The Effects of Self-Aromatherapy Massage on Pain and Sleep Quality in Patients with Rheumatoid Arthritis: A Randomized Controlled Trial.

BACKGROUND: Rheumatoid arthritis is the most common form of inflammatory arthritis and can lead to pain, joint deformity, and disability, resulting in poor sleep quality and lower quality of life. The efficacy of aromatherapy massage on pain levels and sleep quality among rheumatoid arthritis patients remains unclear. AIMS: To investigate the effects of aromatherapy on pain and sleep quality among rheumatoid arthritis patients. METHODS: This randomized controlled trial enrolled 102 patients with rheumatoid arthritis from one regional hospital in Taoyuan, Taiwan. Patients were randomly assigned to the intervention (n = 32), placebo (n = 36), or control groups (n = 34). The intervention and placebo groups underwent self-aromatherapy hand massage guided by a self-aromatherapy hand massage manual and video for 10 minutes 3 times a week for 3 weeks. The intervention group used 5% compound essential oils, the placebo group used sweet almond oil, and the control group had no intervention. Pain, sleep quality and sleepiness were measured by using the numerical rating scale for pain, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale at baseline and at 1, 2, and 3 weeks after the intervention. RESULTS: The intervention and placebo groups had significantly decreased sleep quality and sleepiness scores from baseline to 3 weeks after aromatherapy massage. Compared with the control group, the intervention group showed statistically significant improvement in the sleep quality scores in the first weeks after aromatherapy massage (B = -1.19, 95% confidence interval [CI]: -2.35, -0.02, P =.046), but no statistically significant differences were found in the changes in pain levels from baseline to the three time points. CONCLUSIONS: Aromatherapy massage is effective in improving sleep quality in rheumatoid arthritis patients. More studies are needed to evaluate the effects of aromatherapy hand massage on the pain levels of rheumatoid arthritis patients.

Mindfulness-based programme on the psychological health of pregnant women.

PROBLEM: Preparation of psychological well-being is an important component of antenatal education for childbirth, but few courses focus on this component. BACKGROUND: The psychosocial health of pregnant women is known to affect perinatal outcomes. Psychosocial stress in women has been associated with increased obstetric interventions and has been shown to affect the health of both mother and child. AIM: To explore the efficacy of an eight-week Mindfulness-Based Childbirth and Parenting programme on reducing prenatal stress, depression, mindfulness, and childbirth self-efficacy. METHODS: In this prospective and randomized controlled trial study, 104 women between 13 and 28 weeks gestation were enrolled and assigned randomly into two groups. Participants in the experimental group received mindfulness-based programme and practice-at-home with audio recordings. The comparison group received traditional education classes. Psychological health was assessed at baseline, post-intervention, and 36-week gestation. FINDINGS: Significant differences were seen in both groups in terms of changes over time in stress, depression, childbirth self-efficacy, and mindfulness, as compared with baseline. In gestation week 36, stress scores were slightly higher and childbirth self-efficacy and mindfulness scores were lower for both groups, but all scores were relatively better in the experimental than in the comparison group. CONCLUSIONS: Perinatal mental health problems affect mothers, their infants, and society. The eight-week mindfulness programme effectively reduced self-perceived stress and depression and increased childbirth self-efficacy and mindfulness. Future research is needed to explore the potential benefits, mechanisms, and effects on maternal and infant birth outcomes of mindfulness.

Efficacy of light therapy on nonseasonal depression among elderly adults: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to examine the effectiveness of light therapy in the treatment of geriatric depression. METHODS: A systematic review and meta-analysis were carried out. Data sources for the literature search were PubMed, Cochrane Collaboration's Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and ClinicalTrials.gov. Controlled trials of light therapy on older patients with nonseasonal depression and depression rating scales were eligible. Studies were pooled using a random-effect model for comparisons with light therapy. We used effect size (ES), which expresses changes in depression severity, in each selected meta-analysis to calculate the standardized mean difference on the basis of Hedges' adjusted g; positive values indicated that the depression severity improved after light therapy. All results were presented with 95% CIs. Statistical heterogeneity was explored through visual inspection of funnel plots and the I2 statistic. Moderators of effects were explored using meta-regression. RESULTS: We identified eight trials involving 395 participants that met the inclusion criteria. Light therapy was significantly more effective than comparative treatments, including placebo or dim light, with an ES of 0.422 (95% CI: 0.174-0.709, P=0.001). In addition, six of the eight trials used bright (white) light, resulting in significantly reduced severity of geriatric depression (N=273, ES: 0.460, 95% CI: 0.085-0.836, P=0.016). Furthermore, pale blue light therapy reduced the severity of geriatric depression (N=89, ES: 0.464, 95% CI: 0.046-0.882, P=0.030). CONCLUSION: Our results highlighted the significant efficacy of light therapy in the treatment of geriatric depression. Additional well-designed, controlled studies are necessary to adopt standard parameters, adequate group sizes, and randomized assignment to evaluate more thoroughly the efficacy of light therapy for treating geriatric depression.

The effects of integrated nursing education on quality of life and health-related outcomes among obstructive sleep apnea patients receiving continuous positive airway pressure therapy.

PURPOSE: This study sought to examine the effects of a nursing education program on quality of life and sleep disturbance among obstructive sleep apnea (OSA) patients receiving continuous positive airway pressure (CPAP) therapy. METHODS: This study was a randomized controlled trial with an intervention group consisting of a nursing education program. The intervention group received the instruction of the CPAP nursing education program, and the control group received routine care. Data was collected for both groups before the intervention (pre-test), on the 7th day measurement after the intervention, and on the 30th day measurement after the intervention. RESULTS: The results showed, first, that the intervention group reported a significantly reduced level of disturbance from wearing CPAP compared with that of the control group after the intervention (ß = -1.83, p = .040). Second, the Calgary sleep apnea quality of life index (SAQLI) total scores significantly improved after the intervention (ß = 1.669, p = 0.014). Also, symptoms of the SAQLI sub-items were improved and significantly different (ß = 5.69, p = 0.007) after the intervention in the intervention group. CONCLUSIONS: According to the results of the study, the disturbance from wearing CPAP, the total score of the SAQLI and the symptoms of the SAQLI were significantly improved after the nursing education intervention. Therefore, an adequate nursing education program is recommended for the initial period of CPAP use among OSA patients.

Cost-Effectiveness Analysis of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for Stroke Prevention in Atrial Fibrillation in Taiwan.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the cost effectiveness of novel oral anticoagulants (NOACs) for stroke prevention among atrial fibrillation (AF) patients by incorporating Taiwanese demographic information derived from a population-based database, the National Health Insurance Research Database (NHIRD), into cost-effectiveness analysis. METHODS: From 1 January to 31 December 2012, 98,213 AF patients were selected from the NHIRD database. A Markov model was constructed that combined published secondary data with the Taiwan NHIRD to compare the cost and incremental cost effectiveness of apixaban 5 mg twice daily, dabigatran 110 or 150 mg twice daily, rivaroxaban 20 mg once daily, and warfarin. RESULTS: The lifetime costs of warfarin, dabigatran 110 mg, dabigatran 150 mg, rivaroxaban 20 mg, and apixaban 5 mg were US$10,660, US$13,693, US$13,426, US$13,455, US$15,965, respectively. Apixaban resulted in an incremental cost effectiveness of US$39,351, US$27,039, US$41,298, and US$48,896 per quality-adjusted life-year (QALY) compared with warfarin, dabigatran 110 mg, dabigatran 150 mg, and rivaroxaban 20 mg, respectively. In Monte-Carlo analyses, apixaban 5 mg, rivaroxaban 20 mg, warfarin, and dabigatran 110 mg were cost effective in 83, 10.4, 7, and 0.8%, respectively, of the simulations using a willingness-to-pay (WTP) threshold of US$50,000 per QALY. CONCLUSIONS: Apixaban was more cost effective than warfarin, dabigatran, and rivaroxaban for stroke prevention in patients with AF. Among the anticoagulant therapies, the WTP threshold of apixaban was about US$50,000 per QALY gained. These cost-effectiveness estimations provide useful information to aid clinical decision making in stroke prevention for AF patients.

Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: A randomized controlled study.

BACKGROUND: Dry mouth (xerostomia) is a common symptom in hemodialysis patients, which is associated with a reduced salivary flow. Xerostomia affects patients' oral health and quality of life. OBJECTIVES: The aim of this study was to investigate using a mouthwash as a means to reduce xerostomia and improve saliva flow rates in hemodialysis patients. DESIGN: A randomized controlled trial. SETTINGS AND METHODS: Three dialysis centers in Northern Taiwan served as the study sites. Patients were purposively sampled from three hemodialysis centers in Taiwan and randomly assigned to one of three groups: pure water mouthwash; n=41, licorice mouthwash; n=44, or no mouthwash (control); n=37. The Summated Xerostomia Inventory, and unstimulated whole salivary flow rate measured dry mouth and salivary flow, respectively. Data was collected at baseline, dialysis Day 5 and Day 10. RESULTS: One hundred twenty-two patients participated in this study. Baselines were adjusted for any imbalances in variables and generalized estimating equations analysed the data. Compared to control, a pure water mouthwash resulted in an increase in the unstimulated salivary flow rate of 25.85×10-3mL/min and 25.78×10-3mL/min (p<0.05) at Day 5 and Day 10, respectively. The estimated effect size was 1.38. However, there was no significant decrease in Summated Xerostomia Inventory scores. The licorice mouthwash also significantly improved the unstimulated salivary flow rates to 114.92×10-3mL/min, and 131.61×10-3mL/min at Day 5 and Day 10, respectively (p< 0.001). However, in contrast to the pure water mouthwash, the licorice mouthwash resulted in a significant improvement in the scores for the Summated Xerostomia Inventory (p<0.001). CONCLUSION: Although a pure water or a licorice mouthwash and improved the objective measure of salivary flow rate, only the licorice mouthwash provided subjective relief of xerostomia. This suggests the use of a licorice mouthwash may effectively relieve feelings of dry mouth in hemodialysis patients.

Registered Nurse to Bachelor of Science in Nursing: nesting a fast-track to traditional generic program, teachings from nursing education in Burkina Faso.

BACKGROUND: Nursing education has evolved over time to fit societies' increasing care needs. Innovations in nursing education draw thorny debates on potential jeopardy in the quality, safety, and efficacy of nurse graduates. Accelerated nursing education programs have been among landmark strategic changes to address the persistent bedside nurse shortage. Despite the dearth of empirical studies in sub-Saharan Africa (SSA), the National School of Public Health of Burkina Faso has developed a State Diploma Nursing (SDN) fast-track program. With innovative features, the program is nested into the traditional SDN program. This study investigates preliminary outcomes of the implemented policy using the initial cohort that went through the program. Comparison of the traditional generic program and the fast-track one is drawn to inform nursing education policy. METHODS: The study was conducted in the three campuses delivering the SDN program. Data collected from a representative sample included 255 students from the 2006-2009 cohort, after concluding the program. Surveyed students were assessed according to the program entry status. Outcomes were measured using students' academic performance. Besides descriptive analysis, bivariate t-test, F-test, and multivariate ordinary least square regression (OLSR) were employed to determine the comparative pattern between the traditional generic and the newly nested fast-track program. Students' varied statuses (private pre-registration, state pre-registration, private post-registration, and state post-registration) were kept to better outline the findings trend. RESULTS: A fifth (19.6 %) of surveyed students were enrolled in the fast-track stream from which, one third (33.7 %) consisted of post-registered students. Fast-track students comparatively achieved the best academic performance (mean: 73.68/100, SD: 5.52). Multivariate OLSR confirmed that fast-track students performed better (ß: 5.559, p < 0.001), and further informed differences between campuses. Students entry status also displayed significant differences, yet the academic performance of post-registered students from traditional generic versus fast-track was similar (p = 0.409). CONCLUSION: Findings suggest that fast-track program students performed better than the ones from the traditional generic program. The uniqueness and success of this mixed nursing program experience sheds light for nursing educators engaged in policy making. The study results can serve as a crucial foundation for policymakers to alleviate the nurse shortage in SSA.

[The Impact of Late Umbilical Cord Clamping on Neonatal Jaundice and Postpartum Hemorrhage: A Randomized Controlled Trail].

BACKGROUND: The current evidence supports the clinical benefits of late umbilical cord clamping. These benefits include increased blood volume and total body iron. Furthermore, delayed cord clamping facilitates the transplantation of stem cells, which helps the development of infant bodily systems. However, due to concerns related to postpartum hemorrhaging and neonate jaundice, most maternity units still clamp the cord immediately after a child is born. PURPOSE: This study investigates the impact of delaying cord clamping on neonatal jaundice and postpartum hemorrhage. METHODS: A randomized, controlled trial was conducted at a regional teaching hospital in northern Taiwan. One hundred and five healthy nulliparous women at 36 weeks of pregnancy were included and allocated randomly to the experiment group (n=44) and the control group (n=61). Participants in the experiment group received delayed cord clamping (DCC) at 3 minutes after delivery. Participants in the control group received early cord clamping (ECC) at around 1 minute after delivery. Clinical measures of the outcomes were measured by the infant transcutaneous bilirubin levels (TcB) and postpartum hemorrhage at birth. A structured questionnaire and biophysical measures were used to collect data on participant demographics, obstetrical information, maternal blood loss at birth, neonate weight and TcB level at hospitalization, and whether or not the infant received phototherapy at 4-7 days postpartum. RESULTS: Overall, there was no significant difference between the two groups in terms of neonatal jaundice, maternal hemorrhage at birth, and phototherapy rates at time of hospitalization and at 4-7 days postpartum. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of the present study support that late umbilical cord clamping does not increase the risk of maternal postpartum hemorrhaging or neonate jaundice. Thus, we suggest that clinicians inform clients during prenatal classes of the benefits of delayed cord clamping and also use current, evidence-based knowledge to dispel client worries regarding the dangers to maternal-neonate health of delayed cord clamping.

Changes in the use of complementary and alternative medicine in Taiwan: a comparison study of 2007 and 2011.

OBJECTIVE: In this study, we explored the differences in the use of complementary and alternative medicine (CAM) based on data from 2007 and 2011 national surveys in Taiwan. RESEARCH DESIGN: Two cross-sectional, community-based epidemiological surveys were conducted in Taiwan. Participants 18 years and older were interviewed regarding their CAM use in the previous 12 months. Nationally representative random-household telephone surveys using a sampling method with a probability proportional to size were conducted in 2007 and 2011. The data were analysed to compare the results between surveys. RESULTS: We obtained a total of 1260 and 2266 valid responses in 2007 and 2011, respectively. The use of at least one or more CAM therapies during the previous year decreased from 48.9% in 2007 to 37.8% in 2011 (p < .001). In both surveys, the most common CAM therapies used were Chinese medicinal herbs followed by health supplement products and tuina. We observed the greatest relative increase in CAM use between 2007 and 2011 in health supplement products (12.8% vs. 16.0%) and massage (1.3% vs. 2.9%), whereas the largest relative decrease occurred for tuina (24.4-13.4%) and Chinese medicinal herbs (31.6-25.4%). CONCLUSION: Widespread CAM use reflects a more personal orientation towards maintaining health and selecting health care support services. Thus, a set of standards should be established for the safety and effectiveness of therapies, and consensus building is required to overcome the differences among practitioners from various backgrounds and traditions.

Efficacy of warm showers on labor pain and birth experiences during the first labor stage.

OBJECTIVE: To determine the efficacy of warm showers on parturition pain and the birth experiences of women during the first stage of labor. DESIGN: Randomized controlled trial (RCT). SETTING/PARTICIPANTS: The study was conducted from July 10, 2010 to January 12, 2011 in the maternity ward of a Taipei City regional teaching hospital, site of approximately 220 to 250 births per month. Ninety-two expectant mothers were recruited (recruitment rate: 70.8%) and allocated by block randomization into the two arms of the study. In total, 80 women completed the trial: 41 in the control group and 39 in the experimental group. METHODS: Participants in the experimental group received warm shower bath interventions. Each shower lasted 20 minutes. After a 5-minute full body or lower back shower, participants could spend 15 minutes directing shower water toward any body region that felt most comfortable. Facilities allowed participants to stand and sit as desired. Water was constantly monitored and maintained at a temperature of 37°C. Participants in the control group received standard childbirth care. RESULTS: Labor pain and the birth experience were assessed using the Visual Analogue Scale for Pain (VASP) and the Labour Agentry Scale, respectively. After adjusting for demographic and obstetric data, experimental-group women who participated in warm showers reported significantly lower VASP scores at 4-cm and 7-cm cervical dilations, and higher birth experiences than the control group. CONCLUSION: Apart from the positive physical hygiene effects, warm showers are a cost-effective, convenient, easy-to-deploy, nonpharmacological approach to pain reduction. This intervention helps women in labor to participate fully in the birthing process, earn continuous caregiver support, feel cared for and comforted, and have a more positive overall experience.

Factors associated with subsequent eye care for children in Taiwan: a population-based historical cohort study.

PURPOSE: To investigate patterns and factors associated with subsequent eye care for Taiwan's children. METHODS: We conducted a population-based historical cohort study of 2464 children aged between 3 and 12 years old from the 2005 National Health Interview Survey (NHIS). Participants' ocular conditions were identified based on 2005 NHIS questionnaire answers given by caregivers. Subsequent eye care data was obtained from 2006 and 2007 National Health Insurance claim data. Eye care related to these children's ocular conditions was defined by physician's diagnosis using the International Classification of Diseases version 9 clinical modification codes. Poisson regression with robust variance estimation was used to determine factors associated with eye care use. RESULTS: Of the 2464 children, 712 (28.9%) had ocular conditions in 2005, and 56.5% and 44.7% of them didn't receive eye care during the subsequent 1- and 2-year periods, respectively. Among those with ocular conditions, the 3-4-year-olds were least likely to receive eye care in the subsequent 1 and 2 years. Children with highly educated fathers were more likely to receive eye care in the subsequent 1-year period. Sex, family income, level of mother's education, residential area and eye care resources were not significant factors for children with ocular conditions receiving subsequent eye care within either 1 or 2 years. CONCLUSIONS: Despite the fact that Taiwan has a National Health Insurance Program, lack of subsequent eye care remains high, even when a child's ocular condition is known by the caregiver. Determinants associated with follow-up eye care must be considered when designing eye care enhancing programs for children.

Awareness and use of folic acid among pregnant women in Taipei.

OBJECTIVE: Periconceptional use of folic acid may effectively reduce the risk of fetal neural tube defects. The objective of the present study was to evaluate the awareness and use of folic acid during periconceptional period in Taiwan. MATERIALS AND METHODS: A cross-sectional study was performed at Taiwan Adventist Hospital between March 2008 and December 2008. Data were obtained using a questionnaire from 275 women between 10-12 weeks of gestation. RESULTS: About 90% of women reported having ever heard of folic acid, but only 15.6% of women used folic acid before their pregnancy. There was no significant relationship between awareness and use of folic acid and variant sociodemographic factors. Only 41% of women (78/191) understood the recommended dose of folic acid. About 86% of women (170/197) reported they could identify natural folate-rich food and most of them stated green leaf vegetables as the most important natural source of folic acid. CONCLUSION: Only a small proportion of women have used folic acid before their pregnancies. A public health policy or strategy to increase the preconceptional use of folic acid is needed in Taiwan.

Community-based interventions to reduce falls among older adults in Taiwan - long time follow-up randomised controlled study.

AIMS: The aim of the study was to examine the effects of different interventions that are used to prevent falls. These were education, Tai Chi Chuan and education plus Tai Chi Chuan; the study involved a five-month implantation period and a one-year follow-up period. BACKGROUND: With advancing years, a fall can be very serious and an increased number of falls/re-falls among older adults has been noted. Hence, both education about risk factors and balance exercise programs such as Tai Chi Chuan may help to prevent falls. DESIGN: This study adopted a randomised case-controlled design with a two-by-two factorial approach. It included three intervention groups and one control group in a community-based program. METHODS: Cluster-randomised sampling was used and four villages in Taiwan City were selected. Three interventions groups and one control group were involved over five-months from late July 2000-January 2001 and each participant was followed up one year later (n = 163). RESULTS: The intervention involving education plus Tai Chi Chuan resulted in a statistically significant reduction in falls and the risk factors of falls over the five-month intervention. After one-year follow-up, participants receiving any one of the interventions showed a reduction in falls compared with the control group. CONCLUSIONS: Tai Chi Chuan was able to improve gait balance significantly. Education may also help participants to prevent falls-by eliminating related risk factors present in their environment. However, it was found that at the one-year follow-up, any one of the three interventions had reduced falls significantly. RELEVANCE TO CLINICAL PRACTICE: The prevention of falls among older adults seems to needs multiple interventions. Education plus Tai Chi Chuan has both an immediately and a long-term effect and it is possible that a shorter intervention period using this approach would also be successful.

Socioeconomic and demographic factors associated with health care choices in Taiwan.

By using the data from the 2001 National Health Interview Survey and the National Heath Insurance database in Taiwan, this study aims at investigating the socioeconomic and demographic factors associated with different health care choices. This study incorporated hierarchical cluster analysis into multiple correspondent analysis to determine 5 attribute clusters of socioeconomic and demographic factors associated with different health care choices. This study found that older women with higher education levels were more likely to choose multiple sources of health care and that low- to middle-income people were more likely to use over-the-counter medications in pharmacies. In addition, people's self-reported health care choices were inconsistent with their observed health care seeking behavior. The health policy authority may need to provide more health promotion education programs, especially for older women with higher educational levels, and funding incentives for quality of care provided rather than relying solely on reimbursements for episodic care.