowering BW and BMI compared with 4-, 6-, and 8-week interventions. The methodologic quality of trials included in the quantitative synthesis ranged from scores 2 to 6 based on the modified Jadad scale. Additionally, this meta-analysis combined studies that used different acupoints and outcomes evaluated at different timepoints, which may have been potential sources of bias.

CONCLUSION

The study results indicate that auricular acupressure is effective for weight reduction. However, further vigorous studies that use double-blind randomized controlled design are needed to verify these findings. WC, WHR, BFP, or BFM should be used as obesity-related parameters in weight reduction studies to detect changes in fat, muscle, and skeletal weight.

Back massage intervention for improving health and sleep quality among intensive care unit patients

BACKGROUND

A massage may relax muscles, improve blood circulation and reduce pain and anxiety while also improving sleep quality by increasing comfort. However, there is little research on whether a back massage improves sleep quality in intensive care unit (ICU) patients.

AIMS AND OBJECTIVES

This study examined the effects of a back massage on improving vital signs, sleep quality, anxiety and depression among ICU patients.

DESIGN

Adopting a quasi-experimental design, convenience sampling was used to recruit ICU patients from a medical centre in Southern Taiwan. The experimental group received back massages for three consecutive days (n = 30), while controls received usual care (n = 30).

METHODS

The Verran and Snyder-Halpern Scale and the Hospital Anxiety and Depression Scale were used, and subjective and objective sleep time (wrist actigraphy and sleep duration from nurse observations) was recorded. The effect of the intervention was examined using a generalized estimating equation model with a robust standard error and an exchangeable working correlation matrix adjusting for time.

RESULTS

The results show that subjective sleep quality scores in ICU patients were low. Mean observed sleep time (measured by nurses) was 3·9 h, but mean sleep time measured using wrist actigraphy was 5·9 h. Back massages improved breathing in patients, increased sleep quality reflected by both subjective and objective data and were associated with a significant change in anxiety.

CONCLUSIONS

These findings suggest that a 10-min back massage can improve sleep quality, sleep duration, breathing and anxiety in ICU patients.

RELEVANCE TO CLINICAL PRACTICE

The implementation of a back massage shows positive improvements in the sleep quality of ICU patients. The training and theory of massage interventions should be further applied when developing courses in critical care nursing.

Generalist versus specialist nurses' knowledge, attitudes, and behavioral intentions toward promoting pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: A cross-sectional correlational study

Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. Data were collected by anonymous, self-administered questionnaires. We aimed to understand if there would be differences in the Chest Medicine and Generalist nurses on these outcomes, given the specialty versus generalist nature of their practice. Results were analyzed using multiple linear regressions.Although the 2 groups of nurses (ie, Chest Medicine, General Medicine) showed no differences in PR knowledge, attitudes, or behavioral intentions, they lacked sufficient PR knowledge and skills. The accuracy rate of PR knowledge was approximately 12% and self-evaluated PR skills were less than 50%. Self-efficacy in promoting PR was above average (ie, 57%-60%), and the strength of attitudes and behavioral intentions was over 70%. A multiple linear regression revealed that behavioral intentions of nurses working in the chest medicine ward were influenced by behavioral attitudes, and also PR skills and self-efficacy (explanatory power 33.3%).Attitudes, skills, and self-efficacy heavily affected pulmonary nurses' ability to promote PR; however, PR knowledge and skills remain low. Therefore, future implementation of practical PR training courses is needed to strengthen nurses' behavioral intentions toward PR promotion.Improved pulmonary rehabilitation-related skill, attitudes, clinical experience of PR programs, and/or practical PR training are needed among both generalist and specialist nurses. Education courses and clinical practice training should be increased in the future to promote pulmonary rehabilitation of COPD patients.

Information needs of patients with lung cancer from diagnosis until first treatment follow-up

The aim of this study was to analyze the information needs of lung cancer patients from diagnosis until first treatment follow-up. Sixty-nine participants with lung cancer were recruited from Ditmanson Medical Foundation Chia-Yi Christian Hospital in Midwest Taiwan. The Modified Toronto Informational Needs Questionnaire (TINQ) was used to assess information needs during visits to the outpatient oncology department. Generalized estimating equations were applied to compare changes in information needs over time and to examine correlates of information needs of lung cancer patients. The greatest concern of lung cancer patients was the cancer itself and access to recovery information. The need for information regarding food selection and social welfare resources was also high. However, the means of information needs for each domain significantly decreased over time. Demographic information (age, gender, disease stage, current treatment, education, work status, and having children) was significantly associated with information needs over time. The need for "disease-related information" remained high regardless of disease stage. Oncology nurses can use the results of this study to better address the information needs of patients in an effort to fill knowledge gaps between patients and healthcare providers. Further studies are needed to explore the use of an appropriate instrument, like that used in this study, to identify newly-diagnosed lung cancer patients' difficulties, concerns, and target interventions to improve their quality of life.

Illness Perception as a Predictor of Foot Care Behavior Among People With Type 2 Diabetes Mellitus in Indonesia

INTRODUCTION

Illness perception may contribute to foot care behavior because people with type 2 diabetes mellitus (T2DM) in Indonesia may have different beliefs that influence their foot care behaviors. This study aimed to determine the relationships among foot care knowledge, illness perception, local beliefs, and foot care behaviors in people with T2DM in Indonesia.

METHODS

Cross-sectional study with a convenience sampling technique was used to recruit 200 people with T2DM from the Outpatient Department of Islamic Hospital. The Foot Care Knowledge, Brief Illness Perception, Local Beliefs, and Foot Self-Care Behavior questionnaires were administered.

RESULTS

The predictors of foot care were having a family member or friend with diabetic foot ulcer ( p = .001), diabetes mellitus duration ( p = .026), foot care knowledge ( p < .001), consequences ( p < .001), treatment control ( p < .001), and local beliefs ( p = .017).

DISCUSSION

Health care providers may cultivate a spiritual approach, providing success stories to create positive images of the disease's outcomes and increase patients' confidence to control the disease.

Examining the Effects of Art Therapy on Reoccurring Tobacco Use in a Taiwanese Youth Population: A Mixed-Method Study

BACKGROUND

Cigarette smoking is a primary risk factor affecting mental and physical health worldwide. Many chronic diseases are closely related to smoking. Adolescents in Taiwan are increasingly using tobacco, especially in rural areas.

OBJECTIVES

This research project used a mixed-method study to examine the effects of art therapy on smoking cessation in rural Taiwanese youth smokers.

METHODS

Participants from years 10-11, were drawn from three senior high schools in Taiwan. The experimental group participated in a six-week smoking cessation intervention using art therapy. The comparison group participated in typical courses on smoking cessation. Quantitative measures included need for smoking, nicotine dependence, self-esteem, self-efficacy, and smoking cessation status. Qualitative analysis was based on phenomenology.

RESULTS

A total of 66 students (n = 40 experimental group; n = 26 comparison group) were the subjects of quantitative analysis. No differences were noted in baseline characteristics of groups. Generalized estimating equation analyses suggested significant between-group differences in change from pre- to follow-up test scores in the "social domain" (B = -5.12, p < 0.05). Qualitative data (n = 17 experimental group; n = 10 control group) suggested three domains: effects of art therapy on smoking prevention, benefits of art therapy on other outcome measures, and comparison between art therapy and traditional smoking cessation programs. Conclusions/importance: The findings of this study can potentially contribute significantly to existing knowledge regarding the perceptions of art therapy on reoccurring tobacco use in Taiwanese youth.

Seasonal variation and source apportionment of PM2.5-bound trace elements at a coastal area in southwestern Taiwan

The aim of this study is to investigate the seasonal variations and source apportionment on atmospheric fine particulate matter (PM_2.5) mass and associated trace element concentrations at a coastal area, in Chiayi County of southwestern Taiwan. Particle measurements were conducted in 2015. Twenty-three trace elements in PM_2.5 were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Multiple approaches of the enrichment factor (EF) analysis and positive matrix fraction (PMF) model were used to identify potential sources of PM_2.5-bound trace elements. Daily mean concentration of PM_2.5 in cold season (25.41 μg m^-3) was higher than that in hot season (13.10 μg m^-3). The trace elements contributed 11.02 and 10.74% in total PM_2.5 mass concentrations in cold season and hot season, respectively. The results of EF analysis confirmed that Sb, Mo, and Cd were the top three anthropogenic trace elements in the PM_2.5; furthermore, carcinogenic elements (Cr, Ni, and As) and other trace elements (Na, K, V, Cu, Zn, Sr, Sn, Ba, and Pb) were attributable to anthropogenic emissions in both cold and hot seasons; however, highly enriched Li and Mn were observed only in cold season. The PMF model identified four main sources: iron and steel industry, soil and road dust, coal combustion, and traffic-related emission. Each of these sources has an annual mean contribution of 8.2, 27.5, 11.2, and 53.1%, respectively, to PM_2.5. The relative dominance of each identified source varies with changing seasons. The highest contributions occurred in cold season for iron and steel industry (66.2%), in hot season for traffic-related emission (58.4%), soil and road dust (22.0%), and coal combustion (2.8%). These findings revealed that the PM_2.5 mass concentration, PM_2.5-bound trace element concentrations, and their contributions were various by seasons.

Waist-to-height ratio is a useful index for nonalcoholic fatty liver disease in children and adolescents: a secondary data analysis

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a global problem and pediatric obesity has risen dramatically. Early NAFLD might progress to nonalcoholic steatohepatitis (NASH) or liver cirrhosis and significantly increase liver disease-related mortality. We looked for NAFLD predictors in children and adolescents.

METHODS

This community-based, cross-sectional study ran from December 2012 to September 2013 in southwestern Taiwan. Children <10 and >19 years old, with detected hepatic diseases, or who drank alcohol were excluded. The diagnosis of NAFLD was based on ultrasound: age, sex, anthropometric measurements, and laboratory data were evaluated for associated risks by using logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine cutoff values.

RESULTS

We enrolled one thousand, two hundred and ten children (594 males; 616 females; mean age: 15.5 ± 2.8 years). Age, anthropometric measurements, and laboratory data were significantly higher in children with NAFLD. The association between NAFLD and the waist-to-height ratio (WHtR) was significant (adjusted odds ratio: 2.6; 95% confidence interval: 1.909-3.549; P < 0.001). It indicated highly suspicion of NAFLD (sensitivity: 70.1%; specificity 76.9%) when the WHtR for children and adolescents is above the cutoff value of 0.469.

CONCLUSIONS

The WHtR might be a powerful index of the severity of pediatric NAFLD.

Factors facilitating and hindering the intention to promote pulmonary rehabilitation for patients with COPD among respiratory therapists

Purpose

Pulmonary rehabilitation (PR) is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs) are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients’ knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB) to investigate both the behavioral intentions and the influential factors surrounding PR in RTs.

Patients and methods

This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs.

Results

The response rate after excluding respondents with incomplete data was 88.1% (n=379). A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the knowledge, attitudes, subjective norms, self-efficacy, and behavioral intentions components of total PR scores were 63.12%, 71.33%, 68.96%, 66.46%, and 80.29%. The factors significantly affecting RTs’ intentions to suggest PR participation to COPD patients or encourage it were attitudes, subjective norms, and self-efficacy. The total model explained 22.5% of the variance in behavioral intentions.

Conclusion

The results of the study suggest that RTs strongly intend to promote PR, but are hindered by insufficient knowledge, attitudes, and self-efficacy with regard to it. Applying TPB provided insight into which factors can be addressed, and by whom. For example, enhancing RTs’ self-efficacy can be achieved through PR training via school curricula, further regular continuing education and/or courses, and practical experience.

The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease: A randomised experimental study

AIMS AND OBJECTIVES

To investigate the effects of threshold inspiratory muscle training in patients with stages II through IV chronic obstructive pulmonary disease using maximum inspiratory pressure, baseline dyspnoea index, 6-minute walk test and quality of life.

BACKGROUND

A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training.

DESIGN

Randomised experimental design.

METHODS

A total of 55 patients completed this study between September 2013-April 2014. The experimental group (n = 27) was provided medical treatment and routine care, along with five sessions of threshold inspiratory muscle training per week (21-30 min per session), accompanied by a progressive increase in the pressure threshold over a period of 8 weeks. The control group (n = 28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values <.05 were considered to indicate statistical significance.

RESULTS

After 8 weeks in the experimental group, mean maximum inspiratory pressure improved by -17.6 ± 0.18 cmH₂ O, mean 6-minute walk test improved by 47.8 ± 1.46 m, and the baseline dyspnoea index increased from 4.48 ± 2.12 points to 9.0 ± 2.27 points. These data and quality of life were statistically different between the experimental and the control groups (p < .05).

CONCLUSIONS

The threshold inspiratory muscle training can reduce patients' difficulties with respect to daily activities, thereby reducing the burden on the family, and improving prognosis in patients with moderate-to-very severe chronic obstructive pulmonary disease.

Fine particulate matter on hospital admissions for acute exacerbation of chronic obstructive pulmonary disease in southwestern Taiwan during 2006-2012

This study explored the effects of PM_2.5 on hospital admissions (HAs) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in southwestern Taiwan. Data on HAs for AECOPD, pollutants, and meteorological variables were obtained from the National Health Insurance Research Database and Environmental Protection Administration. The relative risks (RRs) of HAs for AECOPD was estimated using the Quasi-Poisson generalized additive model. A total of 38,715 HAs for AECOPD were recorded. The average daily HAs for AECOPD and mean 24-h average level of PM_2.5 were 15.2 and 38.8 µg/m³, respectively. For both single and multiple pollutant (adjusted for O₃ and NO₂) models, increased AECOPD admissions were significantly associated with PM_2.5 during cold season, with the RRs for every 10 µg/m³ increase in PM_2.5 being 1.02 (95% CI = 1.007-1.040) at lag 0-1 in single-pollutant, and 1.02 (95 % CI = 1.001-1.042) at lag 0 day in multiple pollutant model. People 65 years of age and older had higher risk of HAs for AECOPD after PM_2.5 exposure. The RRs of PM_2.5 on HAs for AECOPD were robust after adjusting for O₃ and NO₂. Findings reveal an association between PM_2.5 and HAs for AECOPD in southwestern Taiwan, particularly during cold season.

Exposure to Indoor Particulate Matter Worsens the Symptoms and Acute Exacerbations in Chronic Obstructive Pulmonary Disease Patients of Southwestern Taiwan: A Pilot Study

Ambient particulate matter (PM) can trigger adverse reactions in the respiratory system, but less is known about the effect of indoor PM. In this longitudinal study, we investigated the relationships between indoor PM and clinical parameters in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Indoor air quality (PM_2.5 and PM₁₀ levels) was monitored in the patients’ bedroom, kitchen, living room, and front door at baseline and every two months for one year. At each home visit, the patients were asked to complete spirometry and questionnaire testing. Exacerbations were assessed by chart review and questionnaires during home visits. Generalized estimating equation (GEE) analysis (n = 83) showed that the level of wheezing was significantly higher in patients whose living room and kitchen had abnormal (higher than ambient air quality standards in Taiwan) PM_2.5 and PM₁₀ levels. Patients who lived in houses with abnormal outdoor PM_2.5 levels had higher COPD Assessment Test scores (physical domain), and those who lived in houses with abnormal PM₁₀ levels in the living room and kitchen had higher London Chest Activity of Daily Living scores. Increased PM levels were associated with worse respiratory symptoms and increased risk of exacerbation in patients with moderate to very severe COPD.

Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients

AIM

The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients.

BACKGROUND

The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before.

DESIGN

A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies.

DATA SOURCES

Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015.

REVIEW METHODS

This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies.

RESULTS

There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test.

CONCLUSIONS

This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.

Association between Atmospheric Fine Particulate Matter and Hospital Admissions for Chronic Obstructive Pulmonary Disease in Southwestern Taiwan: A Population-Based Study

Objectives: This paper reports on the findings of a population-based study to evaluate the relationship between atmospheric fine particulate matter (PM_2.5) levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in southwestern Taiwan over a three-year period, 2008–2010. Methods: Data on hospital admissions for COPD and PM_2.5 levels were obtained from the National Health Insurance Research database (NHIRD) and the Environmental Protection Administration from 2008 to 2010, respectively. The lag structure of relative risks (RRs) of hospital admissions for COPD was estimated using a Poisson regression model. Results: During the study period, the overall average hospitalization rate of COPD and mean 24-h average level of PM_2.5 was 0.18% and 39.37 μg/m³, respectively. There were seasonal variations in PM_2.5 concentrations in southwestern Taiwan, with higher PM_2.5 concentrations in both spring (average: 48.54 μg/m³) and winter (49.96 μg/m³) than in summer (25.89 μg/m³) and autumn (33.37 μg/m³). Increased COPD admissions were significantly associated with PM_2.5 in both spring (February–April) and winter (October–January), with the relative risks (RRs) for every 10 μg/m³ increase in PM_2.5 being 1.25 (95% CI = 1.22–1.27) and 1.24 (95% CI = 1.23–1.26), respectively, at a lag zero days (i.e., no lag days). Lag effects on COPD admissions were observed for PM_2.5, with the elevated RRs beginning at lag zero days and larger RRs estimates tending to occur at longer lags (up to six days, i.e., lag 0–5 days). Conclusions: In general, findings reveal an association between atmospheric fine particulate matter (PM_2.5) and hospital admissions for COPD in southwestern Taiwan, especially during both spring and winter seasons.

Impact of Apolipoprotein B on Hepatosteatosis in a Population Infected with Hepatitis C Virus: A Cross-Sectional Observational Study

OBJECTIVE

Non-alcoholic fatty liver disease (NAFLD) is an established risk factor for diabetes, cardiovascular disease, antiviral treatment resistance, and progression of chronic hepatitis C virus (HCV) infection to fibrosis. Apolipoprotein-B 100 (ApoB-100) is a dyslipidemia marker and steatosis predictor. We assess the correlation between ApoB-100 and hepatosteatosis.

METHODS

This cross-sectional study enrolled 1,218 HCV-seropositive participants from a 2012-2013 health checkup in Taiwan. NAFLD was detected using ultrasound. All anthropometric and laboratory studies that included ApoB-100 were evaluated whether or not ApoB-100 predicts NAFLD. Logistic regression was also used to examine the association between ApoB-100 and NAFLD.

RESULTS

Participants were 47.16 ± 16.08 years old (mean age). The overall prevalence of NAFLD was 35.8% (n = 436; 32.8% men, 38.1% women). Participants with ApoB-100 ≥ 8 had a significantly higher incidence of NAFLD (39.4 vs. 29.4%; 95% CI 0.044-0.156; p < 0.001). After confounding factors had been adjusted for, ApoB-100 was significantly associated with NAFLD (OR 5.45; 95% CI 1.64-18.06; p = 0.006) and high-grade hepatosteatosis (OR 7.73; 95% CI 1.74-34.35; p = 0.007).

CONCLUSION

ApoB-100 is strongly associated with NAFLD in people with non-genotype 3 HCV; greater ApoB-100 content is significantly correlated with higher-grade hepatosteatosis.

Trajectories and associated factors of quality of life, global outcome, and post-concussion symptoms in the first year following mild traumatic brain injury

PURPOSE

To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI).

METHODS

This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi County District Hospitals in Taiwan. The checklist of post-concussion syndromes (CPCS) was used to assess PCS at enrollment and at 1, 3, and 12 months after mTBI; the glasgow outcome scale extended (GOSE), the quality of life after brain injured (QOLIBRI), Chinese version, and the Short Form 36 Health Survey (SF-36), Taiwan version, were used to assess mTBI global outcome and QoL at 1, 3, and 12 months after mTBI.

RESULTS

Latent class growth models (LCGMs) indicated the change trajectories of QOLIBRI, PCS SF-36, MCS SF-36, GOSE, and PCS. Classes of trajectory were associated with age ≥40 years, unemployment at 1 month after injury, and educational level ≤12 years. Univariate analysis revealed that employment status at 1 month post-injury was correlated with the trajectories of QOLIBRI, PCS SF-36, MCS SF-36, and GOSE, but not PCS.

CONCLUSIONS

Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.

Self-efficacy in providing smoking-cessation services among psychiatric nurses in central and southern Taiwan: an exploratory study

Smoking by psychiatric patients remains prevalent. The purpose of this cross-sectional study was to understand the influence of self-efficacy and its correlates among psychiatric nurses when providing smoking-cessation services (SCS). A convenience sample of 193 nurses from psychiatric institutions was obtained. Surveys were conducted using self-report measures regarding SCS provided by psychiatric nurses. The survey questions focused on self-efficacy, attitude, practical experience, and smoke-free policies, and their implementation in the workplace. The participants reported low self-efficacy for providing SCS in their self-assessment, as demonstrated by their scores of 55.3 ± 20.4, on a scale of 0 (low confidence) to 100 (high confidence). Using multiple linear regressions, statistically-significant, relevant factors included perceived provider-related barriers in providing SCS, environmental tobacco smoke exposure, the nurse's attitude towards a patient smoking, and the nurse's frequency and practical experience in providing SCS. The correlates of this self-efficacy can serve as a reference for in-service curriculum planning of SCS by psychiatric nurses. In addition, policies to limit exposure to second-hand tobacco smoke should be explored.

Improving understanding of and adherence to pulmonary rehabilitation in patients with COPD: a qualitative inquiry of patient and health professional perspectives

OBJECTIVES

Although patients with Chronic Obstructive Pulmonary Disease (COPD) who adhere to a pulmonary rehabilitation program are better able to manage their illness and experience a better health-related quality of life, pulmonary rehabilitation remains underused. This study aims to describe the experiences of patients who are in a pulmonary rehabilitation program, and explore the perceptions of both patients and health professionals about what improves effective pulmonary rehabilitation.

METHODS

A qualitative research design, including focus groups and individual interviews with 25 patients and 7 program health professionals, was used to obtain combined perspectives about the factors underpinning the COPD patient's reasons for participation in a rehabilitation program.

RESULTS

Three themes were derived from the descriptive content analysis: (1) building confidence, (2) a perception of immediate tangible results, and (3) being ready and having access to the program.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Qualitative findings from this study suggest that a patient's adherence to a COPD rehabilitation program can be improved by quickly building up the participant's confidence, promoting tangible results, and by timely recognizing and responding to the issues of readiness and access. Based on these findings, health care providers could develop strategies to better serve COPD patients who face multiple barriers to access and successfully complete a pulmonary rehabilitation program.

[Validation of the Chinese-version Self-Efficacy in Smoking Cessation Service Scale (SE-SCS) for clinical psychiatric professionals]

BACKGROUND

Smoking cessation has been an important issue of concern for Taiwan's psychiatric nurses since promulgation of the Tobacco Hazards Prevention Act. However, Taiwan has lacked a qualified tool to evaluate the self-efficacy of nurses in providing smoking cessation services.

PURPOSE

The purpose of this study was to validate the Chinese version of the Self- Efficacy in Smoking Cessation Service Scale (SE-SCS).

METHODS

A back translation approach was used to develop the SE-SCS Chinese version. We enrolled 193 psychiatric nurses from two psychiatric centers in central and southern Taiwan to assess the reliability and validity of the Chinese version scale using internal consistency, test-retest, factor analysis, and concurrent criteria validity.

RESULTS

The reliability of the SE-SCS Chinese version was assessed as good (Cronbach's α = .85) and the Pearson correlation for total test-retest score was acceptable (r = .65, p = .004). Explanatory factor analysis revealed that one factor explained 63.4% of total variance. As to the criteria validity, frequency of smoking cessation service provision was the main criterion, with a correlation of 0.25-0.26. We identified a low, but significant correlation (p < .001).

CONCLUSION

The SE-SCS Chinese version appears to be a valid measure for assessing psychiatric nurse self-efficacy in providing smoking cessation services.

Alcohol, betel-nut and cigarette consumption are negatively associated with health promoting behaviors in Taiwan: a cross-sectional study

Background

Oral cancer is the 2^nd most common cause of death due to cancer in the south-western coastal region of Taiwan; the standardized mortality of oral cancer is higher than elsewhere in the world. According to the evidence, alcohol, betel-nut and cigarette (ABC) consumption cause oral, nasopharyngeal and related cancers. This study describes the relationships between ABC consumers and health promoting behaviors among community adults living around an area with a high prevalence of oral cancer.

Methods

A population-based, cross-sectional study design was conducted in oral cancer epidemic areas in south-western coastal Taiwan in 2010, 6,203 community residents over 20 years of age participated. Demographic data, ABC habits, and health-promoting behaviors were explored. A logistic regression analyses were used to identify factors associated with ABC consumers.

Results

A high percentage of participants consumed alcohol, betel-nut and cigarettes. Betel-nut and cigarette consumers took low levels of exercise, adopted a poor diet, and had poor oral hygiene. After adjusting for potential confounders, the logistic regression model indicated that middle aged males of poor education and low economic status, who did not exercise regularly and had poor oral hygiene, were more likely to chew betel quid and smoke cigarettes.

Conclusions

It has identified that BC consumers are negatively associated with health promoting behaviors. Further research is required to understand the reasons why the subjects consume ABC, and explore ways to prevent initiation and enhance cessation of ABC habits in this population.

Development and preliminary testing of a brief screening measure of healthy lifestyle for diabetes patients

OBJECTIVES

Improving diabetes control is a critical issue world-wide, because mortality rates and costs are increasing dramatically. Maintaining a healthy lifestyle is positively associated with diabetes control. However, the availability of practical screening tools suitable for determining and modifying healthy or unhealthy lifestyle choices is limited. The main aim of this study was to determine the appropriateness of the type 2 diabetes and health promotion scale (T2DHPS) for use in patients with type 2 diabetes.

METHODS

This study examined the Cronbach's alpha, content validity, construct and concurrent validity of the Chinese language version of the T2DHPS for assessing lifestyle and disease control among patients with type 2 diabetes. The dimensions of the T2DHPS were generated from the Chinese version of adult health promotion and interviews with experts, and were corroborated by the literature. A total of 323 patients previously diagnosed with type 2 diabetes were recruited. A cross-sectional, descriptive design questionnaire was developed and tested at diabetes outpatient departments in three teaching hospitals between August 2010 and June 2011. Construct validity was established using factor analysis. The total and subscale scores of the T2DHPS were correlated with biomarkers of diabetes control for concurrent validity.

RESULTS

Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity tests showed that the sample met the criteria required for factor analysis. A 28-item Likert-type scale of the T2DHPS was established, and explained 56.7% of the total variance. The simplified version of the T2DHPS was made up of six dimensions of behavior: physical activity, risk reduction, stress-management, enjoy life, health responsibility and a healthy diet. The reliability coefficient for the total scale was 0.89, and alpha coefficients for the subscales ranged from 0.63 to 0.86. Concurrent validity indicated that the T2DHPS is significantly positively associated with diabetes control.

CONCLUSIONS

T2DHPS was shown to be a reliable and valid tool for assessing patients with type 2 diabetes, and can possibly predict diabetic control. This scale appears to be a useful screening tool for type 2 diabetic people in primary health care settings, to promote health status through modification of an unhealthy lifestyle.

Misperception among rural diabetic residents: a cross-sectional descriptive study

AIMS

To evaluate the self-perception of diabetes control associated with physical indicators and with practicing exercise and a healthy diet, among rural residents.

BACKGROUND

It remains unclear whether a subject's self-perception of diabetes control increases its deleterious effects.

DESIGN

Cross-sectional, correlational.

METHODS

We recruited 715 participants from 18 primary healthcare centres in the rural regions of Chiayi County, Taiwan. Data were collected between 1 January 2009-30 June 2010. Logistic regression was conducted to identify the determinant factors associated with perceptions of diabetes control.

RESULTS

A high percentage of participants overestimated their fasting blood glucose and HbA1 C status. Total cholesterol, triglyceride, low density lipoprotein cholesterol, blood pressure, and waist circumference exceeded the medical standard in the 'feel good' group, and many did not adopt a healthy diet and undertake physical activity. The final logistic regression model demonstrated that residents with diabetes who exercised frequently had normal fasting glucose, and normal HbA1 C tended to perceive 'feel good' control.

CONCLUSION

Misperception and unawareness of diabetes control were prevalent among rural residents. Addressing misperceptions among rural residents with diabetes and increasing their knowledge of professional advice could be important steps in improving diabetes control in an elder population.

Stromal cell-derived factor-1/CXC receptor 4 and β1 integrin interaction regulates urokinase-type plasminogen activator expression in human colorectal cancer cells

The stromal cell-derived factor-1 (SDF-1)/CXC receptor 4 (CXCR4) axis has been shown to play a role in colorectal cancer progression. In addition, the protease urokinase-type plasminogen activator (uPA) is an important factor in tumor cell invasion and metastasis. However, the mechanism by which SDF-1 mediates uPA expression in human colorectal cancer cells remains unknown. We investigated the molecular mechanism governing the interaction between SDF-1 stimulation and uPA expression in three human colon cancer cell lines (DLD-1, SW48, and COLO 205). We found that SDF-1 stimulation led to an increase in the expression and secretion of uPA in these cells. Experiments involving specific inhibitors and small interfering RNA demonstrated that the activation of p38 mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K)/Akt pathways are critical for SDF-1-induced uPA expression. Analysis of transcription factor binding using ELISA and chromatin immunoprecipitation assays revealed that SDF-1 increased Sp1- and AP-1-DNA-binding activities in DLD-1 cells. Inhibition of Sp1 and AP-1 activation blocked the SDF-1-induced expression and activity of the uPA promoter. The effect of SDF-1 on DLD-1 signaling and uPA expression was mediated by the CXCR4/β1 integrin axis. In summary, our findings elucidate the mechanisms of SDF-1/CXCR4 downstream signaling and provide insights into the function of SDF-1 in colon cancer cells.

Baby oil therapy for uremic pruritus in haemodialysis patients

AIMS

The purpose of this study was to investigate the effectiveness of chilled/un-chilled baby oil therapy for treating uremic pruritus in haemodialysis patients.

BACKGROUND

Uremic pruritus affects 50-90% of haemodialysis patients, which makes it one of the most common medical problems in this population. Pruritus can cause skin infection, desquamation, pathological skin change, sleep disorder, anxiety, depression and social dysfunction.

DESIGN

A prospective, pretest-post-test quasi-experimental design was used.

METHODS

Haemodialysis patients with uremic pruritus were recruited and randomly assigned to one of three groups: experimental group 1 (chilled baby oil treatment; n = 30), experimental group 2 (un-chilled baby oil treatment; n = 31) and a control group (routine care only; n = 32). Participants in experimental group 1 and experimental group 2 were treated with chilled and un-chilled baby oil, respectively, for 15 minutes at least once daily for three weeks. The control group received no intervention other than standard care. Data collection included demographic data and itch severity. Medical records were also reviewed.

RESULTS

The baseline characteristics of subjects in this study were as follows: 59% were male, mean age was 61·88 (SD 12·7) years, mean duration of haemodialysis was 5·31 years, mean duration of uremic pruritus was 40·58 (SD 37·8) months and mean intensity of uremic pruritus was mild. The anti-pruritic effects were significantly larger in subjects treated with either chilled or un-chilled baby oil than in those who received routine care. Anti-pruritic effects did not significantly differ between experimental group 1 and experimental group 2.

CONCLUSIONS

The study confirmed that, for relieving pruritus in haemodialysis patients, either chilled or un-chilled baby oil is as effective as moisturising lotions and cooling soothing agents.

RELEVANCE TO CLINICAL PRACTICE

Applying baby oil is a simple, safe, inexpensive and easily administered treatment for itchy skin in haemodialysis patients. By preventing or reducing uremic pruritus, baby oil treatment may also improve quality of life in this patient group.

Decreased renal mRNA expression of TRPM6 is associated with hypomagnesemia in C57BL/6 asthmatic mice

BACKGROUND AND OBJECTIVES

Hypomagnesemia has been reported up to 40% in asthma patients, and a relationship between hypomagnesemia and asthma severity has been previously characterized. However, the mechanism for hypomagnesemia in asthma patients is not clear. Transient receptor potential melastatin 6 (TRPM6) is a newly identified channel that is involved in active epithelial magnesium transport, and downregulation of TRPM6 in the kidney was related to reduced Mg2+ reabsorption in mouse model. The aim of the study was to investigate whether plasma and erythrocyte magnesium levels were correlated with renal expression of TRPM6 mRNA in C57BL/6 asthmatic mice.

MATERIALS AND METHODS

48 healthy C57BL/6 mice were randomly divided into asthmatic group and control group with 24 mice in each group. Each group were randomly taken out 8 mice at 1d, 21d, 34d to detect plasma Mg2+, intracellular Mg2+ and renal TRPM6 mRNA expressions.

RESULTS

There were no significant difference in plasma Mg2+, intracellular Mg2+ and TRPM6 mRNA expression of renal tissues between asthmatic group and control group at 1d. However, plasma Mg2+ and intracellular Mg2+ as well as TRPM6 mRNA of renal tissues in asthmatic group were significantly lower than that of control group at 21d and at 34d. Both plasma Mg2+ and intracellular Mg2+ were positively correlated with TRPM6 mRNA expression in the renal tissues.

CONCLUSION

This study indicates that the consistently reduced expression of TRPM6 mRNA may play a role in the pathogenesis of hypomagnesemia in C57BL/6 asthmatic mice.

Correlates of smoking among adolescents with asthma

AIMS AND OBJECTIVE

This study examined the correlates of smoking among asthmatic adolescents to gain a better understanding of who is at particular risk.

BACKGROUND

Smoking is especially harmful to individuals with asthma. However, smoking is surprisingly prevalent among asthmatic individuals, with prevalence rates similar to or higher than those of the general adult or adolescent populations. Despite this notable finding, there has been little research about factors (i.e. biophysical, psychosocial and behavioural) influencing asthmatic adolescents' tobacco use patterns.

DESIGN

A Canadian provincial cross-sectional survey.

METHOD

The study about adolescents' tobacco use and health status was conducted in secondary schools in 2004, 608 asthmatic adolescents participated. Demographic factors, biophysical (body mass index and physical health), psychosocial factors (parents' and peers' smoking, environmental tobacco smoke exposure and depression) and behavioural factors (marijuana use, alcohol use and exercise frequency) were explored. Multinomial logistic regression analyses were conducted to identify risk factors associated with tobacco use.

RESULTS AND CONCLUSIONS

Of the 608 asthmatic adolescents, 17.4% currently smoked and 12.0% formerly smoked. Girls, compared with boys, were more likely to smoke (OR: 3.34, 95% CI: 1.62-6.96) after adjusting for differences in the other demographic, biophysical, psychosocial and behavioural factors. Asthmatic girls who had relatively higher body mass index, were in the higher school grades, used marijuana or alcohol, had minor to severe depressive symptoms, had environmental tobacco smoke exposure in their homes and had friends who smoked or were currently more likely to smoke. The former smokers had similar risk factors including higher body mass index, environmental tobacco smoke exposure at home, friends who smoked and marijuana use.

RELEVANCE TO CLINICAL PRACTICE

Despite their health condition, asthmatic adolescents continue currently or formerly to smoke. Gender appropriate prevention and cessation interventions for asthmatic adolescents may need to address important psychosocial and environmental factors that increase the risk of these adolescents initiating and maintaining tobacco use.

Do researcher-derived classifications of youths' smoking behavior correspond with youths' characterizations of their behavior?

AIMS

To describe the categories employed by researchers to describe adolescents' smoking behavior and to determine how these various categorizations compare with youths' self-defined smoking status.

STUDY SELECTION

A search of the PubMed and Science Direct databases, limited to articles in the English language, published between January 2002 and November 2007.

DATA EXTRACTION

Employing a mixed methods approach, several categories of youths' smoking status were obtained from a literature review and subsequently reproduced by using responses to detailed questionnaire items. Associations between the researcher-derived smoking categories (from the literature review) and the youths' self-reported smoking status, from survey data, were determined.

RESULTS

The categories of smoking status, from the literature review, varied in definition and in the number of categories. The associations between the literature-based categories and the youths' self-reported smoking status were modest.

CONCLUSIONS

Researcher-derived categories of youths' smoking status may not adequately encapsulate youths' perceptions of their own smoking behavior. There is a need to better describe adolescents' smoking behavior with special consideration of the ways in which adolescents characterize their own smoking behavior.

Light measurement in the hospital: A comparison of two methods

Disrupted sleep in hospitalized patients is widely reported, and ambient environmental lighting may be both a contributor to and a modifier of sleep/wake patterns. This is the first study to examine the congruence between two types of light meters, a wrist-worn device and a stand-alone device, and their respective light intensity measurements. The study sample included 20 light trials in 17 patients for a total of 480 paired light measurements. Descriptive data analysis indicated that both light meters dependably recorded changes in light levels, and Bland Altman plots demonstrated congruence between data from the two types of light meters. The results provide promising data on how to measure patient exposure to ambient light dependably in the continuously changing and unpredictable clinical setting.

Assessing nutritional status in chronically critically ill adult patients

BACKGROUND

Numerous methods are used to measure and assess nutritional status of chronically critically ill patients.

OBJECTIVES

To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation.

METHODS

A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients' nutritional intake compared with physicians' orders, dieticians' recommendations, and indirect calorimetry and physicians' orders compared with dieticians' recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined.

RESULTS

Inconsistencies among nurses' implementation, physicians' orders, and dieticians' recommendations resulted in wide variations in patients' calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%-200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001).

CONCLUSIONS

In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.

Assessing Nutritional Status in Chronically Critically Ill Adult Patients

• Background Numerous methods are used to measure and assess nutritional status of chronically critically ill patients.

• Objectives To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation.

• Methods A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients’ nutritional intake compared with physicians’ orders, dieticians’ recommendations, and indirect calorimetry and physicians’ orders compared with dieticians’ recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined.

• ResultsInconsistencies among nurses’ implementation, physicians’ orders, and dieticians’ recommendations resulted in wide variations in patients’ calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%–200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001).

• Conclusions In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.

[Coping behaviors of the elderly with positive physical examination results in Kaohsiung City]

The objectives of this study were as follows: first, to investigate the coping behaviors of the elderly facing the stress of disease after free physical examination; Second, to identify personal and disease characteristics, and the social support that influences coping behaviors in the elderly. The study sample consisted of 661 elderly patients who were found to have abnormal findings during a free physical examination provided by 11 regional health stations in Kaohsiung City. Data were collected with questionnaires through home interview. Four hundred and eighty-four subjects completed the questionnaires. Data were analyzed using SAS computer program. The major findings were as follows: 1.Problem-oriented coping behaviors were the more frequently used. The most frequently used coping behaviors were "accepting the situation as it is", "reling on myself to solve problems", "hoping that things would get better", "seeking professional help", and "letting things follow their natural cause". 2. The relative variables for problem-oriented coping were marital status, religion, medical insurance, educational level, disease characteristics, and social support. Sex, marital status, religion, medical insurance, perceived disease severity, characteristics of health problem, and newly found abnormality at this free physical examination were the relative variables for affective-oriented coping. 3. The best predictive variables for using problem-oriented coping behaviors were medical insurance, self-esteem support from family and friends, tangible support from health professionals, emotional support from health professionals, and whether it was the first time the patients knew their health problems. Findings from this study had implications for development of nursing care plans for elderly clients, as well as for collaborative team exploration of coping behaviors in the elderly.