College students' perceptions of electronic cigarette risks and benefits: a concept mapping study.

The use of electronic cigarettes (e-cigarettes) is on the rise among young adults, with higher public acceptance than traditional tobacco. A study in Taiwan employed concept mapping to explore risk and benefit perceptions of e-cigarette use among college students. The study involved 100 college students from 11 Taiwanese universities, with 50 being e-cigarette users and 50 non-users. Data collection and analysis were done with the GroupWisdom™ platform. Participants engaged in brainstorming, rating and sorting their perceptions, which were analyzed using multidimensional scaling and hierarchical cluster analyses. The participants' mean age was 19.24 years, and 55% were male. This process resulted in the identification of 10 clusters encompassing 64 statements, with 3 clusters focused on risk perceptions, 6 on benefit perceptions, and 1 dealing with e-cigarette regulations. Notably, risk perceptions were rated higher than benefit perceptions. Non-users held significantly higher risk perceptions and lower benefit perceptions across the nine clusters related to e-cigarette use. Concept mapping proved to be an effective tool for understanding college students' perceptions. These findings can assist health educators in comprehending college students' viewpoints on e-cigarette use and in developing targeted interventions. Additionally, exploring benefit perceptions may enhance students' critical thinking skills regarding e-cigarette advertising.

College Students' E-health Literacy, Social Media Use, and Perceptions of E-cigarettes in Taiwan.

This study aimed to examine the relationship between social media use, e-health literacy, and the risk and benefit perceptions of e-cigarettes among college students in Taiwan. A cross-sectional online survey was conducted with 1,571 Taiwanese college students, which included four questionnaires to assess participants' perceptions, social media use behavior, e-health literacy, and sociodemographic factors. The data were presented in terms of means, standard deviations, and percentages. Stepwise regression was used to identify factors associated with the participants' perceptions. The study found that 75.01% of the participants were exposed to e-cigarette information on social media, with 31.26% actively searching for it and 15.95% sharing it. Participants had a high e-cigarette risk perception, indicating low benefit perception, but acceptable e-health literacy. Factors such as current e-cigarette and tobacco use, e-health literacy, academic achievement, and sex significantly predicted e-cigarette risk perception, while sharing e-cigarette related information, sex, age, academic achievement, and current e-cigarette use significantly predicted its benefit perception. Thus, implementing effective e-health literacy programs to enhance college students' e-cigarette risk perception is recommended along with a proactive approach to tackle e-cigarette advertising messages on social media, minimizing their sharing behavior to decrease their perception of associated benefits.

Attitude and utilization of ChatGPT among registered nurses: A cross-sectional study.

AIM: This study explores the influencing factors of attitudes and behaviors toward use of ChatGPT based on the Technology Acceptance Model among registered nurses in Taiwan. BACKGROUND: The complexity of medical services and nursing shortages increases workloads. ChatGPT swiftly answers medical questions, provides clinical guidelines, and assists with patient information management, thereby improving nursing efficiency. INTRODUCTION: To facilitate the development of effective ChatGPT training programs, it is essential to examine registered nurses' attitudes toward and utilization of ChatGPT across diverse workplace settings. METHODS: An anonymous online survey was used to collect data from over 1000 registered nurses recruited through social media platforms between November 2023 and January 2024. Descriptive statistics and multiple linear regression analyses were conducted for data analysis. RESULTS: Among respondents, some were unfamiliar with ChatGPT, while others had used it before, with higher usage among males, higher-educated individuals, experienced nurses, and supervisors. Gender and work settings influenced perceived risks, and those familiar with ChatGPT recognized its social impact. Perceived risk and usefulness significantly influenced its adoption. DISCUSSION: Nurse attitudes to ChatGPT vary based on gender, education, experience, and role. Positive perceptions emphasize its usefulness, while risk concerns affect adoption. The insignificant role of perceived ease of use highlights ChatGPT's user-friendly nature. CONCLUSION: Over half of the surveyed nurses had used or were familiar with ChatGPT and showed positive attitudes toward its use. Establishing rigorous guidelines to enhance their interaction with ChatGPT is crucial for future training. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers should understand registered nurses' attitudes toward ChatGPT and integrate it into in-service education with tailored support and training, including appropriate prompt formulation and advanced decision-making, to prevent misuse.

Preliminary evaluation of a scenario-based nutrition literacy online programme for college students: a pilot study.

OBJECTIVE: This study aimed to develop and evaluate a scenario-based nutrition literacy (NL) online programme for Taiwanese college students. DESIGN: A randomised pilot trial design was used in this study. SETTING: The study was conducted at a university in Taiwan. The intervention consisted of a five-unit web-based NL programme including videos of real-life scenario-based stories, situational analysis teaching and after-unit quizzes. Theme-related website information and smartphone apps (both iOS and Android systems) were offered for reference in every unit. The NL measure consisted of a self-rated scale, a scenario-based test and a healthy eating behaviour survey. Paired sample t-tests and ANCOVA were performed to test the effects on NL and healthy eating behaviour. PARTICIPANTS: Participants were ninety-eight students, with a retention rate of 98 %. The ratio of men to women was 0·2:1. Most students were freshmen (48 %). RESULTS: Compared with the control group, the experimental group showed significant post-intervention improvements in the NL and healthy eating behaviours after controlling for pretest scores. CONCLUSIONS: This pilot study offers preliminary evidence of the potential positive effects of implementing a scenario-based NL online programme for college students. It offers a possibly novel strategy to enhance health-promoting behaviours in Taiwanese universities. Further research with larger sample sizes and more rigorous designs is warranted to confirm and build upon these initial findings.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey.

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (ß = -.29) and indirect negative effects (ß = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Competence and Stress of Medication Administration Practices for School Nurses in K-12 Taiwan Schools.

We investigated school nurses' experiences, perceived government support, school nurses' acceptance of responsibility for medication administration, perceived stress, and perceived competence of medication administration and analyzed factors associated with perceived competence. In this cross-sectional study, from February to April 2023, we conducted an online survey of 269 school nurses serving at K-12 schools in Taiwan. The results revealed that although 71% of the participants had prior experience with medication administration, they reported low competence and high stress in areas such as drug interactions, adverse drug effects, and referrals. The school nurses' disagreement with responsibilities for medication administration emerged as the only factor to be significantly associated with perceived medication administration competence, accounting for 22.8% of the variance. We recommend implementing continuing training programs to provide school nurses with up-to-date medication information. Additionally, the development of practice guidelines is suggested as a means of enhancing nurses' competence and reducing their stress levels for the administration of medications.

Delay discounting, time perspective, and self-schemas in adolescent alcohol drinking and disordered eating behaviors.

Delay discounting, time perspective, and self-schemas are well-known predictors of health risk behaviors among adolescents. However, the associations between these constructs and their influence on such behaviors are yet to be examined. This study aimed to determine the relationships among three cognitive constructs, namely, delay discounting, time perspective, and self-schemas, and determine the associations of these constructs with alcohol drinking (alcohol use and alcohol problems) and disordered eating behaviors in adolescents. Participants were 436 eighth-graders from three public junior high schools in southern Taiwan, who answered an anonymous questionnaire assessing self-schema, delay discounting, time perspective, and health risk behaviors. Generalized linear models with robust estimation were performed to estimate the effects; gender was the covariate. Delay discounting was associated with alcohol use (OR = 1.15), but not alcohol problems and disordered eating behaviors. Present-Hedonistic time perspective was associated with alcohol use (OR = 2.01), alcohol problems (IRR = 2.23), and disordered eating behaviors (Exp(b) = 1.38); while Future time perspective was associated with alcohol problems (IRR = 2.18). Drinker self-schema was associated with alcohol use (OR = 1.62) and alcohol problems (IRR = 1.71). Fat/overweight self-schema was associated with overall disordered eating (Exp(b) = 1.03). Thus, the findings suggest that each of the three constructs is independently associated with drinking and disordered eating behaviors, and these associations vary according to the specific type of behavior. Future research identifying the underlying mechanisms linking these constructs to the abovementioned behaviors can be useful for developing targeted intervention strategies.

Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity.

OBJECTIVE: The objective of this study was to examine the relationships between students' perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity. DESIGN: Cross-sectional study. SETTING: Primary, middle and high schools in Taiwan. PARTICIPANTS: A nationally representative sample of 2433 primary school (5th-6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018. RESULTS: Multivariate analysis results showed that after controlling for school level, gender and age, the students' perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools' campaigns promoting the eating of vegetables and fruit were positively associated with students' consumption of vegetables. In addition, schools' initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students' engagement in outdoor physical activities and daily moderate-to-vigorous physical activity. CONCLUSIONS: Students' perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

Feasibility of Intervention Program to Prevent Adolescent Health-Compromising Behaviors.

Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12-14 years. Feedback from teachers and students supported the proposed program's feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings.

Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students.

PURPOSE: To investigate the change in the prevalence of reduced visual acuity (VA) in Taiwanese school children after a policy intervention promoting increased time outdoors. DESIGN: Prospective cohort study based on the Taiwan School Student Visual Acuity Screen (TSVAS) by the Ministry of Education in Taiwan. PARTICIPANTS: All school children from grades 1 through 6 were enrolled in the TSVAS from 2001 through 2015. METHODS: The TSVAS requires each school in Taiwan to perform measurements of uncorrected VA (UCVA) on all students in grades 1 through 6 every half year using a Tumbling E chart. Reduced VA was defined as UCVA of 20/25 or less. Data from 1.2 to 1.9 million primary school children each year were collected from 2001 through 2015. A policy program named Tian-Tian 120 encouraged schools to take students outdoors for 120 minutes every day for myopia prevention. It was instituted in September 2010. To investigate the impact of the intervention, a segmented regression analysis of interrupted time series was performed. MAIN OUTCOME MEASURES: Prevalence of reduced VA. RESULTS: From 2001 to 2011, the prevalence of reduced VA of school children from grades 1 through 6 increased from 34.8% (95% confidence interval [CI], 34.7%-34.9%) to 50.0% (95% CI, 49.9%-50.1%). After the implementation of the Tian-Tian 120 outdoor program, the prevalence decreased continuously from 49.4% (95% CI, 49.3%-49.5%) in 2012 to 46.1% (95% CI, 46.0%-46.2%) in 2015, reversing the previous long-term trend. For the segmented regression analysis controlling for gender and grade, a significant constant upward trend before the intervention in the mean annual change of prevalence was found (+1.58%; standard error [SE], 0.08; P < 0.001). After the intervention, the trend changed significantly, with a constant decrease by -2.34% annually (SE, 0.23; P < 0.001). CONCLUSIONS: Policy intervention to promote increased time outdoors in schools was followed by a reversal of the long-term trend toward increased low VA in school children in Taiwan. Because randomized trials have demonstrated outdoor exposure slowing myopia onset, interventions to promote increased time outdoors may be useful in other areas affected by an epidemic of myopia.

Effects of a healthy-eater self-schema and nutrition literacy on healthy-eating behaviors among Taiwanese college students.

Unhealthy eating behaviors contribute to obesity and chronic illness. This study examined the relative contributions of a healthy-eater self-schema (a self-conception as a healthy eater) and nutrition literacy on healthy-eating behaviors and whether nutrition literacy was a mediator among Taiwanese college students. A total of 1216 undergraduate students from six universities in Taiwan participated in the study from April to June 2016. Healthy-eating behaviors, nutrition literacy, healthy-eater self-schema and known determinants of eating behaviors (e.g. nutrition-related information, health status, nutrition knowledge needs, sex, year in college and residence) were measured by a self-report questionnaire. A hierarchical multiple regression and mediation analysis were conducted with the known determinants of eating behaviors as covariates. Results showed that a healthy-eater self-schema and nutrition literacy explained 9% and 12% of the variance in healthy-eating behaviors, respectively, and both had unique effects on healthy-eating behaviors. The effect of a healthy-eater self-schema on healthy-eating behaviors was partially mediated through nutrition literacy. Findings suggest that both a healthy-eater self-schema and nutrition literacy should be considered when promoting healthy-eating behaviors. Additionally, nutrition literacy interventions should be tailored to the healthy-eater self-schema status and emphasize the personal relevance of being a healthy-eater to improve the intervention's effectiveness.

Vision Improvement and Compliance With the Use of Orthokeratology Lenses in School Children: A Sample From Five Primary Schools in Northern Taiwan.

PURPOSE: To assess the visual acuity and compliance with the use of orthokeratology lenses (OrthoK) in school children. METHODS: A retrospective study was conducted to determine the education-related factors influencing the improvement in visual acuity in myopic students using OrthoK in five primary schools in Taiwan. RESULTS: Of the 5,173 eligible students from five primary schools, 1906 (36.8%) students were diagnosed with myopia. Among 201 (10.6%) students wearing OrthoK, 69.7% had used them for at least 1 year, 53.2% achieved visual acuity greater than 0.8 (6/7.5, log of minimal angle of resolution 0.1) in school, and 49.8% had received health education related to OrthoK care. Multiple logistic regression analysis showed that a higher possibility to achieve visual acuity greater than 0.8 was associated with more than 1-year use of OrthoK, good compliance, and receiving health education from an ophthalmologist. CONCLUSION: It is important that children wearing OrthoK receive education and comply with the use of OrthoK for visual acuity improvement.

The prevalence of self-reported premenstrual symptoms and evaluation of regular exercise with premenstrual symptoms among female employees in Taiwan.

Few studies have focused on premenstrual symptoms in employees. This study explored the prevalence of premenstrual symptoms in 7,193 female employees aged 18-55 years in a large electronics manufacturer in Taiwan from August 2014 to December 2014 and examined whether regular exercise was associated with premenstrual symptoms. Information was collected on demographics, lifestyle, menstrual history, menstrual pain, and premenstrual symptoms. Half of the participants reported irregular menstruation; 79.4% reported a moderate menstruation amount, and half reported little impact of menstrual pain at work. In order of prevalence, symptoms were "easy to fatigue" (24%), "backache" (21.2%), and "abdominal bloating" (17.4%). Participants who engaged in regular exercise reported fewer backaches (adjusted odds ratio [aOR] = 0.79, 95% confidence interval [CI] = 0.68-0.91), somatic discomfort (aOR = 0.78, 95% CI = 0.63-0.96), headache (OR = 0.82, 95% CI = 0.69-0.98), diarrhea (aOR = 0.76, 95% CI = 0.60-0.96), constipation (aaOR = 0.59, 95% CI = 0.44-0.78), less irritability (aOR = 0.78, 95% CI = 0.65-0.94), feeling morose and depressed (aOR = 0.75, 95% CI = 0.58-0.95), crying (aOR = 0.51, 95% CI = 0.27-0.87), and emotional lability (aOR = 0.73, 95% CI = 0.58-0.91). Regular exercise was associated with decreased menstrual pain (aOR = 0.85, 95% CI = 0.76-0.96). Our findings provide a better understanding of premenstrual symptoms in female workers, allowing for the development of premenstrual health programs to improve their health and quality of life.

Health literacy and the determinants of obesity: a population-based survey of sixth grade school children in Taiwan.

BACKGROUND: Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people's control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan's sixth grade school children. METHODS: Using a population-based survey, 162,209 sixth grade (11-12 years old) school children were assessed. The response rate at school level was 83%, with 70% of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates. RESULTS: The sample consisted of 48.9% girls, 3.8% were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6% of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2%. Children in the highest health literacy quartile were less likely to be obese (12.4%) compared with the lowest quartile (17.4%). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR) = 0.94, p < 0.001) and underweight (RRR = 0.83, p < 0.001). Those who did not have regular physical activity, or had sugar-sweetened beverage intake (RRR > 1.10, p < 0.0001) were more likely to report being overweight or obese. CONCLUSIONS: This study demonstrates strong links between health literacy and obesity, even after adjusting for key potential confounders, and provides new insights into potential intervention points in school education for obesity prevention. Systematic approaches to integrating a health literacy curriculum into schools may mitigate the growing burden of disease due to obesity.

Effects of a food advertising literacy intervention on Taiwanese children's food purchasing behaviors.

Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising.

Expanding school-district/university partnerships to advance health promoting schools implementation and efficacy in Taiwan.

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Facilitating the implementation and efficacy of health-promoting schools via an action-research approach in Taiwan.

Taiwan launched its evidence-based health-promoting school (HPS) program via an action-research approach in 2010. The program featured a collaborative partnership between schools, local education authorities and university support networks. This study was focused on examining whether an HPS action-research approach was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011, questionnaires were sent to 900 sample schools in Taiwan. A total of 621 schools returned the questionnaire, including 488 primary schools and 133 middle schools. The response rate was 69%. This study compared the difference in HPS implementation status, perceived HPS impact and perceived HPS efficacy between those schools that had implemented action-research HPS (138 schools) and those that had not (483 schools). The univariate analysis results indicated that the HPS implementation levels for components that included school health policies, physical environment, social environment, teaching activities and school-community relations were significantly higher in action-research schools than in non-action-research schools. Teachers in action-research schools reported significantly higher levels of HPS impact and HPS efficacy than non-action-research schools. The multivariate analysis results indicated that after controlling for school level and HPS funding, the HPS action-research approach was significantly positively related to greater levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Assessing the Quality of ChatGPT's Dietary Advice for College Students from Dietitians' Perspectives.

BACKGROUND: As ChatGPT becomes a primary information source for college students, its performance in providing dietary advice is under scrutiny. This study assessed ChatGPT's performance in providing nutritional guidance to college students. METHODS: ChatGPT's performance on dietary advice was evaluated by 30 experienced dietitians and assessed using an objective nutrition literacy (NL) test. The dietitians were recruited to assess the quality of ChatGPT's dietary advice, including its NL achievement and response quality. RESULTS: The results indicate that ChatGPT's performance varies across scenarios and is suboptimal for achieving NL with full achievement rates from 7.50% to 37.56%. While the responses excelled in readability, they lacked understandability, practicality, and completeness. In the NL test, ChatGPT showed an 84.38% accuracy rate, surpassing the NL level of Taiwanese college students. The top concern among the dietitians, cited 52 times in 242 feedback entries, was that the "response information lacks thoroughness or rigor, leading to misunderstandings or misuse". Despite the potential of ChatGPT as a supplementary educational tool, significant gaps must be addressed, especially in detailed dietary inquiries. CONCLUSION: This study highlights the need for improved AI educational approaches and suggests the potential for developing ChatGPT teaching guides or usage instructions to train college students and support dietitians.

Orthokeratology compliance, digital device use, and myopia control among children with myopia during COVID-19 home confinement in Taiwan.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts lifestyle habits and myopia control in children worldwide. This study investigated the changes in eyecare habits, orthokeratology compliance, axial length, and time interval of follow-up visits during home confinement in the COVID-19 pandemic in Taiwan. Methods: This investigation was part of a prospective study undertaken to evaluate the effectiveness of a mobile application. A semi-structured telephone interview was conducted with parents retrospectively to document eyecare habits and myopia control during the COVID-19 home confinement. Results: Thirty-three children with myopia participated in the follow-up of orthokeratology lenses for 2 years. The children's time viewing digital devices such as tablets and televisions significantly increased during the COVID-19 pandemic (P < 0.05). An analysis using McNemar's test found that the proportional growth of axial length <0.2 mm in 2021 was significantly higher than that in 2020 (77.42% vs. 58.06%, P < 0.05). In the multivariate logistic regression analysis, onset <10 years of age (P = 0.001) and parents with high myopia (P < 0.001) were independent risk factors for the growth of axial length ≥0.2 mm in 2021. Conclusion: The suspension of face-to-face classes and after-school tutorials benefited myopic axial elongation in children during COVID-19 home confinement. The use of digital devices and staying indoors may not be the exclusive reasons for myopia progression. Educating parents about the influence of extra learning classes after school on myopia progression would be prudent.

A Pilot Study to Explore the Improvements in Pulmonary and Cognitive Functions With a Kazoo Intervention Among Middle-Aged and Older Adults in a Rural Community.

Dementia is a leading cause of disability and dependence in older adults worldwide. The aim of this pilot study was to explore the effect of using a kazoo instrument to improve pulmonary function and cognitive reserve in middle-aged and older adults in rural areas. This quasi-experimental study was conducted at two community care stations selected using cluster sampling from a rural district in southern Taiwan. We enrolled 85 middle-aged and older adults who were randomly assigned into self-learner and in-class groups. Both groups received a 6-month kazoo program. Cognitive and pulmonary function were compared before and after the intervention between the two groups. Significantly improved pulmonary function with regards to forced vital capacity (p < .05) was found in the self-learner group, and significantly improved maximum expiratory flow 75% (p < .001) was found in both groups. Mini-Mental State Examination scores significantly improved in the self-learner group (p < .01), but there was no significant change in the in-class group. Our results suggest that community care stations could consider implementing wind instrument programs such as a kazoo to enhance pulmonary function and cognitive reserve in middle-aged and older adults residing in rural areas.