Development and construction of the Multidimensional Self-Efficacy Scale for Epilepsy (MSESE) and its psychometric properties.

PURPOSE: It has become evident that patients with epilepsy require strong self-efficacy support in various domains, including work, social interaction, and academic performance, to ensure their complete social functioning. Nevertheless, previous studies have predominantly assessed the self-efficacy of individuals with epilepsy from a singular perspective of disease management. This study aimed to develop the Multidimensional Self-Efficacy Scale for Epilepsy (MSESE) to assess multiple dimensions and establish its psychometric properties. METHODS: We compiled a total of 25 questions for the initial version of the questionnaire based on a review of the literature and insights from experts, patients, and family members. The study included 180 adult patients with epilepsy who met the research criteria, with 126 of them serving as pre-test samples. All participants completed the MSESE, Brief Symptom Rating Scale-50 (BSRS-50), Rosenberg Self-Esteem Scale-Chinese version (RSES-C), and General Self-Efficacy Scale (GSES). RESULTS: The final scale consisted of 12 items across four dimensions, with item factor loadings ranging from .51 to .90. Most of the fit indices indicated a good fit. Construct validity was established through significant correlations with the BSRS-50, RSES-C, and GSES (r = -0.51 to 0.69, p < 0.01). Internal consistency coefficients for the MSESE were strong at .90, with individual dimensions ranging from 0.71 to 0.89. The MSESE also demonstrated a satisfactory test-retest reliability of 0.72. CONCLUSIONS: The MSESE is a convenient, multidimensional, and easy-to-use scale with good psychometric properties, making it suitable for both clinical assessments and research purposes.

Health Behavior Models and Regular Exercise Levels Among Workers in Taiwan.

Purpose: The present study aims to examine the disparate effects of health behavior models, namely exercise self-efficacy (ESE), health belief model (HBM), and planned behavior theory (PBT), applied to clarify the degree of regular exercise among workers in Taiwan. Methods: A cross-sectional research design was adopted. A questionnaire was distributed to obtain information pertaining to regular exercise level, demographic characteristics, and the scores of ESE, HBM, and PBT. In total, 400 full-time workers voluntarily participated in this study. Results: The results showed that only 20.5% of the participants exercised regularly, 37.3% exercised irregularly, and 42.3% did not exercise currently. "Perceived benefits" and "perceived barriers" pertaining to HBM; "attitude" and "perceived behavioral control" pertaining to PBT; and ESE were associated with regular exercise level in the multiple linear regression analyses of each health behavior model. When all three models were considered simultaneously, ESE provided the greatest explanation of the variances for regular exercise levels. PBT total made a smaller contribution in the prediction of regular exercise level, while the effect of HBM did not show statistical significance. In order to explore the practicality of moving beyond theoretical models and focusing on the components across health behavior models to enhance workers' exercise behavior, the components showing statistical significance in separate analysis were put into the multiple linear regression simultaneously. The results showed that ESE, perceived barriers of health behavior, attitude, and perceived behavioral control were significantly associated with regular exercise level. Conclusion: A low percentage of workers exercising regularly should be a notable issue for workplace health promotion. Neither utilizing cues to exercise nor advertising health threats of physical inactivity is sufficient to enable workers to exercise regularly. Enhancing workers' ESE and behavior control and removing the exercise barriers would constitute efficient strategies for maintaining the exercise habit of workers.

Dual nature of ferritin for hematologic, liver functional, and metabolic parameters in older diabetic patients.

This study explored the association between ferritin with hematologic, liver functional, and metabolic parameters in older diabetic patients. A total of 210 diabetic patients aged 65 or older were classified into four groups according to the reference range of serum ferritin. Demographic variables and health-related lifestyle factors were obtained through the utilization of a standardized questionnaire. Anthropometric measures, blood pressure, hematology test, and biochemical assessment were also performed. Among all patients, 29.5% had anemia. The percentage of anemia in groups low ferritin (< 40 µg/L), lower side within the reference range (40-120 µg/L), higher side within the reference range (121-200 µg/L), and high ferritin levels (> 200 µg/L) were 50.0, 27.7, 20.5, and 24.2% (P = 0.025), respectively. Low ferritin levels had a higher risk of anemia and a high red blood cell distribution width (RDW). High ferritin levels were associated with a higher risk of high glutamate pyruvate transaminase, obesity, high fasting blood glucose (FBG), and high postprandial blood glucose. The higher side within the reference range of ferritin also showed a higher risk of high FBG and high glycated hemoglobin. Nevertheless, there was no significant association between ferritin and inflammation marker, serum lipids or blood pressure. Overall, ferritin demonstrates a dual nature in older diabetic patients: low ferritin levels are linked to anemia or elevated RDW, while high levels are linked to obesity, increased liver enzymes, and worse glycemia control.

Unraveling the Connection between Fatty Liver Severity with Gender, Lifestyle, and Health Risks among Workers.

The purpose of this study was to investigate the correlation between the severity of fatty liver and factors such as gender, lifestyle, and the risks of metabolic abnormalities, inflammation, and liver dysfunction in the working population. This cross-sectional study included 2936 workers aged 21-64 years. The severity of fatty liver was assessed using ultrasound. A self-administered survey was used to evaluate lifestyle habits. Data on anthropometric measurements, blood pressure, blood tests, and biochemical evaluations was collected. The 45.5% of workers had fatty liver. Males had a higher prevalence of fatty liver and health risks and several unhealthy lifestyle habits compared to females. The health behavior score related to exercise showed notable declines as the severity of fatty liver increased (p < 0.001). Percentages of current alcohol drinkers differed among different levels of fatty liver, with rates of 43.1, 48.4, 44.8, and 63.4% (p = 0.005) observed in the absence, mild, moderate, and severe fatty liver, respectively. Workers with fatty liver showed increased risks related to metabolic anomalies, especially in severe cases. The risk of inflammation and liver dysfunction also significantly increased with elevated fatty liver severity. Overall, fatty liver presents significant health risks, with nearly half of the workers diagnosed with the condition. To improve liver health, it is crucial to have customized strategies for promoting health, taking into account the different levels of severity in fatty liver.

Mother-Infant Group Intervention on Maternal Depression and Bonding: A Quasi-Experimental Study.

OBJECTIVES: Parent-Infant Psychotherapy (PIP) aims at improving the interaction between parents and their infants. Group intervention has advantages in facilitating universality, support, and social learning. However, the researches on PIP adoption in a group format are limited. This study aims to explore the outcome of a mother-infant group on bonding and maternal depression. METHODS: Eighty-two infant mothers with subjective distress on parenting or depressed mood were recruited to participate in the intervention group (IG). Another sample of one hundred and ninety-four postpartum women was recruited as the control group (CG). Instruments for outcome measure were the Mother-Infant Bonding Scale, Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory-Second Edition (BDI-II), and Social Network Interaction System Questionnaire. Twelve courses of mother-infant groups were conducted for IG women. Each course consisted of twelve 90-min sessions. IG women joined the intervention with their infants and replied to the instruments at baseline, post-intervention, and follow-up. CG women replied to the instruments at similar intervals. Primary data analyses were performed by the intent-to-treat analysis, ANOVA, and GEE. RESULTS: Relative to CG participants, the IG women experienced significant benefits in most mother-infant bonding scores at both post-intervention and follow-up (ps = .000 - .026). IG women also experienced a greater reduction in follow-up depressive symptoms measured by EPDS (p = .023). However, no significant reduction was noted on BDI-II. CONCLUSIONS: Mother-infant group intervention has preliminary effects on improving bonding and reducing depressive symptoms for women with infants. Further studies are warranted to replicate the results.

Literature indicates detrimental impacts of adverse bonding and maternal depression on children development. Parent-infant group psychotherapy suggests a positive effect on facilitating bonding and reducing depression severity. However, the evidence is limited and inconclusive. Since the treatment has never been applied in Taiwan, its effect and feasibility on Taiwanese women is unknown. The results established a preliminary positive outcome of parent-infant group on maternal bonding and depression. Also, by the first practice, we observe the participants have well motivation to join intervention with their infants and with other women. Parent-infant group is a promising treatment that warranted further exploration.

Relationship between Depression with Physical Activity and Obesity in Older Diabetes Patients: Inflammation as a Mediator.

Obesity and physical activity (PA) may affect inflammation and are also related to depression. This study aimed to explore the association between depression, obesity, and PA in older diabetes patients mediated by inflammation. We conducted a cross-sectional study with 197 elderly diabetes patients (≥65 y/o). Participants were interviewed to gather demographic and lifestyle data. Assessment of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. High-sensitivity C-reactive protein was used as a marker of inflammation. Participants with a body mass index (kg/m2) ≥ 27 were considered to be obese. Our data indicated that among all participants with (n = 57) and without (n = 140) depression, older diabetes patients with depression had a lower intake of energy and protein and a lower prevalence of smoking and alcohol consumption than those without depression (p < 0.05). We also found that inflammation may be a partial mediator in the relationship between obesity and depression, and a significant mediator between PA and depression. Additionally, a regression model of obesity and PA showed that PA was a significant predictor of inflammation. However, the association between obesity and inflammation was not significant. When obesity, PA, and inflammation were included in a regression model together, inflammation significantly predicted depression (OR = 4.18, p = 0.004). The association between obesity and depression was also significant (OR = 2.45, p = 0.038). However, the association between PA and depression was not significant, and the mediating effect of inflammation was significant according to the Sobel test (z = −2.01, p = 0.045). In conclusion, the beneficial effects of PA may lower levels of inflammation produced by obesity, thus reducing inflammatory effects that may be related to depression. Overall, inflammation may mediate the relationship between depression and PA in older diabetes patients.

Psychological Well-Being Increment as Post-Traumatic Growth in Women with Breast Cancer: A Controlled Comparison Design Using Propensity Score Matching.

The aim of this study was to confirm post-traumatic growth with respect to the psychological well-being of women with breast cancer compared to women without disease. Propensity score was used to match the two groups according to age, religious beliefs, education level, monthly income, and marital status. A psychological well-being scale with six factors was used, including positive relations with others (PR), autonomy (AU), environmental mastery (EM), personal growth (PG), purpose in life (PL), and self-acceptance (SA). A total 178 women with vs. 178 women without breast cancer were compared by matching with propensity scores, using factorial invariance tests to reduce measurement errors. The results showed that women with breast cancer had significantly higher psychological well-being for all the six factors (Δχ2 = 37.37, p < 0.001) and higher variability in terms of PR, AU, and PL than women without breast cancer (Δχ2 = 45.94, p < 0.001). Furthermore, women with breast cancer exhibited a significantly higher association between PG and PL and a significantly lower association between PG and EM than women without breast cancer (Δχ2 = 44.49, p < 0.001). This implies that psychological well-being could assess broader and more subtle post-traumatic growth in women with breast cancer and that growth was more associated with internal life value than with external environmental control.

The effect of facial expression intensity on emotion recognition and psychosocial performance in patients with frontal or temporal lobe epilepsy.

PURPOSE: No studies have examined the relationship between the intensity of facial emotion expression and theory of mind (ToM) ability in people with epilepsy. This study aimed to explore facial emotion recognition in a group of patients with frontal (FLE) or temporal lobe epilepsy (TLE) and its relationship with the intensities of perceived facial emotion expressions, ToM, and social functioning. METHODS: Twenty-six patients with FLE or TLE and 30 matched controls were included in the study. All participants completed the facial emotion recognition test, Faux Pas Recognition (FPR) test measuring advanced ToM, Symptom Checklist-90-Revised, Social and Occupational Functioning Scale for Epilepsy (SOFSE), and background neuropsychological tests. RESULTS: The patient group was significantly worse than the control group in recognizing facial expressions of negative emotions, particularly for medium-intensity facial expression of fear. There was no significant difference between the groups in recognizing high-intensity fear facial expressions. The scores of FPR (overall and affective ToMs) in the patient group were significantly lower than those in the control group. Additionally, the facial emotion recognition was significantly associated with the total score of FPR, and the FPR total score remarkably correlated with the Communication subscale score of the SOFSE. CONCLUSIONS: Patients with FLE or TLE had impaired ability to recognize medium-intensity facial expressions of fear. Moreover, patients' ToM deficit significantly correlated not only with their emotion recognition problem but also with their social-communicative competence. Nevertheless, we also found that increasing the intensity of expression can improve the accuracy of emotion recognition in patients with epilepsy. These findings may provide considerations for further longitudinal studies and interventions on the social difficulties of people with epilepsy.

Gender Difference in the Relationships between Inflammatory Markers, Serum Uric Acid and Framingham Risk Score.

The purpose of the present study was to explore the role of gender in the relation of high-sensitivity C-reactive protein (hsCRP), white blood cell (WBC) count, and serum uric acid (UA) to the risk of future cardiovascular disease (CVD) events. In total, 404 workers were recruited to obtain the measurements of serum markers for CVD risk. Demographic data, nutrition, exercise, smoking, and alcohol consumption were assessed through a questionnaire. The Framingham Risk Score (FRS) was adopted to estimate the risk of future CVD events. Multiple linear regression models were used to determine CVD risk markers in relation to the FRS by gender. The hsCRP was not significantly correlated with the FRS for all workers after adjusting for covariates, including demographic data and health-related lifestyle. WBC count was positively correlated with FRS for all workers, but WBC count did not show an interaction with gender with respect to the FRS. Serum UA showed an interaction with gender on the FRS, and UA positively correlated with the FRS in males though not in females. With respect to CVD prevention, the WBC count can be used to monitor the risk for all workers. Due to a gender difference shown in the relationship between serum UA and the FRS, serum UA can be a monitor of the risk of future CVD events in male workers only.

The Mediation and Suppression Effect of Demoralization in Breast Cancer Patients After Primary Therapy: A Structural Equation Model.

BACKGROUND: Because of the increasing 5-year survival rate of breast cancer, adjustment to breast cancer survivorship is pertinent to the patient's life after diagnosis. Despite the psychological changes occurring during the transitional period (first 5 years after diagnosis) and after primary therapy having a known, critical effect on survivorship status, the data related to this topic are very limited. PURPOSE: This study was designed to examine the relationships among demoralization, stress, sleep disturbance, and psychological well-being in women with breast cancer after primary therapy. METHODS: Two hundred eight women with breast cancer (mean age = 51.96 ± 8.27) participated in a cross-sectional study in central Taiwan. Recruitment was conducted using convenience snowball sampling at a local teaching hospital. All of the participants had completed primary therapy and were in the 5-year postdiagnosis period. The average duration of cancer was 28 months. The participants completed the Stress of Breast Cancer after Primary Therapy Scale, Demoralization Scale, Pittsburgh Sleep Quality Inventory, and Ryff's Psychological Well-Being Scale-Short Form. Data were analyzed using a structural equation model to find plausible path relationships among stress, demoralization, sleep disturbances, and psychological well-being. RESULTS: Demoralization was shown to completely mediate the effect of stress on sleep disturbances. In addition, the predictive effect of sleep disturbances on psychological well-being was overwhelmingly explained by demoralization when competing with sleep disturbances. Furthermore, a positive path was found between stress and psychological well-being because of the suppression effect of demoralization. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Demoralization was found to be a mediator that suppressed the relationships among stress, sleep disturbances, and psychological well-being in the adaptation process of patients with breast cancer after primary therapy. This article adds to the limited research on women with breast cancer after primary therapy who are in their initial 5 years of diagnosis. In addition, this study used structural equation model to find the plausible path relationships among the psychological factors involved in the well-being of women with breast cancer. Supporting patients with cancer and effectively reducing their perceived demoralization will be key to transforming stress into personal growth and a facilitator of long-term recovery.