Ten years' trend analysis for Taiwanese youth high school students' health behaviors.

PURPOSE: To delineate the 10 years' trend regarding Taiwanese adolescents' health perspectives and compare the differences of six adolescent health aspects between Taiwan and the U.S. METHODS: The anonymous structured questionnaire was done every other year with representative sampling methods as Youth Risk Behavior Surveillance System in the United States. Twenty-one questions from six health aspects were extracted for further analysis. Multivariate regression analysis was performed to delineate the relationship among protective factors and risk-taking behaviors, respectively. RESULTS: Overall, 22,419 adolescents were recruited. There were decreasing trend in terms of risk-taking behaviors, such as early contact to pornography (< age 16) (70.6%-60.9%), early cigarette use (< age 13) (20.7%-14.0%), and seriously considering suicide (36.0%-17.8%). There was an increasing trend in behaviors harmful to health: current alcohol drinkers (18.9%-23.4%), and staying up late every day (15.2%-18.5%). Multivariate regression analysis after adjusting gender and grade; it disclosed an increasing trend in protective assets, such as having multiple intimate friends (75.8%-79.3%), satisfaction to body weight and body shape (31.5%-36.1% and 34.5%-40.7%), as well as always wearing a helmet while riding a bike (1.8%-3.0%). CONCLUSION: We should continuously monitor the health status trend of the adolescents to provide them with a healthier environment and well-being.

The effect of the preoperational psychoeducation program for Taiwanese breast cancer patients: A three-month follow-up study.

Objective: Studies suggest that psychosocial interventions might be more effective during highly stressful periods, such as before surgery. This study aimed to explore the effectiveness of the Preoperational Health Psychology Education program among Taiwanese breast cancer patients. Methods: A total of 137 adult women (1) diagnosed with breast cancer; and (2) admitted to the ward for surgery were recruited to join the program one day before surgery. Emotional distress, worries, and cancer self-efficacy were evaluated at admission, post-program, and 3-month post-surgery. Patients were grouped into high/low distress groups, and mixed-design ANOVA was used to examine the program's effectiveness. Results: The results showed significant interactions of Group × Time in emotional distress (F = 16.15, p = .000) and worry (F = 5.81, p = .005), but not in self-efficacy (F = 2.97, p = .068). The post-hoc tests revealed significant decreases in emotional distress and worry in the high distress group. Conclusion: The program was found helpful in reducing emotional distress and worries. The effect lasting for three-month for those with higher preoperational emotional distresses. Innovation: This psycho-education program with a relatively rare one-session design, targeted at a less-studied pre-surgery period, is helpful to a less-studied population, Asian cancer patients.

The effects of an emergency nurse-led stress-reduction project during the first 120 days of the COVID-19 pandemic in Taiwan.

BACKGROUND: The COVID-19 frontline nurses' stress-reduction programme by the cooperation of manager with the nurses is not-well developed. AIM: This study aimed to examine the effect of an emergency nurse-led stress-reduction project on reducing stress levels during the COVID-19 pandemic. METHODS: The action research was conducted using online and person-to-person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress and needs at the 50th, 80th and 110th days of the pandemic from March to May 2020. RESULTS: The numbers of nurses participating in three-time survey were 160, 166 and 160, respectively. There was a decrease in the nurses' work-related stress after implementing the improvement strategies. Stress from personal protective equipment (PPE), information about infection control and family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID-19 information and a forum for sharing experiences of COVID-19 care decreased whereas needs of allowing more days off increased. CONCLUSIONS: The stress-reduction project targeting at nurses' views of their needs can reduce their stress during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: The online and person-to-person group brainstorming building a good partnership between nurses and managers can be an effective nursing management.

A pilot-study to assess the feasibility and acceptability of an Internet-based cognitive-behavior group therapy using video conference for patients with coronary artery heart disease.

BACKGROUND: Many patients with coronary artery heart disease are unable to access traditional psychosocial rehabilitation conducted face to face due to excessive travel distance. Therefore, this study developed and assessed the feasibility and acceptability of an 8-week Internet-based cognitive-behavior group therapy program, described the patterns of use and measured change in risk factors. METHODS: This study adopted an online video conference system, JointNet, to maintain group interaction functions similar to face to face groups online, and also built an self-learning platform to deliver psychoeducation content and cognitive-behavior therapy related materials and homework. Forty-three out-patients were recruited in the pilot study, who then chose to participate in either the Internet-based cognitive-behavior group therapy or face to face group based on their preference. Fourteen patients were assigned to the waiting-list control. RESULTS: Seventeen participants (17/43 = 39.5%) chose the Internet-based cognitive-behavior group therapy program. Among them, thirteen participants (13/17 = 76.5%) finished the program and were more male (92.3% vs. 50%), employed (53.8% vs. 35.3%), and had longer education duration (13.9 vs. 12.5 years) than the counterparts of the face to face group. Furthermore, they were highly motivated with average number of log-ins (66.5 time), website surfing time (950.94 min), reading frequency (78.15 time) and reading time (355.90 min) for the self-learning platform during eight weeks; and also highly satisfied (97%) with visiting the self-learning platform and video conferences. The treatment effectiveness of Internet-based cognitive-behavior group therapy was comparable with face to face one in reducing anxiety, hostility, respiration rate, and in improving vasodilation but not depression compared with the waiting-list control. CONCLUSION: These results indicated that the Internet-based group therapy program using video conference is feasible and acceptable for the psychosocial rehabilitation of patients with coronary artery heart disease, and provides an alternative for patients who are unable to obtain conventional psychosocial rehabilitation conducted face to face.

Quick screening tool for patients with severe negative emotional reactions to chronic illness: psychometric study of the negative emotions due to chronic illness screening test (NECIS).

Background: Severe negative emotional reactions to chronic illness are maladaptive to patients and they need to be addressed in a primary care setting. Objective: The psychometric properties of a quick screening tool-the Negative Emotions due to Chronic Illness Screening Test (NECIS)-for general emotional problems among patients with chronic illness being treated in a primary care setting was investigated. Method: Three studies including 375 of patients with chronic illness were used to assess and analyze internal consistency, test-retest reliability, criterion-related validity, a cut-off point for distinguishing maladaptive emotions and clinical application validity of NECIS. Self-report questionnaires were used. Results: Internal consistency (Cronbach's α) ranged from 0.78 to 0.82, and the test-retest reliability was 0.71 (P < 0.001). Criterion-related validity was 0.51 (P < 0.001). Based on the 'severe maladaptation' and 'moderate maladaptation' groups defined by using the 'Worsening due to Chronic Illness' index as the analysis reference, the receiver-operating characteristic curve analysis revealed an area under the curve of 0.81 and 0.82 (ps < 0.001), and a cut-off point of 19/20 was the most satisfactory for distinguishing those with overly negative emotions, with a sensitivity and specificity of 83.3 and 69.0%, and 68.5 and 83.0%, respectively. The clinical application validity analysis revealed that low NECIS group showed significantly better adaptation to chronic illness on the scales of subjective health, general satisfaction with life, self-efficacy of self-care for disease, illness perception and stressors in everyday life. Conclusion: The NECIS has satisfactory psychometric properties for use in the primary care setting.

Why Taiwanese hospice patients want to stay in hospital: health-care professionals' beliefs and solutions.

Patient-related barriers and their solution in the planning of discharge to palliative home care were investigated through a nationwide survey conducted in Taiwan. Of 250 questionnaires sent to palliative care workers at 15 hospices in Taiwan, 229 valid questionnaires (91.6%) were retrieved. Most of the respondents were nursing staff (72.5%) while only 38 were physicians (16.6%). Canonical correlation analysis was used to examine the association between the barriers and solutions, and revealed that the value of the first variate was 0.49 ( P<0.05). The barriers and canonical loadings were: unable to manage emergent medical conditions (0.83), the quality of care in the hospital is better (0.74), and insufficient number of caregivers (0.72). The effective solutions that correlated significantly with the above factors were ranked as: to reassure the patient about the possibility of smooth readmission (0.84), to arrange palliative home care programs (0.68), and to educate family members on taking care of the patient at home (0.64). In conclusion, to solve patient-related barriers in the planning of the discharge of patients with terminal cancer, the results suggest that (1). health professionals involved in the care of patients with terminal cancer should have adequate knowledge of palliative care, particularly communication skills, (2). an effective referral system among general or oncology and palliative care units should be established, (3). inpatient care facilities and home-care programs should be provided, and (4). patients and families should be educated as to what may happen and how to manage these conditions at home and should be assured of the availability of medical help.

Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan.

Identifying the concerns of terminal cancer patients and respecting their wishes is important in clinical decision-making concerning the provision of artificial nutrition and hydration (ANH). The aim of this study was to discover terminal cancer patients' wishes and determine influencing factors toward the provision of ANH. One hundred and ninety-seven patients with terminal cancer, admitted to a palliative care unit in Taiwan over a two-year period, completed a questionnaire interview, which included demographic characteristics, knowledge and attitudes on ANH, the health locus of control, subjective norms, and the wishes to use ANH. One hundred and fifty-four patients (78.2%) used ANH in the past month. A knowledge test on issues related to ANH showed the rates of accurate responses were ranked as: peripheral intravenous route can only provide hydration (48.7%), excessive artificial nutrition may increase the proliferation of cancer cells (32%), ANH can prolong life expectancy for all patients (17.3%), and ANH can prevent all patients from starving to death (5.6%). The strongest attitude of patients toward the potential benefit of ANH was "it can provide the body need with nutrition and hydration when inability to eat or drink occurs." Otherwise, the strongest attitude toward the potential burdens of ANH was "gastrostomy makes the illness worse." One hundred and twenty-two of 197 patients (62.9%) expressed their wishes to have ANH. The results of logistic regression analysis showed that the experience of using a nasogastric tube and intravenous fluids, and subjective norms were the most significant variables related to the wishes of patients to use ANH (odds ratio [OR]=11.11, 95% confidence interval [CI]=3.20-38.64; OR=2.51, 95% CI=1.22-5.15, OR=1.30, 95% CI=1.05--1.60, respectively). However, the use of artificial nutrition was negatively affected by the knowledge of ANH (OR=0.53, 95% CI=0.37-0.84). In conclusion, Taiwanese patients with terminal cancer have insufficient knowledge about AHN and still believe in the benefits of ANH, especially in avoiding dehydration or starvation. The findings of this study indicate the importance of medical professional training and decision-making in the initial consideration of using ANH. By improving the knowledge about ANH among patients, more appropriate decisions can be achieved.