[Factors Related to Musculoskeletal Disorders Among Hospital Nurses].

BACKGROUND: Nurses are a high-risk group for musculoskeletal disorders. Few studies conducted in Taiwan have been published regarding the relationships among work characteristics, psychological well-being, and musculoskeletal discomfort in nursing personnel. PURPOSE: This study was designed to investigate musculoskeletal discomfort among hospital nursing staff, as well as its associated factors. METHODS: A secondary data analysis design was used to examine hospital staff health survey data for 2018 from two regional hospitals in southern Taiwan. Data from 328 full-time nurses who had passed their probationary period and been employed for more than 6 months were included in the analysis, which was conducted using a logistic regression model. RESULTS: The prevalence of musculoskeletal disorders was found to be highest in the shoulders (73.8%), lower back (72.9%), and neck (64.0%), respectively. Number of sleep hours, work stress, confidence in dealing with work stress, workload, supervisor support, workplace justice, and depression level differed significantly between the groups with and without full-body musculoskeletal disorders (p < .05). The results of the logistic regression model analysis showed individuals with severe depression have 4.27 times higher odds of experiencing musculoskeletal discomfort compared to those without depression (odds ratio 4.27, 95% confidence interval [1.27, 14.41]). Severe depression was found to be a significant predictor of musculoskeletal disorders. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Nurses are at high risk for musculoskeletal disorders. The results of this study indicate that level of risk is influenced significantly by psychological well-being, work environment, and workload. Efforts should be made to improve the relevant risk factors in the workplace to reduce the incidence of musculoskeletal disorders among nurses.

The biological responses of osteoblasts on titanium: Effect of oxygen level and surface roughness.

BACKGROUND/PURPOSE: Due to the general application of in vitro test, cell culture is generally selected to evaluate the cytocompatibility of devices and materials. The choice of test condition should depend on the probable site and clinical application. The oxygen content of human body could be estimated around 5%∼12%, and the oxygen level of healing bone fracture range from 0.8%∼3.8%%. However, materials for bone implant are traditionally evaluated under laboratory normoxia condition (21% O2) in vitro. The aim was to study the effect of oxygen level on osteoblast upon high stiffness titanium with different roughness. METHODS: After sandblasted and acid-etched (SLA) process, we create titanium surfaces with four different roughness. The differentiation and proliferation of MC3T3-E1 osteoblast cultured on SLA-treated specimens were evaluated in designed chamber with oxygen level of 1%, 5%, 10%, 21%. RESULTS: By scanning electron microscopy, all samples had sub-micro pit inside the micro-holes upon SLA-treated Ti disk surface. The decrease of oxygen level from 21% to 5% promoted osteoblast growth of SLA-treated specimens, but 1% O2 delayed cell proliferation. The surface roughness of specimens influenced osteoblast cell differentiation. The differentiation and proliferation ability of the cells upon SLA-treated specimens is proportional to oxygen level. CONCLUSION: Our results demonstrated that 5% O2 will easily discriminate osteoblasts responses on different SLA-treated specimens. These results suggest that hypoxia (5% O2) environment is better model for biological evaluation of bone-related materials.

Novel system in vitro of classifying oral carcinogenesis based on feature extraction for gray-level co-occurrence matrix using scanned laser pico projector.

Oral cancer is among the top 10 causes of death due to cancer worldwide. The prognosis for oral cancer patients is not good, with a 5-year survival rate of only 50%. Earlier and more precise classification will help clinicians make a diagnosis and patients survive. With the advancement of technology, computer-aided detection methods are used to help clinicians form therapy strategies. Gray-level co-occurrence matrix (GLCM) feature extraction of images describing the spatial distribution of gray levels is widely used in medical imaging analysis. Scanned laser pico projector (SLPP) has advantages such as high intensity, directivity, coherence, and mono-color with low bandwidth. In this study, GLCM feature extraction and SLPP reflex images were combined to make a small, non-staining, noninvasive classification system. According to the various image characteristics in oral carcinogenesis, SLPP reflex images better define the borders and three-dimensional structures and provide effective GLCM features such as contrast, energy, and homogeneity to classify carcinogenesis in dysplastic oral keratinocyte (DOK) and normal oral keratinocyte (NOK) cells. Moreover, it also reliably classifies highly metastatic (HSC-3) and tongue cancer (CAL-27) cells. A promising computer-aided classification system for oral cancer was developed to build a reliable intraoral examination system for in situ computer-aided diagnosis in normal clinics.

[Innovative Community Care and the Sustainable Development of University Social Responsibility in the Post-Pandemic Era].

Corporate social responsibility (CSR) has received increasing attention in recent decades. The concept of social responsibility is being applied in universities. Because universities have goals that differ significantly from corporations, the notion of university social responsibility (USR) has emerged in the academic field. The Ministry of Education in Taiwan has regularly implemented USR practice plans since 2018 (Executive Yuan, Taiwan, ROC, 2019). The core values of these plans are "local coalition" and "talent cultivation". Moreover, these plans encourage universities to use the power of professional knowledge and creation to minimize the gap between learning and application for students and to integrate local resources and hands-on strategies to better collaborate with universities around the world and expand participation in international academic activities. Sustainable development (SD) is a core objective of both CSR and USR. The United Nations has advocated for sustainable development since 1987 and formalized the five-component paradigm (people, partnership, peace, planet, and prosperity, 5Ps) in 2015. UN Agenda 2030 addresses 17 sustainable development goals (SDGs), 169 targets, and 3,155 actions, encouraging all national governments to establish national SD action plans (United Nations, 2015). Based on the review of the literature and conceptual frameworks related to USR and SD (Bokhari, 2017), we integrate practice experiences and propose three suggestions for universities: 1) diversities universities could create a campus-wide climate of and comprehensive practice for social responsibility using their professional knowledge; 2) the social, economy, and environment are included in universities SD. The curriculum development of universities links to social practice activities to achieve the goals of talent cultivation to meet social needs; 3) The university projects include specific actions and timeline. The impacts and achievements of USR and SD may be appraised by internal and external experts. Fooyin University is a school of science and technology related to "Big Health". Based on the above theoretical frameworks, the outcome evaluation model of the Center for USR, the Ministry of Education, and the UN's SDGs, we implemented the "Time Wheel Sustainable Model of Social Responsibility at Fooyin University" (Figure 1) and began cooperating with private and government organizations. The model is an intervention and evaluation guideline for the time-dynamic wheel, with the target goal of cultivating health promotion and sustainable development talent. The outcomes and impacts of the model comprise four domains and sixteen indicators. Stakeholders of this model are students/alumni, teaching faculties and administration staff, communities, and the public. USR curriculum designs involve the School of Nursing, School of Medical and Health Sciences, School of Environment and Life Sciences, and College of Humanities and Management. In 2020, 718 faculties and 2,012 students participated in USR projects. In 2021, the participation numbers were 679 faculties and 2,303 students. The Fooyin USR is now firmly rooted in thirty communities. Starting in 2022, The Fooyin USR has collaborated with local private companies (CSR) and local youths and communities (regional revitalization, RR) to launch the 3 R formula framework of the USR. The goal of the 3 R action plan is to use artificial intelligence technology to provide innovative, community-based care. The USR operations of university sustainable development around Taiwan are achieving wonderful results, with even better achievements expected. This special column presents case studies of innovative community care and sustainable development within the context of university social responsibility at four universities, including Fooyin University, Siaogang Hospital, Kaohsiung Medical University, National Cheng Kung University, and Taipei Medical University. Since 2020, nations around the world have fought off COVID-19. The strategies of national prevention have evolved to better respond to disasters and to live with the virus. Therefore, in the post-pandemic period, universities around Taiwan have been implementing sustainable development practices. These universities are making strong efforts to develop innovative care for communities through academic exchange and publishing in order to accomplish social responsibility.

[Impact of Nurse Practitioners and Nursing Education on COVID-19 Pandemics: Innovative Strategies of Authentic Technology-Integrated Clinical Simulation].

Taiwan Nurses Association and the International Council of Nurses recognize nurse practitioners (NPs) as advanced-practice nurses. A total of 11,266 registered nurses held NP certificates in April 2021 in Taiwan (Tsay, 2021). While international organizations recognize NPs with graduate degrees, over 85% of NPs in Taiwan hold a bachelor degree only. Tsay and Wang (2007) emphasized that NP education in Taiwan should be in step with international trends. Therefore, nursing schools must recruit PhD faculty who hold NP certificates. In addition, complicated and simulation-based learning procedures and teaching plans must be incorporated into the graduate curriculum and clinical practicum to promote the clinical reasoning competences and advanced nursing capabilities of NPs in light of professional training, qualifying examinations, and occupational practice. With the evolution of virtual technology, the strategies for teaching core competences in nursing education have shifted from traditional classroom lectures to online format simulation. Recently, scholars have begun using authentic technology-enhanced clinical simulation to develop and integrate nursing competence to reconceptualize the gap between theory and practice (Weeks et al., 2019). It is increasingly important to teach patient safety, clinical reasoning, and decision-making skills to nursing students using the assistive methods of clinical simulation technology (Aebersold, 2016; Johnsen et al., 2016). Since 2019, the COVID-19 pandemic has had a global impact. In May 2021, clinical practice settings and university campuses in Taiwan were closed following the announcement of a nationwide, level-3 epidemic alert. The Ministry of Education and Taiwan Nurses Association approved the replacement of up to 50% of clinical practicum hours with alternative learning activities. Therefore, faculties require innovative strategies to teach requisite skills and deliver clinical practica online. The faculty members of California State University use virtual clinical education and standardized patient-based telehealth simulations (Shea & Rovera, 2021). In Taiwan, there is a lack of studies in the literature examining the effect of replacing 50% of traditional face-to-face clinical activities with educational alternatives. Prior survey results have demonstrated the efficacy of transitioning to virtual clinical experiences in an online environment for undergraduate and graduate students (Fogg et al., 2020). Moreover, a systematic review provided evidence that virtual simulations support learning outcomes (Foronda et al., 2020). To promote clinical-reasoning competence in graduate students with NP certificates and prepare alternative, virtual-based teaching plans to meet the remaining clinical hours required of students, Fooyin University's School of Nursing has recently established the multi-functional iNursing-Innovative Learning Center. The hardware devices provide interactive virtual patients with character creator 3D, augmented realty (AR) hospital, operating room, intensive care unit, and virtual reality (VR) simulation plans for different nursing divisions as well as editors of electronic book and AR/VR teaching plans. The simulation plans include commercial products and self-design produced by well-trained faculty members. A group of seeding faculty members supported by the Ministry of Education's Higher Education Sprout Project and university funding was tapped to develop a large number of virtual simulation plans. In addition, when developing virtual simulation, it is necessary to follow teaching team discussion and learning objective setting procedures, pre-brief teachers and students, enact plans, conduct debriefing, and collect and evaluate data to explore the learning and teaching process and outcomes (Verkuyl et al., 2021). The nursing clinical practicum continues to be impacted by the ongoing COVID-19 pandemic. In a further study, nursing academic faculty cooperated with clinical preceptors to develop and design education strategies using authentic technology-integrated clinical simulations to promote advanced and comprehensive care competences in nurse practitioners.

[Needs, Dilemmas, and Policy Suggestions Related to Patients With Mental Health Long-Term Care].

In Taiwan, The increase in life expectancy in Taiwan has increased the incidents of age-related problems among patients with mental illness. Therefore, the needs related to long-term care in mental health are significantly important. These needs include: (1) reducing stigmatization; (2) reducing the physical and economic burden of caregivers; (3) constructing a comprehensive, long-term care service system; and (4) developing assessment tools suitable to the long-term care of patients with mental illness. Moreover, six dilemmas in meeting long-term care needs were identified. These dilemmas include: (1) lack of a model of continuous care and of a platform for integrating hospital and community resources; (2) poor / inadequate service quality provided by certain community rehabilitation institutions; (3) the needs of patient/family centered care; (4) the persistence of stigma and misunderstanding; (5) the heavy burdens borne by family members providing long-term care; and (6) the disconnect between subsequent needs and the disability assessment system. Policy suggestions provided in this article include: (1) establish an inclusive platform for mental health long-term care information and resource integration; (2) construct long-term care centers for patients with mental health conditions; (3) train adequate manpower to provide long-term care services to these patients; and (4) promote community inclusiveness for these patients. In order to enter the era of long-term mental health care, government policy should target long-term care programs to meet the needs of patients with mental health conditions. These programs should include seamlessly integrating services into the long-term mental health care system and the care resources of community mental health, developing suitable assessment tools, establishing a multidisciplinary team of long-term care professionals to provide mental health care.

A study of Drynaria fortunei in modulation of BMP­2 signalling by bone tissue engineering

Background/aim: Drynaria fortunei (Gusuibu; GSB) is a popular traditional Chinese medicine used for bone repair. An increasing number of studies have reported that GSB induces osteogenic differentiation in bone marrow mesenchymal stem cells (BMSCs). These results provide insight into the application of GSB for bone tissue engineering techniques used to repair large bone defects. However, few studies have described the molecular mechanisms of GSB. Materials and methods: In the present study, the effects of GSB and naringin, a marker compound, on the binding of BMP-2 to BMPR and BMP-2-derived signal transduction were investigated using surface plasmon resonance (SPR) and coculturing with BMPR- expressed cell line, C2C12, respectively. Furthermore, naringin was also used to prepare naringin contained scaffolds for bone tissue engineering. The physical and chemical properties of these scaffolds were analysed using scanning electron microscopy (SEM) and highperformance liquid chromatography (HPLC). These scaffolds were cocultured with rabbit BMSCs in vitro and implanted into rabbit calvarial defects for bone repair assessment. Results: The results showed that GSB and naringin affect the binding of BMP and BMPR in SPR experiments. GSB is a subtle BMP modulator that simultaneously inhibits the binding of BMP-2 to BMPR-1A and enhances its binding to BMPR-1B. In contrast, naringin inhibited BMP-2 binding to BMPR-1A. In vitro studies involving the phosphorylation of signals downstream of BMPR and Smad showed that GSB and naringin affected stem cell differentiation by inhibiting BMPR-1A signalling. When using GSB for bone tissue engineering, naringin exhibited a higher capacity for slow and gradual release from the scaffold, which promotes bone formation via osteoinduction. Moreover, control and naringin scaffolds were implanted into rabbit calvarial defects for 4 weeks, and naringin enhanced bone regeneration in vivo significantly. Conclusions: GSB and its marker compound (naringin) could inhibit the binding of BMP-2 and BMPR-1A to control cell differentiation by blocked BMPR-1A signalling and enhanced BMPR-1B signalling. GSB and naringin could be good natural BMP regulators for bone tissue engineering.

Texture feature extraction of gray-level co-occurrence matrix for metastatic cancer cells using scanned laser pico-projection images.

Metastasis is responsible for 90% of all cancer-related deaths in humans, and the development of a rapid and promising solution for an early diagnosis of metastasis is required. The present study proposed a promising method combined with scanned laser pico-projection technique and typical texture feature (i.e., contrast, correlation, energy, entropy, and homogeneity) extraction of gray-level co-occurrence matrix (GLCM) image processing model to classify the low- and high-metastatic cancer cells using five common cancer adenocarcinoma cell line pairs (i.e., HeLa/HeLa-S3, CL1-0/CL1-5, OVTW59-P0/OVTW59-P4, and CE81T-FNlow/CE81T-FNhigh cell lines). Highly metastatic cancer cells essentially have the highest levels of disorder. Both contrast and entropy refer to the degree of disorder, and energy and homogeneity refer to the degree of uniformity. These four texture features can be effective evaluation indexes for disorder in cancer cells responding to metastatic ability. Texture feature extraction forms reflection images, which are recorded with scanned laser pico-projection system; they effectively bridge the gap in information derived from transmission images. The low- and high-metastatic cancer cells are statistically and effectively classified from the texture feature of GLCM through transmission and reflection images taken with scanned laser pico-projection system. In particular, it only requires several seconds after producing a confluent monolayer of cells and achieves the rapid method with a more reliable diagnostic performance for metastatic ability of cancer cells in vitro or ex vivo.

[Environmental Health and Adaptation Strategy to Climate Change].

The United Nation's 17 Sustainable Development Goals (SDGs) are an urgent call to all countries for action to combat climate change and its impacts (United Nations, 2015). In response, Taiwan's highest national body, the Executive Yuan, has designated health as one of eight primary areas of threats and challenges in the policy document "Adaptation Strategy to Climate Change in Taiwan". Further, the Ministry of Education has been promoting climate-change adaptation education since 2012 and, in 2016, the Teaching Alliance was established to promote the integration of climate change issues into public education curricula as well as resource sharing and multidisciplinary collaboration (Ministry of Education, 2019). The focus of nursing on primary healthcare and community care makes nursing professionals critical to successfully attaining UN SDGs (Shmian, 2016). In addition, the environmental health component of nursing education addresses core global health and public health competences directly (Clark, Raffray, Hendricks, & Gagnon, 2016). The American Nurses Association (2013) includes environmental health as one of the eleven standards of professional performance for public health nursing. This column invites Teaching Alliance educators to share their experiences in multidisciplinary professional, teaching, and practice environments in articles that hopefully enhance readers' knowledge of adaptation strategies and of the sustainable development of public health under climate change.

Interaction between cytochrome P450 2A6 and Catechol-O-Methyltransferase genes and their association with smoking risk in young men.

BACKGROUND: Although some effects of gene-gene interactions on nicotine-dopamine metabolism for smoking behavior have been reported, polymorphisms of cytochrome P450 (CYP) 2A6 and catechol-O-methyltransferase (COMT) have not been studied together to determine their effects on smokers. The aim of this study was to investigate the effects of the interaction between the CYP 2A6 and COMT genes on smoking behavior in young Taiwanese men. RESULTS: A self-report questionnaire regarding smoking status was administered to 500 young men. Polymorphisms of the CYP 2A6 and COMT genes as well as urinary nicotine and urinary cotinine levels were determined. The odds ratio for starting smoking was significantly lower in subjects carrying a CYP2A6 low activity/variant COMT rs4680 genotype than in those possessing a CYP2A6 wild-type/variant COMT rs4680 genotype (0.44, 95% confidence interval = 0.19-0.98, P = 0.043). Comparisons of Fagerstrom Test for Nicotine Dependence (FTND), Physiological Cigarette Dependence Scale (PCDS), and Cigarette Withdrawal symptoms (CWS-21) among the smokers with different CYP2A6/COMT polymorphisms were not significantly different. The adjusted urinary nicotine concentrations were not significantly different between the two groups carrying different genotypes. The adjusted urinary cotinine level was significantly different between the COMT rs4680 wild-type group and COMT rs4680 variant group [92.46 ng/µL vs. 118.24 ng/µL (median value), P = 0.041] and between the COMT rs4680 wild-type/COMT rs165599 variant group and COMT rs4680 variant/COMT rs165599 variant group (97.10 ng/µL vs. 122.18 ng/µL, P = 0.022). CONCLUSIONS: These findings suggest that a single nucleotide polymorphism (rs4680) of the COMT gene and the interaction between the CYP 2A6 and COMT genes affect smoking status in young Taiwanese men.

GORE-TEX VASCULAR GRAFT FOR MACULAR BUCKLING IN HIGH MYOPIA EYES.

PURPOSE: To evaluate a new application of an expanded polytetrafluoroethylene (Gore-Tex) vascular graft for use in macular buckling surgery for treatment of highly myopic eyes. METHODS: The Gore-Tex vascular graft was used as a macular buckling material in eight consecutive cases of myopic macular diseases which included fovea detachment, foveoschisis, or macular hole retinal detachment. RESULTS: Retinal reattachment was achieved in all cases except one which had partial resolution (88%). The postoperative best-corrected visual acuity ranged from 20/2000 to 20/100 depending on the degree preexisting macular degeneration, and significant better than the preoperative best-corrected visual acuity (P = 0.048, paired t-test). During the follow-up period, which ranged from 8 months to 3 years, no eye developed buckle-related complications such as infection or dislocation. CONCLUSION: The initial pilot results from this series using a Gore-Tex graft for macular buckling is promising. Throughout the follow-up period, the Gore-Tex was well tolerated in the highly myopic eyes. Large scale and long-term follow-up is warranted.

Surface plasmon resonance prism coupler for enhanced circular dichroism sensing.

A novel method for enhanced circular dichroism (CD) detection is proposed based on a surface plasmon resonance (SPR) prism coupler and a polarization scanning ellipsometry technique. An analytical model is derived to extract the CD and degree of polarization (DOP) properties of optical samples with and without scattering effects, respectively. The validity of the analytical model is confirmed by means of numerical simulations. The simulation results show that the proposed detection method has a sensitivity of 10-5~10-6 RIU (refractive index unit) for refractive indices in the range of 1.32~1.36 and 1.3100~1.3118. The practical feasibility of the proposed method is demonstrated by the experimental results for the sensitivity of the CD with the chlorophyllin samples with/without scattering effect. It is shown that for both types of sample, the extracted CD value increases linearly with the chlorophyll concentration over the considered range. In general, the results obtained in this study show that the measured CD response is highly sensitive to the polarization scanning angle. Consequently, the potential of polarization scanning ellipsometry for high-resolution CD detection is confirmed.

Development of a flexible film made of polyvinyl alcohol with chitosan based thermosensitive hydrogel.

Background/purpose: A challenge that arises with periodontal regeneration surgery has been associated with the future development of periodontal regeneration membrane to prevent gingiva and fibroblasts invade the wound and allow alveolar bone successfully regenerated. Materials and methods: Chitosan (CS) has the advantages of non-toxicity, biodegradation, biocompatibility, and has been widely used in wound dressings. A flexible film was made using polyvinyl alcohol (PVA) blending CS based thermosensitive hydrogel. Results: The proposed 2% PVA/CS hydrogel has the highest swelling ratio about 720% after 60 min incubation and keeps its area after 10 min incubation for surgery suture. The elastic modulus of 0%, 1%, 2%, and 4% PVA/CS hydrogel were 7.75 ± 1.96, 0.91 ± 0.16, 0.75 ± 0.21, and 0.37 ± 0.06 MPa, respectively. The maximum strain of 2% PVA/CS hydrogel was 101.00 ± 28.03 (%). After 8 weeks biodegradation, the remain weight of 2% PVA/CS hydrogel was 71.36 ± 0.79 (%). Conclusion: In vitro cytotoxicity tests were performed and demonstrated PVA/CS hydrogel significantly improving cell proliferation. This study realized a promising flexible film for periodontal regeneration membrane that can prevent the rapid growth of fibroblasts to invade the wound and be used for periodontal regeneration surgery.

Effect of thermocycling-induced stress on properties of orthodontic NiTi wires.

Background/purpose: In orthodontic applications, NiTi wires are under continuous bending stress and exposed to fluctuations in temperature over long durations. The sensitivity of NiTi to temperature can have a considerable influence on its mechanical properties. This study investigated the effects of deflected NiTi wire, presented in stress-induced (detwinned) martensite microstructure, combined with thermal cycle on the microstructure and mechanical properties. Materials and methods: We tested four types of as-received orthodontic NiTi: (1) Nitinol Classic (3 M Unitek), (2) Sentalloy (Tomy), (3) 27 °C CuNiTi (Ormco) and (4) 40 °C CuNiTi (Ormco). Each group of specimens was subjected to three different testing conditions: (1) temperature fluctuations (5000 cycles) between 5 and 55 °C, (2) continuous three-point bending force and (3) combination of thermal cycling and bending stress. Results: The specimens that underwent thermocycling as well as loading exhibited a substantial narrowing in stress hysteresis, which may be attributed to crystallinity lower than that of as-received NiTi wires. Reduced crystallinity can manifest in a number of imperfections, such as dislocations and internal stress, as well as a less-organized structure. Micro X-ray diffraction (XRD) analysis revealed the existence of martensite phase in Sentalloy wires subject to thermal and stress conditions. Under loading conditions, stress-induced martensite of NiTi wires exposed to temperature fluctuations of 5-55 °C also induced cyclic changes in bending stress. In a simulated intra-oral environment, the stability of austenite↔martensite transformation decreased. Conclusion: This study determined that bending stress in conjunction with repeated temperature fluctuations can greatly affect the microstructure and mechanical properties of NiTi wires.

[Smoking and cigarette dependence among Taiwanese adolescent smokers: factors of influence].

BACKGROUND: The current literature in Taiwan on adolescent smoking behavior focuses primarily on epidemiological surveys. The literature outside of Taiwan is consistent in indicating that the experience of an individual with his or her first cigarette predicts consequent smoking behavior during adolescence. Smoking behavior has been associated with cigarette dependence. However the concept of smoking behavior differs from cigarette dependence, and their predictors may vary considerably. PURPOSE: The aims of this study were to examine predictors of regular smoking, cigarette dependence and attempts to quit amongst adolescent smokers. METHODS: Researchers conducted a cross-sectional survey in twelve senior high schools in central and southern Taiwan between November 2007 and May 2009. Participants (N = 370), all of who had smoked at least once during the preceding one-year period, completed a questionnaire. Logistic analyses and multiple regression were used to explore predictors of smoking behavior, cigarette dependence and quit attempts. RESULT: The sample included 306 "regular" smokers. In a multivariate logistic regression analysis, having friends who smoked significantly influenced regular smoking behavior. Parental nagging about participant smoking behavior was a protective factor inhibiting regular smoking. Multiple regression analysis found smoking amongst siblings and friends to be a significant predictor of cigarette dependence. Cigarette dependence was found to significantly influence the success of attempts to quit. CONCLUSION / IMPLICATIONS FOR PRACTICE: Family and peer groups were the most important factors of influence on adolescent smoking behavior. This finding suggests that nursing professionals should leverage family and peer support when planning and implementing smoking cessation programs.

Factors Associated With Smoking Behaviors Among Late Adolescents: A Cross-Sectional Study in Taiwan.

ABSTRACT: This study examined factors associated with smoking behaviors among late adolescents in Taiwan. A cross-sectional survey was conducted with 377 adolescents from four high schools who answered self-report questionnaires. The results indicated that 10.8% (n = 41) of the participants were current smokers. Univariate analysis indicated that current smoking status was significantly associated with smoking social confidence, smoking social connection, friend smoking, and smoking policy in schools. Logistic regression showed smoking social confidence (adjusted odds ratio = 1.41, 95% CI [1.16, 1.72], p = .01) and friend smoking (adjusted odds ratio = 2.80, 95% CI [1.67, 4.70], p < .01) were significantly associated with being a current smoker. Health professionals should consider implementing school-based programs to reduce influence of friend smoking, through strategies for resisting peer pressure, to reduce smoking. Educating late adolescents on improving skills related to social confidence, such as increasing communication abilities, should also be a part of these programs.

Biopolymers Hybrid Particles Used in Dentistry.

This literature review provides an overview of the fabrication and application of biopolymer hybrid particles in dentistry. A total of 95 articles have been included in this review. In the review paper, the common inorganic particles and biopolymers used in dentistry are discussed in general, and detailed examples of inorganic particles (i.e., hydroxyapatite, calcium phosphate, and bioactive glass) and biopolymers such as collagen, gelatin, and chitosan have been drawn from the scientific literature and practical work. Among the included studies, calcium phosphate including hydroxyapatite is the most widely applied for inorganic particles used in dentistry, but bioactive glass is more applicable and multifunctional than hydroxyapatite and is currently used in clinical practice. Today, biopolymer hybrid particles are receiving more attention as novel materials for several applications in dentistry, such as drug delivery systems, bone repair, and periodontal regeneration surgery. The literature published on the biopolymer gel-assisted synthesis of inorganic particles for dentistry is somewhat limited, and therefore, this article focuses on reviewing and discussing the biopolymer hybrid particles used in dentistry.

Factors Associated with Attempt for Smoking Cessation among Hardcore Smokers in Taiwan.

Background: Tobacco control activities have mostly influenced those smokers who found it easier to quit and, thus, remaining smokers are those who are less likely to stop smoking. This phenomenon is called "hardening hypothesis," which individuals unwilling or unable to quit smoking and likely to remain so. The aim of this study was to identify the factors correlated with smoking cessation among hardcore smokers. Methods: A cross-sectional descriptive correlational research design was employed. Hardcore smokers from communities in Taiwan were recruited to participate in the study (N = 187). Self-report questionnaires were used to collect demographic data as well as data on nicotine dependence, quitting self-efficacy, social smoking motives, attitudes towards the Tobacco Hazards Prevention Act (THPA), and smoking cessation. Logistic regression analysis was used to examine the factors that were related to quit smoking. Results: About 30.3% (n = 54) reported having experienced quitting smoking over 7 days in the past year. Logistic regression analysis indicated that attitudes towards the THPA was identified as a particularly important factor contributing to the increase in smoking cessation among hardcore smokers. Conclusions: Nurses should cooperate with smoking cessation coaches to facilitate the improvement of attitudes towards the THPA as a key means through which to increase the smoking cessation rate among hardcore smokers.

Cigarette dependence questionnaire: development and psychometric testing with male smokers.

AIM: This paper is a report of a study conducted to develop and test a theoretically derived Cigarette Dependence Questionnaire for adult male smokers. BACKGROUND: Fagerstrom questionnaires have been used worldwide to assess cigarette dependence. However, these assessments lack any theoretical perspective. A theory-based approach is needed to ensure valid assessment. METHODS: In 2007, an initial pool of 103 Cigarette Dependence Questionnaire items was distributed to 109 adult smokers in Taiwan. Item analysis was conducted to select items for inclusion in the refined scale. The psychometric properties of the Cigarette Dependence Questionnaire were further evaluated 2007-08, when it was administered to 256 respondents and their saliva was collected and analysed for cotinine levels. Criterion validity was established through the Pearson correlation between the scale and saliva cotinine levels. Exploratory factor analysis was used to test construct validity. Reliability was determined with Cronbach's alpha coefficient and a 2-week test-retest coefficient. RESULTS: The selection of 30 items for seven perspectives was based on item analysis. One factor accounting for 44.9% of the variance emerged from the factor analysis. The factor was named as cigarette dependence. Cigarette Dependence Questionnaire scores were statistically significantly correlated with saliva cotinine levels (r = 0.21, P = 0.01). Cronbach's alpha was 0.95 and test-retest reliability using an intra-class correlation was 0.92. CONCLUSION: The Cigarette Dependence Questionnaire showed sound reliability and validity and could be used by nurses to set up smoking cessation interventions based on assessment of cigarette dependence.

Characteristics of Hardcore Male Smokers in Taiwan: A Qualitative Study.

Objectives: The purpose of this study was to explore the characteristics of hardcore smokers who were previously hospitalized. Study design: A descriptive qualitative design was used to investigate a sample of 29 male Taiwanese smokers. Methods: Male hardcore smokers were recruited at a hospital in southern Taiwan and their smoking behaviors and attitudes were explored in semistructured interviews. Inclusion criteria were: (1) smoking at least weekly or daily during the past year, (2) 100 cigarettes during the lifetime, (3) persistent smoking, or (4) at least one hospitalization. Audio-recorded interview data were analyzed using content categorization of the responses. Results: Four main themes emerged to describe characteristics of Taiwanese hardcore smokers: (1) physiological and psychological dependence, (2) no motivation to quit despite knowledge of negative health consequences, (3) social interaction and cultural norms, and (4) negative attitudes toward, but compliance with, smoking-free policies. Conclusions: The results can inform public health nurses of characteristics of Taiwanese hardcore smokers, which in turn may develop effective smoking cessation program to increase smoking cessation rate among Taiwanese hardcore smokers.