Changes in family functioning among primary family caregivers of patients with schizophrenia.

INTRODUCTION: Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6-month post-discharge period. DESIGN: A prospective, longitudinal study was conducted. METHODS: A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1-, 3-, and 6-month intervals post-discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis. RESULTS: Approximately 59.6%-77.6% of primary family caregivers presented unhealthy family functioning during the 6-month post-discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively. CONCLUSION: This study highlights affiliate stigma and family empowerment as long-term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care. CLINICAL RELEVANCE: Family-centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge.

A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study.

BACKGROUND: The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread. OBJECTIVE: This study aims to understand people's intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform. METHODS: From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from "strongly disagree" (1 point) to "strongly agree" (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software. RESULTS: A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income

T Cells Infiltrating Diseased Liver Express Ligands for the NKG2D Stress Surveillance System.

NK cells, which are highly enriched in the liver, are potent regulators of antiviral T cells and immunopathology in persistent viral infection. We investigated the role of the NKG2D axis in T cell/NK cell interactions in hepatitis B. Activated and hepatitis B virus (HBV)-specific T cells, particularly the CD4 fraction, expressed NKG2D ligands (NKG2DL), which were not found on T cells from healthy controls (p < 0.001). NKG2DL-expressing T cells were strikingly enriched within HBV-infected livers compared with the periphery or to healthy livers (p < 0.001). NKG2D+NK cells were also increased and preferentially activated in the HBV-infected liver (p < 0.001), in direct proportion to the percentage of MICA/B-expressing CD4 T cells colocated within freshly isolated liver tissue (p < 0.001). This suggests that NKG2DL induced on T cells within a diseased organ can calibrate NKG2D-dependent activation of local NK cells; furthermore, NKG2D blockade could rescue HBV-specific and MICA/B-expressing T cells from HBV-infected livers. To our knowledge, this is the first ex vivo demonstration that non-virally infected human T cells can express NKG2DL, with implications for stress surveillance by the large number of NKG2D-expressing NK cells sequestered in the liver.

Translation and Psychometric Analysis of the Chinese Version of the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) in Taiwanese Preadolescents.

PURPOSE: This study aimed to translate and evaluate the psychometric properties of a Chinese version of the (DEBQ-C) among Taiwanese preadolescents. DESIGN AND METHODS: The DEBQ-C was translated into Mandarin Chinese (CDEBQ-C) using established translation and back-translation methods and reviewed by an expert panel for cultural equivalence. A convenience sample of 349 preadolescents was randomly split to conduct exploratory factor analysis (EFA) on the first half and confirmatory factor analysis (CFA) on the second. Internal consistency estimates for subscales were evaluated using Cronbach's alpha. Construct validation with academic stress, a theoretically related construct, was also examined. RESULTS: The theoretical dimensions of the original DEBQ-C were supported with an EFA that revealed the presence of three factors with 41.23% variance explained, and model fit was confirmed by CFA. Construct validation was supported by positive correlations with academic stress. Each subscale of the CDEBQ-C demonstrated satisfactory internal consistency (Cronbach's alpha = 0.72-0.86). Overweight/obese preadolescents scored significantly higher on restrained eating compared to other weight groups. CONCLUSIONS: The findings suggest that the CDEBQ-C is a psychometrically valid and reliable instrument for assessing overeating tendencies with Taiwanese preadolescents. Replication studies with greater diversity in age, ethnicity, and weight are needed to provide further evidence of construct validity for the CDEBQ-C. PRACTICE IMPLICATIONS: Clinicians and researchers can use the CDEBQ-C to assess or expand the knowledge of children's overeating. At-risk preadolescents can be identified at an early stage and effective and individualized intervention programs may be designed and facilitated.

Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

BACKGROUND: Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced "My health bank," a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR. OBJECTIVE: This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it. METHODS: This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 ("disagree strongly") to 5 ("Agree strongly"). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis. RESULTS: This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65.1%). They were still students (195 out of 350 participants, 56.6%), with a monthly income of less than NT $30,000 (230 of 350 participants, 65.7%), and living in the North Taiwan (236 of 350 participants, 67.4%), with a good self-identified health status (171 of 350 participants, 48.9%). After performing the importance-performance analysis, we found the following: (1) instead of complex functions, people just want to have a platform that can let them integrate and manage their medical visit, health examination, and life behavior records; (2) they do not care whether their PHR is shared with others; and (3) most of the participants think the system security design is not important, but they also do not feel satisfied with the current security design. CONCLUSIONS: Overall, the issues receiving the most user attention were the system functions, circulation, integrity, ease of use, and continuity of the PHRs, data security, and privacy protection.

Metadata Correction: Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

[This corrects the article DOI: .].

Progressive rear-view mirror for motorcycles.

In this work, we present the design and fabrication of a progressive rear-view mirror for motorcycles. In the context of physiological and physical background knowledge, we first analyze the geometric relationships among the profile of the mirror, the blind spot, the field of view, and the reflected image size. On the basis of Walker's eye model, the binocular disparity is further calculated according to the image size on each retina. We present the polynomial expansion that specifies our progressive mirror's profile, as well as the fused deposition modeling process for fabricating physical mirrors. Compared with a conventional aspheric or flat mirror, this progressive mirror can achieve a wider horizontal viewing angle and shows a more stable image, thus enhancing riding safety.

Biomedical Evaluation of Early Chronic Kidney Disease in the Air Force: Building a Predictive Model from the Taiwan Military Health Service.

OBJECTIVE: Chronic kidney disease (CKD) is one of the most common diseases worldwide. The increasing prevalence and incidence of CKD have contributed to the critical problem of high medical costs. Due to stressful environments, aircrew members may have a high risk of renal dysfunction. A better strategy to prevent CKD progression in Air Force personnel would be to diagnosis CKD at an early stage. Since few studies have been conducted in Taiwan to examine the long-term trends in early CKD in Air Force aircrew members, this study is highly important. We investigated the prevalence of CKD and established a predictive model of disease variation among aircrew members. MATERIALS AND METHODS: In this retrospective study, we included all subjects who had received physical examinations at a military hospital from 2004 to 2010 and who could be tracked for four years. The Abbreviated Modification of Diet in Renal Disease Formula (aMDRD) was used to estimate the glomerular filtration rate (GFR) and was combined with the National Kidney Foundation/ Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) to identify CKD patients. RESULTS: A total of 212 aircrew members were assessed. The results showed that the prevalence of CKD was 3.8%, 9.4%, 9.0%, and 9.4% in each of the four years. According to the logistic regression analysis, abnormal urobilinogen levels, ketones, and white blood cell (WBC) counts in urine and a positive urine occult blood test increased the risk of CKD. A positive urine occult blood test can be used to predict the future risk of CKD. Moreover, the generalized estimating equation (GEE) model showed that a greater risk of CKD with increased examination time, age and seniority had a negative effect. In conclusion, abnormal urobilinogen levels, ketones, and urine WBC counts in urine as well as a positive urine occult blood test might serve as independent predictors for CKD. CONCLUSION: In the future, we can focus not only on annual physical examinations but also on simple and accurate examinations, such as urine occult blood testing, to determine the risk of CKD and prevent its progression in our aircrew members.

Gene expression profiling of breast cancer survivability by pooled cDNA microarray analysis using logistic regression, artificial neural networks and decision trees.

BACKGROUND: Microarray technology can acquire information about thousands of genes simultaneously. We analyzed published breast cancer microarray databases to predict five-year recurrence and compared the performance of three data mining algorithms of artificial neural networks (ANN), decision trees (DT) and logistic regression (LR) and two composite models of DT-ANN and DT-LR. The collection of microarray datasets from the Gene Expression Omnibus, four breast cancer datasets were pooled for predicting five-year breast cancer relapse. After data compilation, 757 subjects, 5 clinical variables and 13,452 genetic variables were aggregated. The bootstrap method, Mann-Whitney U test and 20-fold cross-validation were performed to investigate candidate genes with 100 most-significant p-values. The predictive powers of DT, LR and ANN models were assessed using accuracy and the area under ROC curve. The associated genes were evaluated using Cox regression. RESULTS: The DT models exhibited the lowest predictive power and the poorest extrapolation when applied to the test samples. The ANN models displayed the best predictive power and showed the best extrapolation. The 21 most-associated genes, as determined by integration of each model, were analyzed using Cox regression with a 3.53-fold (95% CI: 2.24-5.58) increased risk of breast cancer five-year recurrence. CONCLUSIONS: The 21 selected genes can predict breast cancer recurrence. Among these genes, CCNB1, PLK1 and TOP2A are in the cell cycle G2/M DNA damage checkpoint pathway. Oncologists can offer the genetic information for patients when understanding the gene expression profiles on breast cancer recurrence.

Impaired natural killer cell phenotype and function in idiopathic and heritable pulmonary arterial hypertension.

BACKGROUND: Beyond their role as innate immune effectors, natural killer (NK) cells are emerging as important regulators of angiogenesis and vascular remodeling. Pulmonary arterial hypertension (PAH) is characterized by severe pulmonary vascular remodeling and has long been associated with immune dysfunction. Despite this association, a role for NK cells in disease pathology has not yet been described. METHODS AND RESULTS: Analysis of whole blood lymphocytes and isolated NK cells from PAH patients revealed an expansion of the functionally defective CD56(-)/CD16(+) NK subset that was not observed in patients with chronic thromboembolic pulmonary hypertension. NK cells from PAH patients also displayed decreased levels of the activating receptor NKp46 and the killer immunoglobulin-like receptors 2DL1/S1 and 3DL1, reduced secretion of the cytokine macrophage inflammatory protein-1ß, and a significant impairment in cytolytic function associated with decreased killer immunoglobulin-like receptor 3DL1 expression. Genotyping patients (n=222) and controls (n=191) for killer immunoglobulin-like receptor gene polymorphisms did not explain these observations. Rather, we show that NK cells from PAH patients exhibit increased responsiveness to transforming growth factor-ß, which specifically downregulates disease-associated killer immunoglobulin-like receptors. NK cell number and cytotoxicity were similarly decreased in the monocrotaline rat and chronic hypoxia mouse models of PAH, accompanied by reduced production of interferon-γ in NK cells from hypoxic mice. NK cells from PAH patients also produced elevated quantities of matrix metalloproteinase 9, consistent with a capacity to influence vascular remodeling. CONCLUSIONS: Our work is the first to identify an impairment of NK cells in PAH and suggests a novel and substantive role for innate immunity in the pathobiology of this disease.

HLA class I allelic sequence and conformation regulate leukocyte Ig-like receptor binding.

Leukocyte Ig-like receptors (LILRs) are a family of innate immune receptors predominantly expressed by myeloid cells that can alter the Ag presentation properties of macrophages and dendritic cells. Several LILRs bind HLA class I. Altered LILR recognition due to HLA allelic variation could be a contributing factor in disease. We comprehensively assessed LILR binding to >90 HLA class I alleles. The inhibitory receptors LILRB1 and LILRB2 varied in their level of binding to different HLA alleles, correlating in some cases with specific amino acid motifs. LILRB2 displayed the weakest binding to HLA-B*2705, an allele genetically associated with several autoimmune conditions and delayed progression of HIV infection. We also assessed the effect of HLA class I conformation on LILR binding. LILRB1 exclusively bound folded ß(2)-microglobulin-associated class I, whereas LILRB2 bound both folded and free H chain forms. In contrast, the activating receptor LILRA1 and the soluble LILRA3 protein displayed a preference for binding to HLA-C free H chain. To our knowledge, this is the first study to identify the ligand of LILRA3. These findings support the hypothesis that LILR-mediated detection of unfolded versus folded MHC modulates immune responses during infection or inflammation.

Systematic review and meta-analysis of nonpharmacological interventions for fatigue in children and adolescents with cancer.

BACKGROUND: Fatigue is one of the most distressing and prevalent symptoms reported by pediatric oncology patients. With the increase in cancer survival rates, medical teams have focused on methods that control cancer-related fatigue in children during the disease and its treatment in order to increase the quality of life for these patients. AIM: The objective of this systematic review was to synthesize the best available evidence concerning the effectiveness of nonpharmacological interventions for fatigue in children and adolescents with cancer. METHODS: The search strategy was designed to retrieve studies published between 1960 and 2010 in either English or Chinese. This review included randomized controlled trials and quasi-experimental studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments. RESULTS: The review included six studies, and the meta-analysis revealed a statistically significant effect of exercise interventions in reducing general fatigue (effect size = -0.76; 95% CI [-1.35, -0.17]) in children and adolescents with cancer. CONCLUSIONS AND IMPLICATIONS: The review provides an evidence-based guide to future priorities for clinical practice. Exercise interventions could reduce the levels of general fatigue in children aged 6-18 years. In particular, exercise interventions for fatigue are feasible and safe.

Developing the "Healthcare CEO App" for patients with type 1 diabetes transitioning from adolescence to young adulthood: A mixed-methods study.

AIM: To develop and test a mobile application that supports the disease self-management of adolescents with type 1 diabetes during their transition to early adulthood. DESIGN: A sequential mixed-methods design was employed. METHODS: The application content was designed according to previously identified care needs and expectations, followed by application development on the Android operating system. From the outpatient clinic of the Department of Paediatric Endocrinology and Metabolism at a medical centre in northern Taiwan, 35 individuals aged between 16-25 years participated in application testing. RESULTS: The overall median score of the QUIS was 4-5, most of the 25% quartile was 4-5, and all of the 75% quartile was 5, indicating adequate user interaction satisfaction.

Blockade of NKG2D ameliorates disease in mice with collagen-induced arthritis: a potential pathogenic role in chronic inflammatory arthritis.

OBJECTIVE: To assess the role of the activating receptor NKG2D in arthritis. METHODS: Levels of NKG2D and its ligands were determined by fluorescence-activated cell sorting, real-time polymerase chain reaction, and immunohistochemistry in rheumatoid arthritis (RA) synovial membrane tissue and in paw tissue from arthritic mice. Arthritis was induced in DBA/1 mice by immunization with type II collagen, and mice were treated intraperitoneally with a blocking anti-NKG2D antibody (CX5) on days 1, 5, and 8 after clinical onset and were monitored for 10 days. RESULTS: We demonstrated expression of NKG2D and its ligands on human RA synovial cells and extended this finding to the paws of arthritic mice. Expression of messenger RNA for the NKG2D ligand Rae-1 was up-regulated, and NKG2D was present predominantly on natural killer (NK) and CD4+ T cells, in arthritic paw cell isolates. NKG2D was down-modulated during the progression of collagen-induced arthritis (CIA). NKG2D expression in arthritic paws was demonstrated by immunohistochemistry. Blockade of NKG2D ameliorated established CIA, with significant reductions in clinical scores and paw swelling. Histologic analysis of arthritic joints from anti-NKG2D-treated mice demonstrated significant joint protection, compared with control mice. Moreover, anti-NKG2D treatment significantly reduced both interleukin-17 production from CD4+ T cells in arthritic paws and splenic NK cell cytotoxic effector functions in vivo and in vitro. CONCLUSION: Our findings indicate that blockade of NKG2D in a murine model and in human explants has beneficial therapeutic potential that merits further investigation in RA.

The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study.

BACKGROUND: Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. OBJECTIVE: The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. METHODS: We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test. RESULTS: A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=-3.551, P<.001 and Z=-3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=-2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=-3.643, P<.001). CONCLUSIONS: The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

Gender-Specific Determinants of eHealth Literacy: Results from an Adolescent Internet Behavior Survey in Taiwan.

Adolescents' Internet health information usage has rarely been investigated. Adolescents seek all kinds of information from the Internet, including health information, which affects their Health Literacy that eHealth Literacy (eHL). This study is a retrospective observational study, we have total of 500 questionnaires were distributed, 87% of which were recovered, and we explored the channels that adolescents use to search for health information, their ability to identify false information, and factors affecting the type and content of health information queried. Adolescents believe that the Internet is a good means to seek health information because of its instant accessibility, frequent updating, convenience, and lack of time limits. More boys use the Internet to seek health information than girls in junior high schools (p = 0.009). The Internet is an important source of health information for adolescents but contains extensive misinformation that adolescents cannot identify. Additionally, adolescent boys and girls are interested in different health issues. Therefore, the government should implement measures to minimize misinformation on the Internet and create a healthy, educational online environment to promote Adolescents' eHealth Literacy (eHL).

From Bench to Bedside: Clinical and Biomedical Investigations on Hepatitis C Virus (HCV) Genotypes and Risk Factors for Albuminuria.

An extrahepatic manifestation of nephropathies can be a feature of the chronic hepatitis C virus (HCV) infection. Albuminuria is a major risk factor for nephropathies and chronic kidney disease (CKD). The correlation between HCV genotypes and albuminuria is still unclear. In this study, investigations have been done for the biomedical tools and methodologies used in the National Health and Nutrition Examination Survey (NHANES) public database. We searched the 2007−2016 NHANES public database to retrieve data regarding the different HCV genotypes and clinical scenarios. This study attempted to investigate the impacts of HCV genetic diversity, associated comorbidities, and racial differences on albuminuria. The urine albumin/creatinine ratio (ACR) was the primary endpoint. Among 40,856 participants, 336 participants with positive and 237 with negative HCV RNA tests were analyzed, excluding 14,454 participants with negative HCV antibodies and 25,828 which were missed. After controlling for sex, race, education level, smoking, diabetes mellitus, hepatitis B, alcohol use, and body mass index (BMI) with a generalized linear equation, HCV genotype 2 was more likely than any other genotype to cause albuminuria based on the urine ACR (p < 0.001). The generalized linear equation also demonstrated a significantly higher urine ACR, including hepatitis B (p < 0.001), diabetes mellitus (p < 0.001), and smoking (p = 0.026). In summary, the patients with HCV genotype 2 presented with increased albuminuria in comparison with other HCV genotypes in this 10-year retrospective analysis. HCV infection could be a risk factor of CKD; early diagnosis and appropriate treatment may improve clinical outcomes.

Effects of a home-based aerobic exercise programme in children with type 1 diabetes mellitus.

AIMS: To explore the effects of exercise programme on glycosylated haemoglobin and peak oxygen uptake in children and adolescents with type 1 diabetes mellitus. BACKGROUND: Regular exercise has been shown to be effective in blood glucose control, which includes improving glucose tolerance and insulin sensitivity, decreasing glycosylated haemoglobin levels and improving cardiorespiratory fitness. DESIGN: Quasi-experimental design with a twelve-week home-based aerobic exercise programme. METHOD: Twenty-eight participants completed the study: 12 in the home-based exercise group, 11 in the non-exercise control group and five in the self-directed exercise group. A mixed model was used to capture longitudinal change in glycosylated haemoglobin levels. RESULTS: The home-based aerobic exercise group showed no significant effect on glycemic control and peak oxygen uptake in this study across assessment times. However, a group difference in glycosylated haemoglobin levels at the nine-month follow-up was significant (general linear model: F = 4.06, p = 0.03). A Bonferroni test indicated that glycosylated haemoglobin levels in the home-based exercise group were higher than in the self-directed exercise group (p < 0.05) and higher in the control group than in the self-directed exercise group (p < 0.05) at the nine-month follow-up. Home-based aerobic exercise showed no significant effect on peak oxygen uptake in this study. CONCLUSIONS: A three-month home-based aerobic exercise programme has no significant effect on glycosylated haemoglobin and peak oxygen uptake levels in children with type 1 diabetes mellitus. RELEVANCE TO CLINICAL PRACTICE: Our exercise programme has designed that children can practice exercise at home and is a viable component of self-care intervention to improve patient's self-care skill and diabetes care control. However, how to encourage patients to adhere the exercise programme is a challenge for health care providers.

The Mediating Effects of Nursing Professional Commitment on the Relationship between Social Support, Resilience, and Intention to Stay among Newly Graduated Male Nurses: A Cross-Sectional Questionnaire Survey.

The current shortage of nurses is an important global issue. Most male nurses leave nursing within four years of starting their nursing career. It is crucial to understand the influencing factors on newly graduated male nurses staying in nursing. Previous studies on intentions to stay as nurses were seldom based on theory and failed to consider the differences between genders. Based on the Job Demands-Resources (JD-R) model, this study tested the model that social support, resilience, and nursing professional commitment influence the intention to stay and the mediating effect of nursing professional commitment in the above relationship. This cross-sectional study adopted purposive and snowball sampling methods. Data were collected using online questionnaire, and 272 newly graduated male nurses completed it. The hypothetical model had a good fit with the data. Nursing professional commitment had a complete mediating effect between social support and intention to stay and between resilience and intention to stay. Nursing professional commitment was highly positively correlated to intention to stay. It is suggested that future research and practice should enhance male nurses' professional commitment to increase their intention to stay. The findings can serve as reference for developing newly graduated male nurse retention programs.

A Delphi Study on the Healthcare Needs of Patients with Type 1 Diabetes during the Transition from Adolescence to Adulthood: Consensus among Patients, Primary Caregivers, and Healthcare Providers.

Patients with type 1 diabetes mellitus at the age of 16-25 face the challenges of the deterioration of disease control and accelerated exacerbation. Providing interventions that meet patient's healthcare needs can reduce the impact and improve health outcome. The purpose of this study was to identify the healthcare needs of patients with type 1 diabetes during the adolescence to adulthood transition period from the perspectives of patients, parents and healthcare providers. A two-round Delphi study was conducted among 48 participants, and included 17 patients, 16 primary caregivers, and 15 healthcare providers. The central tendency and dispersion were computed to establish a consensus. Seventy-one healthcare needs were identified across five dimensions-technology, external support, internal support, management, and healthcare-and 56 were considered as important healthcare needs and with a moderate to high level of agreement. Meanwhile, patients, primary caregivers, and healthcare providers were found to display significantly different opinions (p < 0.05) for 23 healthcare needs. This study concluded the consensus of the healthcare needs of patients with type 1 diabetes mellitus during the adolescence to adulthood transition period from a systematic investigation. The findings can serve as reference for developing transitional intervention strategies.