Cultural adaptation and validation of the Chinese version of the Fatigue Severity Scale in patients with major depressive disorder and nondepressive people.

PURPOSE: The aims of the study were to adapt the Fatigue Severity Scale to Chinese conditions and assess the psychometric properties of the Chinese version in patients with major depressive disorder (MDD) and nondepressive people. METHODS: A total of 101 patients with MDD and 94 nondepressive persons were included in this study. A forward and backward translation procedure was performed for developing a culturally acceptable Chinese version of the Fatigue Severity Scale (CFSS). Validity was assessed according to construct validity, internal consistency, concurrent validity, divergent validity, and contrasted-group validity. RESULTS: The CFSS exhibited a one-factor structure in patients with MDD and the nondepressive participants. A 7-item version of CFSS and an 8-item version of the CFSS demonstrated better model fit than the original 9-item version in the patients with MDD and the nondepressive participants, respectively. In both participant groups, internal consistency values were within acceptable ranges. In addition, concurrent validity and divergent validity were confirmed in both groups. The average CFSS score of patients with MDD was significantly higher than that of the nondepressive participants. CONCLUSION: The 9-item CFSS is a valid instrument for assessing fatigue-related impairment in Chinese-speaking patients with MDD. However, the two reduced-item CFSS versions showed better psychometric properties than the original version in the patients with MDD and the nondepressive participants.

Neighborhood disadvantage and physical aggression in children and adolescents: A systematic review and meta-analysis of multilevel studies.

Child and adolescent physical aggression are influenced by multiple contexts, such as peers, family, school, and neighborhood. However, the effect of neighborhoods on youth physical aggression remains unclear. The objective of this study was to quantitatively synthesize studies that have examined the effect of neighborhood disadvantage on physical aggression in children and adolescents and to identify potential moderators. We searched seven databases for articles published before April 25, 2015. Studies were considered eligible if they were published in peer-reviewed journals, used multilevel data, controlled for neighborhood clustering, used physical aggression as the study outcome, and considered children or adolescents as the study population. Of the 152 eligible studies, we included 43 in the meta-analysis. The results from the random-effects model revealed that neighborhood disadvantage was positively and significantly associated with physical aggression (P < .001). Metaregression and moderator analyses further indicated a stronger association between neighborhood disadvantage and physical aggression among studies with younger participants, a higher percentage of female participants, and a longer follow-up period (P < .05). Current findings, however, may not be generalized to other types of aggression. The observed neighborhood effects may also be limited because of the omission of studies that did not provide sufficient information for calculating the pooled effect. In summary, the results provide supporting evidence for the adverse effect of living in disadvantaged neighborhoods on physical aggression after adjusting for the individual-level characteristics of children and adolescents. Interventions targeting structural contexts in neighborhoods are required to assist in reducing physical aggression in young people. Aggr. Behav. 42:441-454, 2016. © 2016 Wiley Periodicals, Inc.

Effects of Massage on Blood Pressure in Patients With Hypertension and Prehypertension: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Massage may help reduce blood pressure; previous studies on the effect of massage on blood pressure have presented conflicting findings. In addition, no systematic review is available. OBJECTIVE: The aim of this study was to evaluate the evidence concerning the effect of massage on blood pressure in patients with hypertension or prehypertension. METHODS: A search was performed on electronic database records up to October 31, 2013, based on the following medical subject headings or keywords: hypertension, massage, chiropractic, manipulation, and blood pressure. The methodological quality of randomized controlled trials was assessed based on the Cochrane collaboration tool. A meta-analysis was performed to evaluate the effect of massage on hypertension. The study selection, data extraction, and validation were performed independently by 2 reviewers. RESULTS: Nine randomized controlled trials met our inclusion criteria. The results of this study show that massage contributes to significantly enhanced reduction in both systolic blood pressure (SBP) (mean difference, -7.39 mm Hg) and diastolic blood pressure (DBP) (mean difference, -5.04 mm Hg) as compared with control treatments in patients with hypertension and prehypertension. The effect size (Hedges g) for SBP and DBP was -0.728 (95% confidence interval, -1.182 to -0.274; P = .002) and -0.334 (95% confidence interval, -0.560 to -0.107; P = .004), respectively. CONCLUSION: This systematic review found a medium effect of massage on SBP and a small effect on DBP in patients with hypertension or prehypertension. High-quality randomized controlled trials are urgently required to confirm these results, although the findings of this study can be used to guide future research.

Effect of Feedback Signal on Blood Pressure Self-regulation Capability in Individuals With Prehypertension or Stage I Hypertension: A Randomized Controlled Study.

OBJECTIVES: We aimed to determine the efficacy of an 8-week direct blood pressure (BP) biofeedback training program for prehypertensive or stage I hypertensive patients with a particular focus on the impact of the authenticity of feedback signals on the efficacy of BP regulation. DESIGNS: This study has a randomized, double-blind, parallel-group design. PARTICIPANTS AND METHODS: Fifty-nine individuals with ages from 18 to 64 years and who met the criteria for the diagnosis of prehypertenion or stage 1 hypertension participated in this study. The participants were referrals from physicians or community-dwelling volunteers. No participants had taken antihypertensive medication within the previous 2 months prior to enrollment. The participants were randomly assigned to the biofeedback group (n = 31) trained with real-time BP feedback signals or the control group (n = 28) trained with pseudofeedback signals. The primary outcome measures were systolic BP (SBP) and diastolic BP (DBP). Systolic BP and DBP were assessed at baseline, 1 week after training (week 9), and 8 weeks after training (week 16) in both groups. Only 54 participants had week 16 data. RESULTS: The changes in SBP and DBP from baseline to week 9, from baseline to week 16, and from week 9 to week 16 were not significantly different between the groups (All P > 0.05). Both groups were able to significantly decrease BP after completing the training. A percentage of 45.2% of the participants in the biofeedback group and 63.0% of the participants in the control group lowered their SBP by 5 mm Hg or more at week 9. The SBP-lowering effects were also maintained for at least 8 weeks after the completion of training. CONCLUSIONS: The equivalent magnitude of BP reduction between the 2 study groups suggests that repeated practice in BP self-regulation was more likely responsible for the efficacy of direct BP biofeedback training than was the type of feedback signals.

Effects of health qigong on sleep quality: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This study assessed the effects of Health Qigong on sleep quality in adults. DESIGN: Systematic review and meta-analysis. METHOD: We searched 10 databases to identify relevant randomized controlled trials (RCTs) published in English or Chinese languages that evaluated the effects of Health Qigong on sleep quality in participants aged ≥18 years old with or without diseases in comparison with any type of controls. Quality of the included studies was assessed by the revised Cochrane risk-of-bias tool for randomized trials. The between-group treatment effect size was estimated by calculating Hedges' g and associated confidence interval (CI) through a random effects model. Cochran's Q test and I2 were used to determine heterogeneity. RESULTS: The initial search yielded 730 articles, of which 13 studies involving 1147 participants were included in the systematic review and meta-analysis. The overall effect size was -0.955 (95 % CI: -1.601 to -0.309, p = 0.004). A homogeneity test revealed high heterogeneity (Q = 278.187, p < 0.001, I2 = 95.686 %). A sensitivity analysis was conducted through the exclusion of an outlier, which revealed a small but statistically significant effect size (Hedges' g = -0.423, 95 % CI: -0.603 to -0.243, p < 0.001; Q = 18.073, p = 0.08, I2 = 39.137 %). CONCLUSIONS: Our study results suggest that Health Qigong is beneficial for improving sleep quality in adults with and without disease. However, the effects of Health Qigong could be partially due to nonspecific effects as half of the included studies did not employ an active control.

Clinical Decision Path for Identifying Recurrent Falls in Late Middle-Aged and Older Patients With Chronic Schizophrenia.

BACKGROUND: Falls are a major hazard for elderly patients with schizophrenia. As patients with schizophrenia may experience a more-accelerated rate of physical aging than the overall elderly population, the risk of falls may emerge during the late middle-age period in this population. Furthermore, the risk of falls is affected by multiple, interrelated risk factors. PURPOSE: This study was undertaken to capture the complexity of the risk of falls in patients with schizophrenia. A cross-sectional approach was used to apply classification and regression tree (CART) analysis to generate a clinical decision path to identify the risk factors of recurrent falls in late middle-aged and older patients with schizophrenia. METHODS: Two hundred ninety-one patients aged 55 years or older were recruited from psychiatric halfway houses for assessment. Frailty, physical functional performance, depressive severity, cognitive function, and level of fatigue were measured, respectively, using the Study of Osteoporotic Fractures Frailty Index, Short Physical Performance Battery (SPPB), Center for Epidemiological Studies Depression Scale, Short Portable Mental Status Questionnaire (SPMSQ), and Chinese version of the Fatigue Severity Scale. The variables revealed by descriptive statistics to be statistically significant were further analyzed using CART analysis. RESULTS: The overall proportion of recurrent fallers in this study was 19.2%. CART analysis revealed eight end groups and identified four predictors: frailty, physical functional performance, cognitive function, and sex. The most prominent condition for recurrent fallers was frailty, present in 57.1% of the frail participants. In the nonfrail group (both prefrail and robust), participants with an SPPB score of less than 10 had a 29.7% chance of being a recurrent faller versus 13.6% for those with an SPPB score of 10 or more. Furthermore, an SPMSQ score of 7 was the next-best split among participants without frailty, with an SPPB score of 10 or more. Finally, among participants without frailty and with an SPPB score of 10 or more and an SPMSQ score of more than 7, the proportion of recurrent fallers was higher in women than men. CONCLUSIONS: The results of this study indicate that assessing frailty status may be an effective, first-step approach to identifying schizophrenic patients at an increased risk of recurrent falls. Among patients with prefrailty or robust status, an SPPB score cutoff of 10, an SPMSQ score cutoff of 7, and being female may be used sequentially to identify individuals at a heightened risk of recurrent falls.

[Noninvasive measurement of cardiovascular functions: blood pressure reactivity to stress].

Advances in medical engineering have introduced novel tools to monitor changes in hemodynamics in a continuous and non-invasive manner. Blood pressure or cardiovascular reactivity to laboratory-induced mental stresses in individuals with certain traits or diseases differs from that of healthy controls. Therefore, blood pressure reactivity to stress can be used as an index of cardiovascular function. It can also be used in research to elucidate linkages between exaggerated blood pressure response and cardiovascular disease. This paper introduces the stress response and its physiologic mechanisms, blood pressure reactivity, short-term regulation of blood pressure, and blood pressure reactivity assessment methods.

The efficacy of reflexology: systematic review.

AIM: This paper is a report of a systematic review to evaluate the efficacy of reflexology in any condition. BACKGROUND: Anecdotal evidence has shown potential benefits of reflexology in a variety of health conditions. However, the efficacy of reflexology has yet to be determined. DATA SOURCES: Cochrane library, PubMed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: reflexology, foot reflexotherapy, reflexological treatment, foot massage and zone therapy. Chinese articles were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996 to 2007. REVIEW METHODS: Studies were selected if they were written in English or Chinese, used a controlled clinical trial design, used reflexology as a stand-alone modality, and reported such outcomes as symptoms relief, quality of life and patients' perceptions of reflexology. Study quality was reviewed based on the evidence rating system of the United States Preventive Services Task Force, and studies with the evidence rating of II-2 fair or above were included in this review. RESULTS: Among the five studies suitable for review, there was only one report of a statistically significant treatment effect. Among the 12 outcome variables examined, the treatment effect size for urinary symptoms was large, whereas the effect size for other conditions was negligible. CONCLUSION: There is no evidence for any specific effect of reflexology in any conditions, with the exception of urinary symptoms associated with multiple sclerosis. Routine provision of reflexology is therefore not recommended.

A systematic review of the efficacy of non-pharmacological treatments for depression on glycaemic control in type 2 diabetics.

AIMS AND OBJECTIVES: This paper reported a systematic review of three randomised controlled clinical trials evaluating the efficacy of non-pharmacological treatment of depression on glycaemic control in individuals with type 2 diabetes. BACKGROUND: Depression is associated with poor adherence to self-care regimen in individuals with diabetes. A significant relationship between depression and poor glycaemic control has also been suggested. Hence, the management of depression becomes an important aspect of diabetes care. DESIGN: Systematic review. METHODS: Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words - depression, mood disorder, depressive symptoms, diabetes mellitus, glycaemic control, glycated haemoglobin, glucose, psychological therapy, psychotherapy, non-pharmacological therapy and cognitive behaviour therapy. The publication date was limited from 1996-2007. Studies were selected if they used a randomised controlled trial design, were written in English, used non-pharmacological treatments for treating depression, included individuals with type 2 diabetes mellitus as participants and included depressive symptoms and glycaemic control (determined by haemoglobin A(1)C) as outcomes. RESULTS: Non-pharmacological treatments of depression reduce depressive symptoms in diabetic patients. However, cognitive behaviour therapy did not improve glycaemic control. The treatment effect sizes for glycaemic control in the two collaborative-care programmes were also small. CONCLUSIONS: The available evidence indicated that non-pharmacological treatment of depression had limited effect on glycaemic control in individuals with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE: The depression-focused interventions might not achieve optimal diabetes-related outcomes. The beneficial effect of psychological treatment for glycaemic control may be strengthened by employing treatments tailored to each individual's diabetes self-care needs in addition to depression management.

Systematic review and meta-analysis of the efficacy of tuina for cervical spondylosis.

AIMS AND OBJECTIVES: This study performed a meta-analysis of seven parallel-group comparison studies evaluating the efficacy of tuina in treating cervical spondylosis. BACKGROUND: Tuina is a form of Chinese manipulative therapy. It has been used as a modality for the treatment of symptoms associated with such a musculoskeletal condition as cervical spondylosis. However, evidence regarding the efficacy of tuina for cervical spondylosis has yet to be determined. DESIGN: Systematic review. METHODS: Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: tuina, tuinaology, manual medicine, massotherapy, cervical spondylopathy, cervical spondylosis and cervical vertebrae. Chinese research papers were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996-2007. Studies were selected if they were written in English or Chinese, used tuina as a stand-alone modality, used a parallel-group comparison design and explicated raw data regarding symptoms relief. Two independent reviewers reviewed the selected studies based on the evidence rating system of the US Preventive Services Task Force. Studies with an evidence rating of II-2 fair or above were included in this review. RESULTS: The direction of the effect size for the improvement of blood flow velocity of vertebral artery and basilar artery was not consistent across studies. Moreover, the pooled effect size was negligible. No evidence supported that tuina could improve headache and vertigo. A small effect of tuina on the viscosity of blood and plasma was found. CONCLUSION: Based on the results of this systematic review, a definitive conclusion regarding the effects of tuina on cervical spondylosis remains to be determined. RELEVANCE TO CLINICAL PRACTICE: The efficacy of tuina is not supported by parallel-group comparison studies.

Blood pressure biofeedback exerts intermediate-term effects on blood pressure and pressure reactivity in individuals with mild hypertension: a randomized controlled study.

OBJECTIVE: This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension. METHODS: Participants in the active biofeedback group (n=20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group (n=18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training. RESULTS: The decreases in systolic (12.6 +/- 8.8 versus 4.1 +/- 5.7) and mean BP (8.2 +/- 6.9 versus 3.3 +/- 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group (p=0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP (p=0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group (p=0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged. CONCLUSIONS: BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress.

Demographic characteristics and perceived health status of users of folk therapies in Taiwan.

OBJECTIVES: This study examined the prevalence of folk therapy use among Taiwanese adults and factors associated with such use. SUBJECTS AND METHODS: The data used in this study were from the 2001 National Health Interview Survey in Taiwan, which utilized a multistaged stratified systematic sampling scheme. Included in the current analysis were 11,290 individuals from 20 to 65 years. RESULTS: Only 1.3% of those surveyed were classified as users of folk therapy. Users of folk therapies were older (p = 0.002), had higher annual incomes (p < 0.001), and experienced more health problems (p = 0.006) than nonusers. The two groups were comparable in the areas of marital status, employment status, gender, and educational level. Users had lower scores in the physical functioning (p < 0.001), role physical (p = 0.041), general health perception (p = 0.002), and bodily pain (p < 0.001) domains of the Medical Outcome Studies 36-Item Short-Form Health Survey. The two groups were not significantly different regarding the utilization and satisfaction with conventional medical resources and the domain scores of the brief version of the World Health Organization Quality of Life (QOL) questionnaire. CONCLUSIONS: Less than 2% of adult Taiwanese population reported relying primarily on folk therapies for their common physical discomfort. Users of folk therapies are older, have higher incomes, and have more health problems and poorer health-related QOL, but they neither make more frequent use of conventional medical services nor are they dissatisfied with the available services.

Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis.

CONTEXT: The Child Behavior Checklist-Attention Problem (CBCL-AP) scale and Conners Rating Scale-Revised (CRS-R) are commonly used behavioral rating scales for diagnosing attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. OBJECTIVE: To evaluate and compare the diagnostic performance of CBCL-AP and CRS-R in diagnosing ADHD in children and adolescents. DATA SOURCES: PubMed, Ovid Medline, and other relevant electronic databases were searched for articles published up to May 2015. STUDY SELECTION: We included studies evaluating the diagnostic performance of either CBCL-AP scale or CRS-R for diagnosing ADHD in pediatric populations in comparison with a defined reference standard. DATA EXTRACTION: Bivariate random effects models were used for pooling and comparing diagnostic performance. RESULTS: We identified and evaluated 14 and 11 articles on CBCL-AP and CRS-R, respectively. The results revealed pooled sensitivities of 0.77, 0.75, 0.72, and 0.83 and pooled specificities of 0.73, 0.75, 0.84, and 0.84 for CBCL-AP, Conners Parent Rating Scale-Revised, Conners Teacher Rating Scale-Revised, and Conners Abbreviated Symptom Questionnaire (ASQ), respectively. No difference was observed in the diagnostic performance of the various scales. Study location, age of participants, and percentage of female participants explained the heterogeneity in the specificity of the CBCL-AP. CONCLUSIONS: CBCL-AP and CRS-R both yielded moderate sensitivity and specificity in diagnosing ADHD. According to the comparable diagnostic performance of all examined scales, ASQ may be the most effective diagnostic tool in assessing ADHD because of its brevity and high diagnostic accuracy. CBCL is recommended for more comprehensive assessments.

Effect of valproic acid on dementia onset in patients with bipolar disorder.

BACKGROUND: Valproic acid (VPA) is widely used for treating patients with bipolar disorder; however, it has adverse effects on cognitive function. This study investigated the effect of VPA on the risk of dementia in patients with bipolar disorder. METHODS: We analyzed data from Taiwan's Longitudinal Health Insurance Database 2010. Patients with bipolar disorder who were prescribed VPA for 28 days or at least once per month for 3 consecutive months after the index date were classified as the VPA-treated group, whereas those who did not receive VPA were classified as the VPA-untreated group. Both groups were tracked until the end of 2013 or until loss to follow-up to identify new-onset dementia events. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) of subsequent dementia associated with VPA treatment after adjustment for confounding variables. RESULTS: The study comprised 5158 patients with bipolar disorder. The multivariable-adjusted HR for newly diagnosed dementia was 1.73 (95% confidence interval [CI], 1.24-2.41, P=0.001) for the VPA-treated group compared with the VPA-untreated group after adjustment for potential confounders. The VPA-treated group had a higher risk than did the VPA-untreated group after propensity score adjustment (HR=1.95, 95% CI=1.42-2.67, P<0.001). LIMITATION: Certain variables that may affect the incidence of dementia were unavailable in the claims database and thus could not be considered. CONCLUSION: Treating bipolar disorder with VPA increases the risk of dementia by 73-95%.

Cardiovascular Reactivity in Patients With Major Depressive Disorder With High- or Low-Level Depressive Symptoms: A Cross-Sectional Comparison of Cardiovascular Reactivity to Laboratory-Induced Mental Stress.

Depression increases the risk of adverse cardiac events. Cardiovascular reactivity is defined as the pattern of cardiovascular responses to mental stress. An altered pattern of cardiovascular reactivity is an indicator of subsequent cardiovascular disease. Because depression and adverse cardiac events may have a dose-dependent association, this study examined the differences in cardiovascular reactivity to mental stress between patients with major depressive disorder (MDD) with high depression levels and those with low depression levels. Moreover, autonomic nervous system regulation is a highly plausible biological mechanism for the pattern of cardiovascular reactivity to mental stress. The association between cardiovascular reactivity and parameters of heart rate variability (HRV), an index for quantifying autonomic nervous system activity modulation, was thus examined. This study included 88 patients with MDD. HRV was measured before stress induction. The Stroop Color and Word Test and mirror star-tracing task were used to induce mental stress. We observed no significant association between depressive symptom level and any of the cardiovascular reactivity parameters. Cardiovascular reactivity to mental stress was comparable between patients with MDD with high-level depressive symptoms and those with low-level depressive symptoms. After adjusting for confounding variables, the high-frequency domain of HRV was found to be an independent predictor of the magnitude of heart rate reactivity (ß = -.33, p = .002). In conclusion, the magnitude of cardiovascular reactivity may be independent of depression severity in patients with MDD. The autonomic regulation of cardiovascular responses to mental stress primarily influences heart rate reactivity in patients with MDD.

The EPCOR model: a model for promoting the successful implementation of evidence-based nursing in hospital-based settings.

BACKGROUND: An effective organizational infrastructure is essential to successfully implement and sustain an evidence-based nursing (EBN) practice. Although EBN has been promoted in Taiwan for more than 10 years, variations in the organizational policies and strategies necessary to support EBN among healthcare organizations have prevented effective implementation. Barriers to the implementation of EBN located at the organizational level have also been reported. The need for a model that focuses on the organizational infrastructure to promote EBN in Taiwan has therefore become increasingly apparent. PURPOSE: This study aims to develop a model that contains the key contextual elements of organizational infrastructure necessary to effectively promote EBN, especially in hospital settings. METHODS: A steering committee drafted the components and related strategies of the proposed model. Delphi technique was used to obtain consensus on the proposed model among a group of experts with expertise in EBN. Thirty experts participated in all three rounds of the Delphi survey. To confirm the appropriateness of the proposed model for clinical settings, the model was further reviewed by a focus group composed of experts with experience in implementing EBN or evidence-based medicine in hospitals. The strategies were then further modified based on the suggestions of this focus group, and only those strategies that best fit hospital settings were retained. RESULTS: Five key contextual elements and related strategic processes were identified, including equipment, policy, training courses, outcome indicators, and reward plans. The resultant model was named EPCOR, an acronym composed of the names of each identified element. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: EPCOR is a comprehensive model of organizational infrastructure and strategic procedures for implementing EBN in hospital-based settings in Taiwan. Organizations may use the EPCOR model to initiate and implement EBN practices and then to evaluate their effectiveness.

CE: original research: The efficacy of a nurse-led breathing training program in reducing depressive symptoms in patients on hemodialysis: a randomized controlled trial.

BACKGROUND: Depression is common in patients with chronic kidney disease who are on hemodialysis. Available behavioral modalities for treating depression may not be feasible for patients who receive hemodialysis two or three times per week. OBJECTIVES: The purpose of this randomized controlled trial was to examine the efficacy of a nurse-led, in-center breathing training program in reducing depressive symptoms and improving sleep quality and health-related quality of life in patients on maintenance hemodialysis. PARTICIPANTS AND METHODS: Fifty-seven patients on hemodialysis were randomly assigned either to an eight-session breathing training group or to a control group. The Beck Depression Inventory II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Medical Outcome Studies 36-Item Short Form Health Survey (SF-36) were used to assess self-reported depressive symptoms, sleep quality, and health-related quality of life, respectively. RESULTS: The intervention group exhibited significantly greater decreases in BDI-II scores than the control group. No significant differences in PSQI change scores were observed between the groups. SF-36 change scores for both the domain of role limitation due to emotional problems and the mental component summary were significantly higher in the breathing training group than in the control group. CONCLUSION: This intervention significantly alleviated depressive symptoms, reduced perceived role limitation due to emotional problems, and improved the overall mental health component of quality of life in patients on maintenance hemodialysis.

Continuing education needs and barriers for public health nurses in Aboriginal townships in Taitung, Taiwan.

In the fast-changing arena of health care, it is important for public health nurses (PHNs) to receive professional training through continuing education (CE) to maintain practice competencies in the community. However, little information is currently known about needs for and barriers to CE for PHNs in role transition; therefore, the aim of this study was to identify CE needs and barriers for 21 PHNs in four Taitung Aboriginal townships where density of Aborigines is the highest in Taiwan. Focus group interviews were used to collect data. Interview data were then analyzed using the four step processes of data analysis suggested by Webb and Kevern (2001). The results indicated that CE for PHNs in Taitung was limited. Community assessment, psychological consultation, gerontological care, palliative care, statistical analysis and interpretation, and emergency care were identified by PHNs as CE needs. For CE barriers, about 98% of the PHNs indicated that long distance traveling was the main barrier. Family factors and inadequate support from administrative leaders were the next. It is concluded that establishing local nursing schools, using the Internet to provide CE, and planning computer systematic education courses may reduce barriers for PHNs in Taitung county.

Psychometric testing of a Mandarin Chinese Version of the Clinically Useful Depression Outcome Scale for patients diagnosed with type 2 diabetes mellitus.

BACKGROUND: The Clinically Useful Depression Outcome Scale (CUDOS) is a self-report instrument that assesses symptoms and the severity of depression, but its psychometric properties in patients with type 2 diabetes mellitus in Chinese-Speaking populations are unknown. OBJECTIVES: To examine the psychometric properties of the Mandarin Chinese version of the CUDOS (CUDOS-Chinese). DESIGN: A methodological research design. SETTING: Endocrinology and metabolism outpatient clinics at 2 university-affiliated hospitals in northern Taiwan. PARTICIPANTS: Two-hundred and fourteen type 2 diabetic patients with the mean age of 62.6 years were enrolled, and two-hundred and twelve of them completed the study. METHODS: Internal consistency, test-retest reliability, concurrent, and contrasted-groups validity were assessed. A receiver operating characteristic curve analysis was performed to assess sensitivity and specificity. Construct validity by means of confirmatory factor analysis was conducted. RESULTS: Internal consistency (Cronbach α of total scale and four subscales=0.93, 0.80, 0.66, 0.80, and 0.83, respectively), test-retest reliability (intra-class correlation coefficients of total scale and four subscales=0.92, 0.89, 0.94, 0.89, and 0.91, respectively), and strong correlations with the Beck Depression Inventory-II (r=0.87) suggested good reliability and validity. The confirmatory factor analysis supported a four-factor model. A cut-off score of 19/20 yielded 77.8% sensitivity and 75.6% specificity. CONCLUSIONS: The CUDOS-Chinese demonstrated satisfactory validity and reliability for detecting depression in type 2 diabetic patients in Taiwan.

Early morning awakening and nonrestorative sleep are associated with increased minor non-fatal accidents during work and leisure time.

BACKGROUND: The relationship between a composite measure of insomnia and occupational or fatal accidents has been investigated previously; however, little is known regarding the effect of various insomnia symptoms on minor non-fatal accidents during work and leisure time. OBJECTIVE: We investigated the predicting role of insomnia symptoms on minor non-fatal accidents during work and leisure time. METHODS: Data from the 2005 Taiwan Social Development Trend Survey of 36,473 Taiwanese aged ≥18 years were analyzed in 2013. Insomnia symptoms, including difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS) were investigated. A minor non-fatal accident was defined as any mishap such as forgetting to turn off the gas or faucets, accidental falls, and abrasions or cuts occurring during work and leisure time in the past month that do not require immediate medical attention. Multivariable logistic regression was performed to assess the odds ratios (ORs) and associated 95% confidence interval (CI) of minor non-fatal accidents (as a binary variable) for each insomnia symptom compared with those of people presenting no symptoms, while controlling for possible confounders. RESULTS: EMA and NRS increased the odds of minor non-fatal accidents occurring during work and leisure time (adjusted OR=1.19, 95% CI=1.08-1.32 and adjusted OR=1.27, 95% CI=1.17-1.37, respectively). CONCLUSION: EMA and NRS are two symptoms that are significantly associated with an increased likelihood of minor non-fatal accidents during work and leisure time after adjusting for of a range of covariates.