Prevalence of and Associated Factors for Overactive Bladder Subtypes in Middle-Aged Women: A Cross-Sectional Study.

Background and Objectives: The living environment can manifest physiological responses in humans, with cohabiting couples often having similar health statuses. The aim of this study was to (1) examine the prevalence of the overactive bladder (OAB) with or without incontinence and (2) identify associated factors for OAB with and without incontinence (including environmental factors, such as living with a partner who has OAB) in middle-aged women. Materials and Methods: In this cross-sectional study, the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OBA) was administered to 970 couples. Data were analyzed using descriptive statistics, chi-square analyses, and multivariate logistic regression. Results: Responses to the ICIQ-OBA among middle-aged women generated a higher prevalence of OAB with incontinence (OABwet; 41%) than OAB without incontinence (OABdry; 26%; p < 0.001). The factors associated with OABwet were as follows: being age ≥ 55 years (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.02−1.95), having a body mass index (BMI) ≥ 27 kg/m2 (OR, 1.50; 95% CI, 1.03−2.17), having vaginitis (OR, 1.89; 95% CI, 1.28−2.80), and having partners with OABwet (OR, 2.35; 95% CI, 1.74−3.19). Having partners with OABdry (OR, 1.81; 95% CI, 1.34−2.44) was an associated factor for OABdry. Conclusions: This study identified the associated factors for OAB subtypes (OABwet and OABdry) in middle-aged women. These findings can support treatment and preventive strategies for health providers who care for patients with OAB. As part of the treatment and preventative strategies, the risk that partners may introduce to the development of OAB in women should also be considered.

Overactive Bladder during Pregnancy: A Prospective Longitudinal Study.

Background and Objectives: Overactive bladder (OAB) is a serious urination-related symptom of unknown pathogenesis that affects one's everyday activities. The objective of this study was to examine how OAB prevalence, symptom severity, and degree of distress caused by OAB symptoms evolved throughout the course of pregnancy. Materials and Methods: A total of 659 pregnant women were recruited from 2015 to 2020, and were evaluated through the International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) on OAB symptoms, administered in the early, middle, and late stages of pregnancy. Results: Generalized estimating equation analysis revealed that the odds of OAB occurring in the middle and late stages of pregnancy were 1.90 and 2.33 times higher, respectively, than in early pregnancy. The corresponding odds for OAB-wet were 1.63 and 2.07 higher, respectively, and the odds of OAB-dry occurring during late pregnancy were 0.80 higher than during early pregnancy. Symptoms were more severe by 0.07 and 0.21 points (on a 4-point scale) in the middle and late stages of pregnancy, respectively, than in early pregnancy; distress was greater by 0.13 and 0.27 points (on a 10-point scale) in the middle and late stages of pregnancy, respectively, than in early pregnancy. The prevalence of OAB, OAB-dry, and OAB-wet was significantly higher in early pregnancy than pre-pregnancy. Conclusions: The prevalence of OAB and OAB-wet increased over the course of pregnancy, but the prevalence of OAB-dry decreased. Furthermore, symptom severity and degree of distress increased over time.

Hepatoprotective effects of Methyl ferulic acid on alcohol-induced liver oxidative injury in mice by inhibiting the NOX4/ROS-MAPK pathway.

AIMS: The present study aimed to investigate the hepatoprotective effects of Methyl ferulic acid (MFA) against oxidative stress and apoptosis as well as inflammation in mice with liver injury induced by alcohol and its underlying mechanisms. METHODS: C57BL/6 mice were divided into a control group,a model group, and Methyl ferulic acid with high dosage (20 mg/kg), moderate dosage (10 mg/kg) and low dosage (5 mg/kg) groups. The general condition and organ index of each group were investigated. Histopathological analysis was performed to determine the degree of hepatic injury. Biochemical analyses of functional liver enzymes, lipid peroxidation enzymes and lipid content in each group. The levels of inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA). The mechanisms were investigated by detecting levels of NADPH Oxidase 4 (NOX4),p22phox, cytochrome P4502E1 (CYP2E1),Bax,B-cell lymphoma 2 (Bcl-2),cleaved-caspase 3 and 9 and phosphorylated extracellular regulated protein kinases(ERK),phosphorylated c-Jun N-terminal kinase (JNK), and phosphorylated p38 mitogen-activated protein kinase (MAPK) using real-time polymerase chain reaction (PCR) and Western blotting. RESULTS: MFA treatment significantly decreased serum enzymatic activities of alanine aminotransferase (ALT) and aspartate aminotransaminase (AST). MFA markedly increased levels of superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GSH-Px) and total antioxidative capacity (T-AOC), and reduced the concentration of malondialdehyde (MDA) and reactive oxygen species (ROS). Histopathological examination of livers showed that MFA reduced cytoplasmic vacuolisation necrosis and inflammatory cell infiltration in alcohol-treated mice. MFA treatment remarkably reduced the levels of trigyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL), decreasing the levels of high-density lipoprotein (HDL), alcohol dehydrogenase(ADL) and aldehyde dehydrogenase (ALDH). MFA treatment remarkably inhibited the expression of inflammatory factors tumour necrosis factor (TNF)-α, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-1ß and IL-6. MFA attenuated both mRNA and protein expression of NOX4,p22phox,CYP2E1,Bax/Bcl-2. In addition, MFA inhibited the activation of caspase 3 and 9 and downregulated the levels of p-JNK,p-p38 MAPK and p-ERK in liver. CONCLUSION: MFA has a protective effect on alcohol-induced liver injury, which may be related to its antioxidant,anti-inflammatory,lipid-eliminating properties and its ability to regulate the NOX4/ROS-MAPK signalling pathway.

Sex life and role identity in Taiwanese women during menopause: a qualitative study.

AIM: Our goal was to examine Taiwanese women's perspectives on the way menopause affected their sexual behaviour to gain an in-depth understanding of their experiences during this transition. BACKGROUND: Physical symptoms associated with menopause may affect women's sexual experiences. Little is known about how menopause-related changes in sexual behaviour may affect role identity of women living in a modernizing urban culture that is still strongly rooted in traditional beliefs and attitudes. DESIGN: This was a qualitative study involving face-to-face interviews using open-ended questions. METHODS: During 2011-2012, eighteen peri or postmenopausal women visiting a medical clinic for gynaecological examinations or treatment were interviewed about their sexual experiences. Responses were analysed for common themes. FINDINGS: Four themes were identified about the effects of menopause on women's sex life: (1) changes in physical responses during sex; (2) the acceptance/non-acceptance of the current situation; (3) sexual pressure related to their marital role; (4) efforts to improve sexual interest or activity. Menopause-related physical changes often (but not always) made sexual interactions difficult. But women's responses to the changes varied. Some used sexual discomfort as a reason to avoid sexual intercourse. Others sought to improve their sexual encounters through behavioural modifications or hormone therapy. CONCLUSIONS: Given the variety of reactions to the impact of menopause on sexual behaviour/relationships seen here, it is clear that health professionals need to assess of each woman's specific situation and be prepared to recommend a variety of behavioural or hormonal treatment options.

Concealing emotions: nurses' experiences with induced abortion care.

AIMS AND OBJECTIVES: To explore the experiences of nurses involved with induced abortion care in the delivery room in Taiwan. BACKGROUND: Induced abortion has emotional, ethical and legal facets. In Taiwan, several studies have addressed the ethical issues, abortion methods and women's experiences with abortion care. Although abortion rates have increased, there has been insufficient attention on the views and experiences of nurses working in the delivery room who are involved with induced abortion care. DESIGN: Qualitative, semistructured interviews. METHODS: This study used a purposive sampling method. In total, 22 nurses involved with induced abortion care were selected. Semistructured interviews with guidelines were conducted, and the content analysis method was used to analyse the data. RESULTS: Our study identified one main theme and five associated subthemes: concealing emotions, which included the inability to refuse, contradictory emotions, mental unease, respect for life and self-protection. CONCLUSION: This is the first specific qualitative study performed in Taiwan to explore nurses' experiences, and this study also sought to address the concealing of emotions by nurses when they perform induced abortion care, which causes moral distress and creates ethical dilemmas. The findings of this study showed that social-cultural beliefs profoundly influence nurses' values and that the rights of nurses are neglected. RELEVANCE TO CLINICAL PRACTICE: The profession should promote small-group and case-study discussions, the clarification of values and reflective thinking among nurses. Continued professional education that provides stress relief will allow nurses to develop self-healing and self-care behaviours, which will enable them to overcome the fear of death while strengthening pregnancy termination counselling, leading to better quality professional care.

Exploring clinical judgment ability in second-degree baccalaureate of science nursing students: A mixed methods study.

BACKGROUND: As they have not yet embarked on clinical practice, most students who already have a bachelor's degree but require a bachelor's degree in nursing occasionally perceive the educator's instruction on clinical situations as abstract and challenging for making accurate clinical judgments. OBJECTIVES: This study aims to implement a clinical judgment model and case scenarios in classroom teaching to evaluate improvements in students' clinical judgment and critical thinking abilities. DESIGN: A mixed-method design. SETTING: A second-degree Bachelor of Science in Nursing at a university in Taiwan. PARTICIPANTS: First-year undergraduate nursing students. METHODS: This mixed-methods study featured a survey at the beginning and end of a course, followed by one-on-one online interviews. A purposive sample of sophomore nursing students was recruited from a university in northern Taiwan between March 2020 and May 2021. Semi-structured interviews were conducted after a preliminary analysis of the collected quantitative data. RESULTS: In total, 48 participants completed the study questionnaire, and 20 were interviewed. The results show that the students' ability to make clinical judgment and identify individual health problems from case scenarios significantly improved after completing the course. However, critical thinking did not differ significantly after the course. Qualitative data analysis revealed three key themes relevant to the participants' learning experiences: (1) establishing the context of clinical judgment, (2) building a bridge between basic medical science and clinical nursing, and (3) having a broader perspective. CONCLUSIONS: Incorporating clinical judgment measurement model and case scenarios in the curriculum may benefit second-degree Bachelor of Science in Nursing students who have not yet begun their clinical practice. Additionally, the result provides educators with valuable learning goals and evaluation strategies in the classroom and clinical practice.

Experiences of Family Caregivers Providing Home Care to Older Patients With Cancer: A Qualitative Study.

BACKGROUND: Older patients with cancer receive anticancer therapy in outpatient settings, and care-related issues may occur after discharge, which often requires family caregivers (FCs) to play a significant role in providing cancer care at home. However, relatively few studies have been focused on exploring the care experiences of these FCs. PURPOSE: The aim of this study was to explore the care experiences of FCs caring for older family members with cancer at home. METHODS: A qualitative study design and in-depth individual interviews were used to explore the at-home care experiences of FCs of older patients with cancer. The research was conducted in chemotherapy outpatient settings of a medical center in northern Taiwan. Content analysis was used to analyze data. The analyses focused on first extracting meaningful units from the text and then inducting categories from these units and determining the major themes. RESULTS: Twenty FCs were interviewed. The three themes identified included (a) increased information needs and challenges in diet preparation and treatment decision making, (b) personal and patient-induced emotional stress, and (c) life rebalancing through the care experience. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings highlight the educational requirements, especially related to meeting personal dietary needs and obtaining psychological support, for FCs caring for older patients with cancer to help them rebalance their life.

Methyl ferulic acid ameliorates alcohol-induced hepatic insulin resistance via miR-378b-mediated activation of PI3K-AKT pathway.

A previous study indicated that microRNA-378b (miR-378b) plays a critical role in controlling hepatic insulin resistance by targeting insulin receptor (IR) and p110α in alcoholic liver disease (ALD). Methyl ferulic acid (MFA), a bioactive ingredient in Securidaca inappendiculata Hassk rhizomes, exhibits multiple pharmacological activities. It has been reported that MFA ameliorates insulin resistance in ALD, whereas the underlying molecular mechanism remains unclear. The objective of study was to evaluate the influence of MFA on insulin sensitivity in ethanol-induced L-02 cells as well as alcohol-fed mice and illuminate the function of miR-378b-mediated phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway in system. MFA was found to remarkably down-regulate miR-378b level and increase IR and p110α expressions. Furthermore, the effect of MFA on modulating miR-378b/PI3K-AKT pathway to enhance insulin sensitivity was corroborated by overexpressing and inhibiting miR-378b. Taken together, MFA exhibited a positive effect against ALD by attenuating the inhibition of miR-378b on IR/p110α and partly activating the insulin signaling to alleviate alcohol-induced hepatic insulin resistance.

microRNA-378b regulates ethanol-induced hepatic steatosis by targeting CaMKK2 to mediate lipid metabolism.

Alcoholic liver disease (ALD) has seriously harmed the health of people worldwide, but its underlying mechanisms remain unclear. This study aims to clarify the biological function of microRNA-378b (miR-378b) in ethanol (EtOH)-induced hepatic lipid accumulation. Here, we report miR-378b is over-expressed in EtOH-induced cells and EtOH-fed mice and finally accelerates lipid accumulation. MiR-378b directly targets Ca2+/calmodulin-dependent protein kinase kinase 2 (CaMKK2), a kinase of AMP-activated protein kinase (AMPK), and mediates the protein level of CaMKK2. Over-expression of miR-378b exacerbated the lipid accumulation induced by EtOH and inhibited CaMKK2 and the AMPK cascade while inhibition of miR-378b ameliorated lipid metabolism dysfunction in vivo and in vitro. In brief, our results show that miR-378b plays an important role in the regulation of lipid metabolism by directly targeting CaMKK2.

miR-378b Regulates Insulin Sensitivity by Targeting Insulin Receptor and p110α in Alcohol-Induced Hepatic Steatosis.

Insulin resistance has been implicated in alcoholic liver disease. A previous study has shown that microRNAs (miRNAs) play a major role in the production, secretion, and function of insulin. MiRNAs are capable of repressing multiple target genes that in turn negatively regulate various physiological and pathological activities. However, current information on the biological function of miRNAs in insulin resistance is limited. The goal of the present study was to elucidate the role of miR-378b in alcohol-induced hepatic insulin resistance and its underlying mechanism. This study has observed that miR-378b is up-regulated in National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcoholic mouse models as well as in ethanol-induced L-02 cells in vitro. Furthermore, miR-378b overexpression impaired the insulin signaling pathway, and inhibition of miR-378b improved insulin sensitivity in vivo and in vitro. A mechanistic study revealed that IR and p110α are direct targets of miR-378b. Together, these results suggest that miR-378b controls insulin sensitivity by targeting the insulin receptor (IR) as well as p110α and possibly play an inhibitory role in the development of insulin resistance, thereby providing insights into the development of novel diagnostic and treatment methods.

Relationships between body image, sexual dysfunction, and health-related quality of life among middle-aged women: A cross-sectional study.

OBJECTIVES: To examine whether body image, sexual function, and relationship with a partner influence health-related quality of life (HRQoL) among middle-aged women, as well as to identify the association with menopausal symptoms. MAIN OUTCOME MEASURES: Physical component summary and mental component summary of HRQoL. METHODS: This was an analysis of 1026 women (2013-2014); data regarding demographic characteristics, sexual function, body image, relationship with partner, menopausal symptoms and HRQoL during middle age were collected. HRQoL, sexual function, body image, relationship with partner, and menopausal symptoms were measured using the Medical Outcomes Study SF-12, Female Sexual Function Index (FSFI), Multidimensional Body-Self Relations Questionnaire-Appearance Scale, the Relationship Assessment Scale, and the Greene Climacteric Scale, respectively. A multivariate regression was used to examine factors influencing HRQoL. RESULTS: After adjusting for covariates, significant factors predicting the physical component summary (PCS) of HRQoL among middle-aged women included the orgasm domain of the FSFI (ß = 0.69; p = 0.023), appearance evaluation (ß = 0.93; p = 0.037), and menopausal symptoms (ß = -0.25; p < 0.001). The factors predicting the mental component summary (MCS) of HRQoL included the satisfaction domain of the FSFI (ß = 0.70; p = 0.014), appearance evaluation (ß = 2.09; p < 0.001), self-classified weight (ß = 1.21; p < 0.001), relationship with partner (ß = 0.16; p = 0.034), and menopausal symptoms (ß = -0.36; p < 0.001). CONCLUSION: The results indicated that negative appearance evaluation and menopausal symptoms predicted poor HRQoL among middle-aged women. Higher frequency of orgasm predicted better PCS; sexual satisfaction and satisfaction with relationship with a partner predicted better MCS of HRQoL.

Ethanol-Induced Hepatic Insulin Resistance is Ameliorated by Methyl Ferulic Acid Through the PI3K/AKT Signaling Pathway.

One of the key events during the development of alcoholic liver disease (ALD) is that alcohol inhibits the insulin signaling pathway in liver and leads to disorders of glucose and lipid metabolism. Methyl ferulic acid (MFA) is a biologically active monomer isolated from the root of Securidaca inappendiculata Hasskarl. It has been reported that MFA has a hepatoprotective effect against alcohol-induced liver injury in vivo and in vitro. However, the effect of MFA on ethanol-induced insulin resistance in ALD remains unclear. In this study, we investigated whether MFA could exert protective effects against hepatic insulin resistance in ethanol-induced L-02 cells and ALD rats. ALD was induced in vivo by feeding Lieber-DeCarli diet containing 5% (w/v) alcohol for 16 weeks to Sprague-Dawley rats. Insulin resistance was induced in vitro in human hepatocyte L-02 cells with 200 mM ethanol for 24 h followed by 10-7 nM insulin for 30 min. MFA exhibited the effects of inhibited insulin resistance, reduced enzymatic capacity for hepatic gluconeogenesis, and increased hepatic glycogen synthesis both in vivo and in vitro. In addition, the results of transcriptome sequencing of liver tissues in the ethanol- and MFA-treated groups indicated that "pyruvate metabolism," "glycolysis/gluconeogenesis," and "fatty acid metabolism" were significantly different between ethanol- and MFA-treated groups. Further studies suggested that MFA activated the hepatic phosphatidylinositol 3-kinase (PI3K)/AKT pathway in vivo and in vitro. Taken together, these findings suggested that MFA effectively ameliorated hepatic insulin resistance in ALD at least partially by acting on the PI3K/AKT pathway.

Methyl ferulic acid attenuates liver fibrosis and hepatic stellate cell activation through the TGF-ß1/Smad and NOX4/ROS pathways.

Liver fibrosis is a pathological wound-healing response caused by chronic liver damage due to a virus, autoimmune disorder, or drugs. Hepatic stellate cells (HSCs) play an essential role in the pathogenesis of liver fibrosis. Methyl ferulic acid (MFA), a biologically active monomer, has a protective effect on liver injury. However, the effects and roles of MFA in liver fibrosis remain unknown. The purpose of the current study was to investigate the effect of MFA on hepatic fibrosis and the underlying mechanisms. Human hepatic stellate LX-2 cells were exposed to 5 µg/L TGF-ß1 for 48 h to stimulate liver fibrosis in vitro. Using MTT, RT-PCR and Western blot analysis, we revealed that MFA significantly inhibited the proliferation of LX-2 cells as well as decreased the expressions of α-SMA and type I collagen in LX-2 cells. SD rats were fed with ethanol, and this combined with the intraperitoneal injection of CCl4 induced liver fibrosis in vivo. We found that the administration of MFA markedly decreased the levels of hyaluronic acid (HA), procollagen type III (PC-III), type IV collagen (CIV) and laminin (LN) in the serum, inhibited the expression of α-smooth muscle actin (α-SMA) as well as type I and type III collagen, and up-regulated the ratio of MMP-2/TIMP-1 in rats. The antifibrotic effects of MFA were also evaluated by H&E staining and Masson's trichrome staining. In addition, further studies suggested that this protection by MFA from liver fibrosis was possibly related to the inhibition of TGF-ß1/Smad and NOX4/ROS signalling. In conclusion, our results demonstrate that MFA attenuated liver fibrosis and hepatic stellate cell activation by inhibiting the TGF-ß1/Smad and NOX4/ROS signalling pathways.

Methyl ferulic acid attenuates ethanol-induced hepatic steatosis by regulating AMPK and FoxO1 Pathways in Rats and L-02 cells.

Methyl ferulic acid (MFA) is a biologically active monomer extracted and purified from the Chinese herbal medicine Securidaca inappendiculata hasskarl. The previously studies showed that MFA improved acute liver injury induced by ethanol. However, the effect of MFA on ethanol-induced hepatic steatosis in alcoholic liver disease (ALD) still remains unclear. The current study was aimed at elucidating the effect of MFA on alcohol-induced hepatic steatosis and the underlying mechanisms. Human hepatocyte L-02 cells exposed to 200 mM ethanol for 24 h to simulate alcoholic steatosis in vitro. SD rats were fed a Lieber-DeCarli diet containing 5% (w/v) alcohol for 16 weeks to induce alcoholic liver disease in vivo. We examined the effect of MFA on ethanol-induced lipid deposition in L-02 cells and SD rats. The results showed that MFA reduced the accumulation of lipid in L-02 cells, improved alcoholic liver injury in rats, alleviated hepatic pathological lesions, and reduced lipid deposition in rat serum and liver. Further studies suggest that MFA reduces lipid synthesis by activating AMPK-ACC/MAPK-FoxO1 pathway. In addition, MFA also promotes lipid oxidation by up-regulating the expression of SIRT1, PPAR-α, and CPT-1α. Taken together, MFA ameliorates ethanol-induced hepatic steatosis by activating AMPK-ACC/MAPK-FoxO1 pathway and up-regulating the expression levels of SIRT1, PPAR-α, and CPT-1α.

NOX4/ROS mediate ethanol­induced apoptosis via MAPK signal pathway in L­02 cells.

The aim of the present study was to assess the molecular mechanism of ethanol­induced oxidative stress­mediated apoptosis in L­02 liver cells in order to elucidate novel pathways associated with alcoholic liver disease. L­02 cells were treated with 400 mM ethanol with or without inhibitors. The cell viability was measured by an MTT assay. Cell apoptosis was assessed by flow cytometry and a single­stranded DNA (ssDNA) assay. Intracellular reactive oxygen species (ROS) production of L­02 cells was determined using the 2',7'­dichlorofluorescein­diacetate dye. The protein expression of c­Jun N­terminal kinase (JNK), phosphorylated (p)­JNK, P38, p­P38, NADPH oxidase (NOX)1, NOX4, p22phox, B­cell lymphoma 2 (Bcl­2) and Bcl­2­associated X protein were measured by western blot analysis. The mRNA expression of NOX1, NOX4 and p22phox was measured by reverse transcription polymerase chain reaction analysis. The results indicated that after treatment with various concentrations of ethanol for the indicated durations, L­02 cells were displayed a significant decrease in cell viability in a dose­and time­dependent manner. Ethanol­induced apoptosis and cell death of L­02 cells was accompanied by the generation of ROS, elevated expression of NOX, as well as phosphorylation of JNK and P­38. In addition, increased expression of Bcl­2 was induced by 400 mM ethanol. Furthermore, treatment with NOX inhibitor attenuated the ethanol­induced a decrease in cell viability, and an increase in apoptosis and Bcl­2 expression. In conclusion, ethanol induced apoptosis in the L­02 hepatocyte cell line via generation of ROS and elevated expression of NOX4. This indicated that activation of JNK and p38 in the mitogen­activated protein kinase pathway promotes apoptosis in L­02 cells.

Decision-making tree for women considering hysterectomy.

AIMS: This paper reports on a study carried out to establish a decision tree model to describe how women in Taiwan make the decision whether or not to have a hysterectomy. In addition, we examined the predictability of the decision-tree model. BACKGROUND: Hysterectomy is the second most common surgical procedure performed worldwide. Medical professionals believe that the operation can relieve pain and prevent cervical cancer, thus improving a woman's quality of life. While most physicians advise hysterectomy even for benign uterine conditions, feminists decry the belief that the uterus has no purpose, believing that it is an important symbol of womanhood. METHODS: The study was conducted in two phases. Phase I, the model development phase, was carried out to generalize data from a qualitative study of 14 women and to establish a tree model outlining their decision to proceed with hysterectomy. The second phase was the model prediction phase that applied inductive and deductive methods to data analysis and development of the decision-tree model. The model tree was then tested with 18 women who were deciding whether or not to undergo hysterectomy. Using the decision-making tree, we studied the women's thought processes and analysed their primary concerns. The study was carried out in 1999-2001. RESULTS: The study determined 13 criteria that Taiwanese women use when deciding about having a hysterectomy. Developed in accordance with Gladwin's methodology, the model tree successfully predicted 90% of decisions whether or not to have a hysterectomy. CONCLUSIONS: Nurses working in gynaecological services should understand how women decide to undergo hysterectomy so that the proper counselling and follow-up can be provided. With further testing, our decision tree may help in this process.