A higher incidence rate of acute coronary syndrome following radiation therapy in patients with breast cancer and a history of coronary artery diseases.

This study aims to investigate whether patients with breast cancer and a history of cardiovascular diseases (CADs) are at an increased incidence of acute coronary syndrome (ACS) after receiving radiation therapy (RT). In Taiwan, 5828 patients who had a history of CAD were newly diagnosed of breast cancer and received mastectomy between 1999 and 2009. Among these patients, 1851 also received RT. The study cohort was prospectively followed to the end of 2010 for estimating the incidence of ACS in association with exposure to RT. A Cox proportional hazard model that was adjusted for covariates was used to estimate the hazard ratio (HR) of ACS. Over the study period, the incident rates of ACS for RT and control patients were estimated at 1.51 and 1.77 per 100 person-years, respectively. Covariate-adjusted regression analysis indicated that the hazard of ACS significantly increased in RT patients at an adjusted HR of 1.48 [95% confidence interval (CI) 1.18-1.87]. Both hypertension and diabetes significantly increased the hazard of ACS in this patient cohort, with adjusted HRs of 3.31 (95% CI 1.94-5.66) and 1.50 (95% CI 1.19-1.89), respectively. This 12-year follow-up study suggested excess of ACS events in association with RT exposure in patients with breast cancer who had a higher cardiovascular risk. In consideration of the benefit associated with RT, intensive cardiac care should be given to patients with breast cancer and high cardiovascular risk.

Development and preliminary testing of an instrument to measure healthiness of lifestyle among breast cancer survivors.

Monitoring lifestyle to maintain health is an important issue for breast cancer survivors. No multidimensional instrument has previously been available specifically for assessing overall healthiness of lifestyle among breast cancer survivors. This study aims (i) to establish the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS) and (ii) to examine the reliability and validity of the established scale. A quantitative cross-sectional design was used. This project was conducted in four phases. In phase I, using the Health-Promoting Lifestyle Profile as the core concept, we created 50 preliminary measurement items. In phase II, we invited 10 breast cancer survivors and five professional experts to conduct a content validity assessment. In phases III and IV, a total of 220 breast cancer survivors were enrolled to assess the construct validity and the internal consistency and reliability. The final HLI-BCS contains 20 items across five domains: dietary habits, environment and physiology, health responsibility and stress management, social and interpersonal relations and spiritual growth. Through the information presented in the HLI-BCS, breast cancer survivors can assess their lifestyles on multiple dimensions and subsequently adjust their lifestyles to enhance their recovery and quality of life.

Health-seeking behavior, alternative medicine, and quality of life in Taiwanese panic disorder patients.

OBJECTIVE: Panic disorder (PD) is an anxiety disorder characterized by spontaneous and unexpected panic attacks of varying frequency. Clinically manifest PD is widespread among the general population in developed countries worldwide. This study is aimed to identify factors influencing Taiwanese patients' decision to seek psychiatric help and to assess relationships between patients' health-seeking behaviors and quality of life (QOL). METHODS: One hundred patients from the outpatient psychiatric clinic of a university hospital in Taiwan were evaluated for PD. RESULTS: Delayed diagnosis of panic disorder, high comorbidity with other mental and physical disorders, and high utilization of health care services were identified. Thirty-three percent of PD patients sought alternative therapies, delaying their seeking psychiatric care. CONCLUSIONS: More PD patients in Taiwan seek care from family practitioners and alternative and complementary medicine than from psychiatrists. Taiwanese patients with PD who seek psychiatric consultation more than one year after disease onset have lower QOL and lower physical health scores.

Patients with colorectal cancer: relationship between demographic and disease characteristics and acceptance of disability.

AIM: This article is a report of a study conducted to examine acceptance of disability among patients with colorectal cancer and its relationships to other disease-related factors. BACKGROUND: Colorectal cancer had become the third leading cause of cancer death worldwide. Recently, the topic of acceptance of disability in patients with chronic disease, especially cancer, has attracted enormous attention because the higher acceptance, the better coping with disease and the better quality of life after therapy. METHOD: A cross-sectional study was carried out with 110 patients with colorectal cancer recruited from a medical centre in northern Taiwan in 2008. Data were collected using the Acceptance of Disability Scale. Descriptive statistics, Pearson correlations and multiple linear regression analysis were used for analysis. FINDINGS: Participants reported moderate levels of acceptance of disability. The regression model showed that those with shorter disease duration, stoma, lower educational level (below 9th grade), or in Duke C1 stage or above reported lower levels of acceptance, and these variables accounted for 25% of the total variance. CONCLUSION: The results suggest that acceptance of disability (i) is a useful construct to examine in future studies on psychosocial adaptation to cancer, and (ii) can be integrated into a clinical intervention programme of providing holistic care to patients with colorectal cancer.

Retention and attrition of certified care assistants in the long-term care industry from the Taipei area: an interview survey.

BACKGROUND/OBJECTIVES: The question, "do certified care assistants (CCAs), after finishing their training, devote themselves to the long-term care industry in accordance with the original expectations?", is still unknown. Few studies have focused on CCAs who have left the long-term care industry. The purposes of this study were to identify the employment status of CCAs over the January 2000-July 2002 time period who had undergone a training program sometime in 1999 and to explore the factors affecting whether the CCAs stay or leave the long-term care industry in the Taipei area. Understanding retention and attrition of CCAs is important for developing the strategies of managing manpower in this industry. DESIGN/SETTING/PARTICIPANTS: A descriptive survey design was conducted to telephone interview 826 CCAs who had trained during the 1999 certification training program in Taipei area. Three hundred and thirteen participants (an interview-completed rate of 38%) provided usable data. METHODS: A structured interview schedule was developed by authors for interview. Descriptive statistics and chi(2) test were adopted to report the subjects' characteristics and factors that influenced his/her intention to stay or leave this industry. RESULTS: One hundred and sixty-eight respondents (53.7%) had still stayed in this industry, while 145 respondents (46.3%) had left already. Major reasons for staying were personal interest in caring elderly, good financial benefits from the facility, and supportive leadership. In contrast, low wages, heavy workloads, long working hours, a high level of stress, and poor financial benefits were factors contributing to careers leaving this industry. CONCLUSIONS: Many factors affected whether CCAs stayed or left, including personal factors, work-related factors, the welfare system, the managerial system, the leadership style and the work environment. However, the sequence of these factors and their importance were different between two groups. This study has significant implications for managing the manpower of the long-term care industry.

Validity and Reliability of the Taiwanese Version of the General Fatigue Scale in Cancer Patients.

BACKGROUND: Fatigue has been described as the most frequent and distressing problem of cancer patients undergoing chemotherapy. OBJECTIVE: The aim of this study is to evaluate the validity and reliability of the Taiwanese version of the General Fatigue Scale (GFS-T) and to evaluate the severity of the fatigue among breast cancer patients in Taiwan. METHODS: A cross-sectional research design was used, recruiting breast cancer patients from 2 medical centers in Taiwan. Patients completed the scale exploring their GFS-T, the Brief Fatigue Inventory-Taiwan Form, and the Eastern Cooperative Oncology Group Performance Status. The data were collected between the day before the first chemotherapy (T1) and 1 week after the first chemotherapy (T2). RESULTS: A total of 171 patients participated in this study. Cronbach's α for the GFS-T at both time points both were .94. Factor analysis generated 1 factor that accounted for 73.7% of variance in participants' fatigue. The receiver operating characteristic curve analyses suggested that the GFS-T cut-point of 24 had an adequate combination of sensitivity and specificity to distinguish high and low performance status. The receiver operating characteristic curve is 0.67 (95% confidence interval, 0.59-0.75). CONCLUSIONS: The GFS-T is a reliable and valid instrument for assessing fatigue among cancer patients. Further research is needed to better understand predictors of cancer-related fatigue. IMPLICATIONS FOR PRACTICE: The GFS-T can provide clinical nurses with a useful measure to assess fatigue in cancer patients.

Predictors for Reconstruction and Mood Disorder Associated With Reconstruction in Patients With Breast Cancer and Mastectomy: A Retrospective Cohort Study.

This study used Taiwan's National Health Insurance medical claims to investigate the predictors for operative modes chosen by early-stage breast cancer patients; as well as to assess whether operative modes are associated with risk of mood disorder. We included 36,377 patients with breast cancer who received surgery between 2000 and 2008, and were followed to the end of 2010; they were further classified into 3 groups: mastectomy alone (n = 34,900), along with early reconstruction (n = 1080), and along with delayed reconstruction (n = 397). The results showed that age, insurance premium, urbanization level, and postsurgery chemotherapy and radiotherapy were all significant predictors for the selection of operative modes. Breast cancer patients with mastectomy alone, early reconstruction, and delayed reconstruction showed a cumulative incidence rate of mood disorder of 36.90%, 41.56%, and 33.89%, respectively. The multiple cox proportional model further revealed that early (hazard ratio [HR] = 1.06, 95% confidence interval (CI) = 0.93-1.21) and delayed (HR = 1.17, 95% CI = 0.96-1.42) reconstruction were associated with a slightly higher but insignificant risk of mood disorder, as compared to the patients received no reconstruction.

Sleep Quality among Female Hospital Staff Nurses.

Purpose. To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures. Methods. Female staff nurses at a regional teaching hospital in Northern Taiwan were recruited. The Chinese version of the pittsburgh sleep quality index (C-PSQI) was used to assess subjective sleep quality, and an electrocardiogram-based cardiopulmonary coupling (CPC) technique was used to analyze objective sleep stability. Work stress was assessed using questionnaire on medical worker's stress. Results. A total of 156 staff nurses completed the study. Among the staff nurses, 75.8% (117) had a PSQI score of ≥5 and 39.8% had an inadequate stable sleep ratio on subjective measures. Nurses with a high school or lower educational degree had a much higher risk of sleep disturbance when compared to nurses with a college or higher level degree. Conclusions. Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses. More studies are warranted on this important issue to discover possible factors and therefore to develop a systemic strategy to cope with the problem.

Participation in decision making as a property of complex adaptive systems: developing and testing a measure.

Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores. We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems-level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them.

Offspring birth weight and risk of mortality from diabetes in mothers.

BACKGROUND: Mothers with lower birth weight (LBW) offspring have been found to be associated with cardiovascular disease (CVD) morbidity, which shares many risk factors with diabetes. Aims To investigate the relation between offspring birth weight and maternal risk of mortality from diabetes. METHODS: A total of 1 400 383 singletons of primigravida registered in Taiwan between 1978 and 1987 were followed to the end of 2006. The offspring birth weight was assessed with and without standardisation for the gestational age of offspring. Cox model was used to estimate the HR of maternal diabetes mortality in relation to offspring birth weights. RESULTS: Altogether, 812 (5.8%) mothers died of diabetes. Mothers with LBW (<2500 g) and macrosomia (>4000 g) offspring were both at increased risks of mortality from diabetes with HR 1.76 (95% CI 1.46 to 2.19) and 2.86 (95% CI 2.32 to 3.53), respectively. Similar results were seen while birth weight was standardised for gestational age. CONCLUSIONS: This cohort study found that mothers with LBW and macrosomia offspring had an increased mortality risk of diabetes. This relationship could be attributable to the possible pathway of intergenerational effects or maternal insulin resistance due to maladaptation to pregnancy.