Traditional Chinese-version reliability test of the Pieper-Zulkowski pressure ulcer knowledge: Psychometric and assessment.

This study was to translate the Pieper-Zulkowski pressure ulcer knowledge test (PZ-PUKT) into Traditional Chinese and evaluate its psychometric properties as well as identify the predictors of knowledge on pressure injury. The PZ-PUKT was translated into Traditional Chinese (TC-PZ-PUKT), and its content validity was evaluated. A total of 296 nurses participated in this study and completed the 72-item TC-PZ-PUKT online. The reliability of the TC-PZ-PUKT was analysed by evaluating its internal consistency and test-retest reliability. Hierarchical regression was used to determine factors associated with TC-PZ-PUKT scores. Content validity was achieved with a score of 0.986. Internal consistency was observed to be reliable, with a Cronbach's alpha of 0.858. The mean knowledge score on the TC-PZ-PUKT was 72.5%, with a 1-week test-retest reliability of r = 0.849. Education level, certification as a wound specialist and self-learning through reading articles, books or guidelines on pressure injury were significantly associated with TC-PZ-PUKT scores. The TC-PZ-PUKT is a valid and reliable tool. Education level, certification as a wound specialist and self-learning regarding pressure injury are related to knowledge of pressure injury.

Effects of Virtual Reality on Pain and Anxiety During Children's Circumcision: A Systematic Review and Meta-Analysis.

BACKGROUND: Circumcision-a common pediatric procedure-can cause significant pain and anxiety. Virtual reality has been proposed as a nonpharmacological intervention to alleviate these negative experiences. OBJECTIVE: This systematic review and meta-analysis was conducted to evaluate the effects of virtual reality interventions on pain and anxiety in children undergoing circumcision. METHODS: This study comprehensively searched PubMed, Embase, and Cochrane Library for articles published from database inception to October 2, 2023. Randomized controlled trials that investigated the effects of virtual reality interventions on pain and anxiety during circumcision in children were included. The Cochrane risk-of-bias tool was used to appraise the included studies. The primary outcomes were pain and anxiety scores. RESULTS: Three randomized controlled trials and four data sets involving a total of 224 children were included in our meta-analysis. Virtual reality interventions significantly reduced children's pain and anxiety scores. CONCLUSIONS: Virtual reality interventions are promising nonpharmacological strategies for alleviating children's pain and anxiety during circumcision. Pediatric healthcare professionals use virtual reality interventions to create a child-friendly and healthy healthcare environment.

Trajectories of sleep quality and depressive symptoms in women from pregnancy to 3 months postpartum: a prospective cohort study.

Sleep quality and depression during pregnancy often affect women's adaptation to motherhood and are linked with adverse maternal and neonatal outcomes. Using a prospective cohort study comprising 190 pregnant women in central Taiwan, we investigated the trajectories of sleep quality and depressive symptoms and their associated predictors in perinatal women from pregnancy to postpartum. Sleep and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index and the Edinburgh Postnatal Depression Scale, respectively, from mid-pregnancy to 3 months postpartum. We used group-based trajectory modelling and logistic regression modelling to analyse the data collected from the structured questionnaires. Pregnant women (50.5% primipara) with a mean (standard deviation) age of 32.3 (4.1) years were included. We identified three distinctive classes of sleep quality trajectories during the perinatal period: 'stable good' (18.4%), 'increasing poor' (48.9%), and 'stable poor' (32.6%). We further detected three stable trajectories of depressive symptoms: 'stable low' (36.3%), 'stable mild' (42.1%), and 'stable high' (21.6%). A significant association between sleep quality and depression trajectories was evident (p < 0.001). High fatigue symptoms and low social support predicted the high trajectories of poor sleep and depressive symptoms. Distinctive dynamic sleep quality and stable depression trajectories were characterised. Our findings revealed that both the sleep and depression trajectories were closely associated with one another, with common predictors of fatigue symptoms and social support. The early assessment of maternal sleep and depression status is important for identifying at-risk women and initiating interventions tailored to perinatal women to improve their sleep and mental health.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study.

BACKGROUND: Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults. METHODS: We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T). RESULTS: The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL. CONCLUSIONS: Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

Sleep and Its Disturbance in Parents of Children and Adolescents with Epilepsy: A Systematic Review and Meta-Analysis.

Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. This systematic review and meta-analysis was conducted to quantify pooled mean estimates of parental sleep variables and to determine the prevalence of sleep disturbances in parents of children and adolescents with epilepsy. Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Eleven observational studies examining parents of pediatric patients aged <18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were reviewed. Our results showed that the pooled nocturnal sleep duration was 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores compared to parents of healthy children (differences in means 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%). Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should proactively initiate screening for sleep disturbances in parents of children and adolescents with epilepsy and refer parents to a sleep specialist when necessary.

Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: A single-blind randomised controlled trial.

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

Health Literacy and Exercise to Treat Frailty in Community-Dwelling Older Adults: A National Survey Study.

Aging is a major challenge facing modern society and has attracted global attention. Studies have provided some initial evidence that health literacy plays a role in determining frailty; however, most of these studies have used small convenience samples of individuals recruited from geographically limited areas, thus limiting the generalizability of their findings. The present study explored the relationships among health literacy, exercise, and frailty in Taiwanese older adults by using the data of a national population-based survey. We retrieved data from the Taiwan Longitudinal Study on Aging, a population-based survey. We gathered the 2015 data on the age, sex, education level, marital status, exercise habits, and activities of daily living (ADLs) of each eligible respondent. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. Frailty was diagnosed according the Fried criteria. Our final sample consisted of 7702 community-dwelling older adults (3630 men and 4072 adults). Of these, 25.3% had low health literacy. The proportion of respondents who had two or more disabilities in terms of ADLs or instrumental ADLs was higher among the women (36.4% and 12.6%, respectively), and regular exercise was more common among the men (19.6%). Frailty was more prevalent among the women; the prevalence of frailty among the male and female respondents was 4.5% and 8.1%, respectively. High health literacy and regular exercise were protective factors for frailty. According to our results, poor health literacy is a risk factor for prefrailty and frailty, and regular exercise is significantly negatively associated with prefrailty and frailty. Additional studies are necessary to define practical strategies for reducing the risks of disability and death for older adults with low health literacy who do not exercise regularly, thereby improving their quality of life.

Sex-Influenced Risk Factors for Cognitive Impairment Among Community-Dwelling Older Adults.

The current study aimed to explore sex-influenced risk factors for cognitive impairment among community-dwelling older adults in Taiwan. This cross-sectional study was a secondary analysis using a population-based design. We accessed and analyzed data from the Taiwan Longitudinal Study on Aging survey of 2011. Participants were older adults aged ≥55 years living in non-indigenous townships. A total of 3,392 community-dwelling older adults were included. Results showed that the prevalence of cognitive impairment in females and males was 15.3% and 5.7%, respectively. Having a low educational level and being single (i.e., single, widowed, or divorced) were risk factors for cognitive impairment in both sexes. Males who had more than two chronic diseases had a higher risk of cognitive impairment. Self-reported hearing loss and depression increased risk of cognitive impairment in older females. Older age, lower educational level, and single marital status were associated with cognitive impairment among community-dwelling older adults in Taiwan. The effects of self-reported hearing loss, depression, and chronic disease on cognitive impairment were influenced by sex. [Journal of Gerontological Nursing, 48(6), 19-25.].

Effects of Acupressure on Anxiety: A Systematic Review and Meta-Analysis.

Objectives: The research aim was to perform a systematic review and meta-analysis evaluating the ability of acupressure to reduce anxiety. Design: Randomized controlled trials were obtained through a search of electronic medical databases (four in English and one in Chinese) from inception to October 5, 2020. Two authors searched the databases, evaluated studies' methodological quality, and performed data extraction independently. The final studies for analysis were identified after discussion with the third author. Results: We obtained 27 studies for our systematic review and meta-analysis. Eight studies had a low overall risk of bias, and 13 had some bias concerns with methodological quality. According to the results, acupressure significantly reduced patient anxiety (standardized mean difference = 1.152; 95% confidence interval: 0.847-1.459, p < 0.001), and the study heterogeneity was high (Q = 299.74, p < 0.001, I2 = 91.333%). Two studies reported acupressure-associated adverse events. We also performed a sensitivity analysis by omitting one outlier study, which had the largest effect size; however, high heterogeneity remained (I2 = 87.816%). A subgroup analysis revealed significant differences between participant types (Q = 46.573, p < 0.001), levels of methodological quality (Q = 6.228, p = 0.044), and massage equipment (Q = 4.642, p = 0.031). Conclusions: Our meta-analysis suggests that acupressure can alleviate anxiety. Acupressure was more effective for inpatients and preoperative patients when finger massage was applied. In individuals with anxiety and a stable hemodynamic status, acupressure could be a promising treatment option. However, the substantial heterogeneity across studies means that any inference from the results should be performed cautiously.

The Effect of Paternal Skin-to-Skin Care: A Systematic Review and Meta-analysis of Randomized Control Trials.

BACKGROUND: Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. PURPOSE: The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. RESULTS: Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 µg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 µg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. IMPLICATIONS FOR PRACTICE AND RESEARCH: P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.

Predicting exercise behaviors and intentions of Taiwanese urban high school students using the theory of planned behavior.

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

Impacts of tai chi exercise on functional fitness in community-dwelling older adults with mild degenerative knee osteoarthritis: a randomized controlled clinical trial.

BACKGROUND: Degenerative osteoarthritis (OA) often leads to pain and stiffness of the affected joints, which may affect the physical performance and decrease the quality of life of people with degenerative knee OA. Compared to traditional exercise, tai chi is a safe exercise with slow movements which can facilitate physical functioning and psychological well being, and might be suitable for improving the physical activities of older adults with knee OA. Therefore, this study investigated the impacts of tai chi exercise on the functional fitness of community-dwelling older adults with degenerative knee OA. METHODS: Sixty-eight community-dwelling older adults with knee OA were recruited from the local community to participate in this randomized controlled clinical trial. All subjects were randomly assigned to either an TCE group that practiced tai chi exercise (TCE) (n = 36) or a control group (CON) (n = 32) that received regular health education programs twice per week for 12 weeks. Outcome measurements were determined using functional fitness tests before and after the intervention, including a 30-s chair stand (number of repeats), 30-s arm-curl (number of repeats), 2-min step (number of steps), chair sit-and-reach (reaching distance, cm), back-scratch flexibility (distance between hands, cm), single-leg stand (time, s), functional reach (reaching distance, cm), 8-foot up-and-go (time, s), and 10-m walk tests (time, s). Pre-post comparisons of functional fitness were analyzed using the ANCOVA test with SPSS software version 18.0. RESULTS: Results revealed that participants' functional fitness in the TCE group had significantly higher adjusted mean post-tests scores than that in the CON group after the intervention, including the 8-foot up-and-go (s) (mean difference [MD]=-2.92 [-3.93, -1.91], p = 2.39*10- 7), 30-s arm curl (MD = 4.75 (2.76, 6.73), p = 1.11*10- 5), 2-min step (MD = 36.94 [23.53, 50.36], p = 7.08*10- 7), 30-s chair stand (MD = 4.66 [2.97, 6.36], p = 6.96*10- 7), functional-reach (MD = 5.86 [3.52, 8.20], p = 4.72*10- 6), single-leg stand with eyes closed (MD = 3.44 [1.92, 4.97], p = 2.74*10- 5), chair sit-and-reach (MD = 3.93 [1.72, 6.15], p = 0.001), and single-leg stand with eyes opened (MD = 17.07 [6.29, 27.85], p = 0.002), with large effect sizes (η²=0.14 ~ 0.34). CONCLUSIONS: Community-dwelling older adults with knee OA in the TCE group had better functional fitness performances after the 12-week tai chi intervention than those receiving only health education.

Effects of Parental Education on Screen Time, Sleep Disturbances, and Psychosocial Adaptation Among Asian Preschoolers: A Randomized Controlled Study.

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

Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study.

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

Effects of extracorporeal magnetic stimulation on urinary incontinence: A systematic review and meta-analysis.

AIMS: To examine the effectiveness of extracorporeal magnetic stimulation for treatment of stress urinary incontinence. DESIGN: Systematic review and meta-analysis. DATA RESOURCES: Four electronic databases from inception to 18 May 2019. REVIEW METHODS: Two authors independently performed the search, assessed the methodological quality, and extracted data. The final studies included in the analysis were selected after reaching consensus with the third author. RESULTS: A total of 20 studies were included in the systematic review and 12 of these in the meta-analysis. Quality assessment indicated that only 8 of 17 randomized controlled trials had low risk in overall risk of bias, whereas all controlled trials had serious risk of bias. The weighted mean effect size of magnetic stimulation on quality of life, number of leakages, pad test outcomes, and number of incontinence events was 1.045 (95% CI: 0.409-1.681), -0.411 (95% CI: 0.178-0.643), -0.290 (95% CI: 0.025-0.556), and -0.747 (95% CI: -1.122 to -0.372), respectively. Subgroup analysis revealed a significant difference in the type of quality of life measurement used. Sensitivity analyses revealed that a high degree of heterogeneity persisted even after omitting studies individually. CONCLUSIONS: Extracorporeal magnetic stimulation may be effective in treating urinary incontinence and improving quality of life without major safety concerns. However, because of a high degree of heterogeneity among studies, inferences from the results must be made with caution. IMPACT: We recommend that clinical nurses apply extracorporeal magnetic stimulation to treat stress urinary incontinence among female patients and encourage researchers to conduct further qualitative and quantitative studies to develop consistent content and dosage for the intervention. STUDY REGISTRATION: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.york.ac.uk/Prospero with the registration number #CRD42019138835).

Investigating missed care by nursing aides in Taiwanese long-term care facilities.

AIMS: (a) To identify the frequencies and reasons for missed care by nursing aides in long-term care facilities and (b) to clarify the correlation between missed care and the characteristics of nursing aides and facilities. BACKGROUND: Missed care by nursing aides in long-term care facilities affects the resident's quality of care and, therefore, requires attention. METHODS: A cross-sectional study was conducted, wherein 184 nursing aides and 80 registered nurses were recruited from 10 long-term care facilities. RESULTS: (a) The most frequently missed item of care by nursing aides was assistance with body cleaning (30.4%). (b) Among all participants, 90.2%, 89.8% and 64% indicated poor communication, labour shortages and material resource insufficiencies, respectively, as the reason for missed care. (c) Participants who perceived staff to be insufficient missed care tasks more frequently than those who perceived staff to be sufficient (p < .05). CONCLUSIONS: Missed handover and insufficient nursing aides on duty were identified as the primary reasons for missed care. IMPLICATIONS FOR NURSING MANAGEMENT: Handover as a nursing process should be improved to promote accuracy and continuity. Flexibility in human resources should be maintained to respond adequately to resident's emergencies, thereby ensuring effective completion of the job.

Effects of a parenting sexual education program for immigrant parents: A cluster randomized trial.

OBJECTIVES: The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents. METHODS: A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants' knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention. RESULTS: After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of <14.62, <110.27, and <41.5, respectively. CONCLUSIONS: An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents. PRACTICE IMPLICATIONS: In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Predicting Exercise Intentions and Behaviors of Taiwanese Children in a Longitudinal Sample.

PURPOSE: The primary purpose of this study was to investigate changes in exercise intentions and behaviors among children across time. Then, we investigated how determinants in the Theory of Planned Behavior (TPB) predicted exercise intentions and behaviors, and explored if demographic predictors contributed to predicting behaviors. DESIGN AND METHODS: A three-wave, 12-month longitudinal study was conducted. A proportional stratified random sampling method was adopted, and 1997 children from 11 elementary schools in Taipei City were recruited. Numbers of participants were 1074, 1064, and 995 at times 1, 2, and 3, respectively. RESULTS: Children's exercise intentions and behaviors significantly changed (both p < .05) during a 6-month interval. Attitudes, subjective norms, and perceived behavioral control (PBC) at time 1 could respectively explain 51.0% and 17.1% of the variance in time 1 and 2 intentions (F(3, 1068) = 372.20, F(3, 1059) = 73.92, both p < .001). PBC was the strongest predictor of the intention to exercise. Intentions were the immediate determinant of exercise behaviors. PBC not only indirectly affected exercise behaviors through intentions but also directly affected exercise behaviors. Gender and sports club participation directly affected children's exercise behaviors. CONCLUSIONS: The findings support the TPB model being suitable for use in longitudinal studies; its core constructs significantly predicted children's exercise intentions and behaviors. PRACTICE IMPLICATIONS: This study highlights that clinical practitioners and school nurses working with children can help youth engage in regular exercise by enhancing their intentions and perceived behavioral control, and cultivating positive attitudes and subjective norms when planning exercise intervention programs.

Effects of aromatherapy on sleep quality: A systematic review and meta-analysis.

PURPOSE: The objective of this study was to conduct a systematic review and meta-analysis to examine the effects of aromatherapy on sleep improvements. METHODS: A search of randomized controlled trials was conducted in four English and two Chinese medical electronic databases. Two authors independently performed the search, assessed the methodological quality, and extracted data. Then, final studies were selected after consensus with the third author. RESULTS: In total, 31 trials met the inclusion criteria, of which four had low risk, while the overall bias in 26 was uncertain in terms of methodological quality. The heterogeneity was high among the trials (Q = 341.544, p < 0.001, I2 = 91.216%). There was a significant effect of aromatherapy on sleep quality (Hedges's g = 1.103 (95% confidence interval: 0.813˜1.393, p < 0.001). There was a publication bias (Egger's regression intercept = 7.127, t = 3.055, p = 0.004 and Begg test, Kendall's tau with continuity correction, tau = 0.335 and Z = 2.651, p = 0.008). The subgroup analysis showed that there was a significant difference in the methodological quality among different studies (Q = 18.350, p <  0.001). Sensitivity analyses still revealed high heterogeneity after omitting one study at a time. CONCLUSIONS: The results showed that aromatherapy can be applied by clinical staff to effectively improve sleep quality. However, because there was a high degree of heterogeneity among studies, the inferences of the results need to be applied with caution.