Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study.

Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation.

Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study.

BACKGROUND: Frailty in older adults is a common geriatric syndrome that could be prevented; thus, coping strategies for the aging population are essential. Self-management behaviors may represent cost-effective strategies to prevent physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association between transitions of self-management behaviors and frailty status over 4 years of follow-up (2007 to 2011). METHODS: Data were retrieved from the Taiwan Longitudinal Study of Aging (TLSA), years 2007 and 2011. In this prospective cohort study, 1283 community-dwelling older adults aged 65 years and older without cognitive impairment were recruited. Frailty was defined based on Fried's frailty phenotype. Self-management behaviors (maintaining body weight, quitting smoking or no smoking, drinking less or no drinking, exercising, keeping diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multinomial logistic regression analyses were used to investigate the associations between changes in self-management behaviors and in frailty status. The age group was further stratified to examine the moderation effect in the relationship between changes in self-management behaviors and in frailty status among older adults. RESULTS: The prevalence of frailty was 8.7% at baseline and 14.9% after 4 years of follow-up, with 196 (15.3%) deaths. Overall, 514 (40.1%) participants maintained their frailty status, 424 (33.0%) worsened, and only 149 (11.6%) improved. Being aged ≥75 years old, having chronic diseases, and an absence of self-management behaviors were associated with frailty at baseline and after follow-up. Among individuals aged 65-74, compared to those who maintained no self-management behaviors, those who decreased the exercise behaviors (yes-to-no) had a higher risk of worsening (RRR = 2.518), while increasing (no-to-yes) and maintaining (yes-to-yes) frequent physical exercise were associated with a lower risk of worsening (RRR = 0.466 and 0.572, respectively) than stable frailty; those who maintained body weight (yes-to-yes) were associated with a lower risk of worsening (RRR = 0.327) than stable frailty after controlling for individual covariates and chronic diseases. Among individuals over 75 years old, compared to no exerciser, older old who decreased their physical exercise had a higher risk of frailty worsening (RRR = 3.255), and increasing frequent physical exercise (no-to-yes) was associated with an improvement in frailty status (RRR = 3.684). Age was a moderator between the effects of maintaining body weight on frailty worsening. There were no associations between the behavioral transitions of smoking, drinking, diet control, or regular lifestyle on the frailty status changes. CONCLUSIONS: Maintaining body weight and frequent physical exercise increased the ratio of frailty stability among individuals 65-74 years old. Increasing exercise behavior is the only factor to improve their frailty status among older adults aged 75 years and over. Older adults should be encouraged to perform adequate physical exercise and maintain a healthy body weight to maintain the frailty status in younger old aged 65-74 years, and especially perform more frequent exercise to improve frailty status in older old over 75 years.

Psychometric Properties of the Taiwanese Pressure Ulcer Management Self-Efficacy Scale in Nursing Practice.

Self-efficacy strongly predicts clinical performance and competence. In Taiwan, there is no reliable method for assessing self-efficacy in the management of pressure injury. This study aims to establish psychometric properties of the Pressure Ulcer Management Self-Efficacy Scale (PUM-SES) translated for Taiwan and determine the validity and reliability of the Taiwanese version of the PUM-SES. Materials and methods: The PUM-SES was translated for use in Taiwan using Brislin's method. The translation's content validity, concurrent validity, predictive validity, internal consistency, and test−retest reliability were evaluated. The Pressure Ulcer Management Self-Efficacy Scale, Taiwanese version (PUM-SES-T), the Attitude toward Pressure Injury Prevention Scale (APIPS) and the Practice toward Pressure Injury Prevention Scale (PPIPS) of preventing pressure injury, and the General Self-Efficacy Scale (GSES) were tested using Pearson's correlation. A cross-sectional survey with 330 RNs in Taiwan was conducted. The PUM-SES-T was used to predict the PPIPS, and a predictive regression model was constructed considering nursing demographic variables. Results: Seven experts evaluated the PUM-SES-T with a CVI value of 0.995. An internal consistency, using Cronbach's α, of 0.762 and a test−retest reliability of 0.997 were obtained. The PUM-SES-T was positively correlated with the GSES (p < 0.001). Multiple regression revealed that the PUM-SES-T predicted practice with a strong predictive validity (F = 8.077, p < 0.001), had an adjusted R2 of 0.455, but collinearity was insignificant. In this study, PUM-SES-T is a valid instrument for intervention-related educational programs to measure self-efficacy with good reliability and validity. It can be employed when intervening in related education strategies or promoting policies.

Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients.

BACKGROUND: Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d' Evaluation du Risque de Perte d'Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward. METHODS: A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily living (ADL), and screening instruments. The Barthel Index was used to measure functional disability. Functional decline was defined as a decline of at least five points on the Barthel Index 30 days after discharge compared to that at pre-admission. RESULTS: Patients had a mean age of 77.7 years, with 55.7% being female. Functional decline was observed in 39.1% of all patients. The best cutoff point, sensitivity, specificity, and area under the receiver operating characteristic curve were 2.5, 96.1%, 52.5%, and 0.751 for ISAR-HP; 1.5, 83.1%, 62.5%, and 0.761 for VIP; and 4.75, 89.6%, 54.2%, and 0.758 for SHERPA, respectively. CONCLUSIONS: All three instruments showed moderate diagnostic accuracy as indicated by their best cutoff points. Therefore, the results presented herein can guide health care professionals in selecting the appropriate assessment tool for predicting functional decline among hospitalized elderly patients in a clinical setting.

Prevalence of Frailty among Community-Dwelling Older Adults in Asian Countries: A Systematic Review and Meta-Analysis.

This study aimed to synthesize frailty prevalence among community-dwelling older adults in Asia and identify factors influencing prevalence estimates. Five electronic databases were searched by 29 April 2022, including representative samples of community-dwelling adults who were aged 60 years and older and lived in Asia. Cross-sectional or national longitudinal population-based cohort studies completed with validated instruments were selected. Twenty-one studies with 52,283 participants were included. The pooled prevalence rate of frailty was 20.5% (95% CI = 15.5% to 26.0%). The estimated frailty prevalence was 14.6% (95% CI = 10.9% to 18.8%) while assessed by the Fried frailty phenotype, 28.0% (95% CI = 21.3% to 35.3%) by the Cumulative Frailty Index, 36.4% (95% CI = 33.6% to 39.3%) by the Study of Osteoporotic Fractures (SOF) index, and 46.3% (95% CI = 40.1% to 52.4%) by the Clinical Frailty Scale (p < 0.01). Subgroup analysis in studies using the Fried's phenotype tool found that frailty prevalence was increased with older age (p = 0.01) and was higher in those who were single (21.5%) than in married participants (9.0%) (p = 0.02). The study results supported a better understanding of frailty prevalence in different geographical distributions and provide references for health policy decision-making regarding preventing frailty progression in older adults.

The association between visual trajectories and cognitive impairment: insights from the Taiwan Longitudinal Study on Aging.

BACKGROUND: Visual impairment (VI) was associated with cognitive impairment. However, different visual trajectories might contribute to different risks of cognitive decline in the elderly. AIMS: This study aimed to evaluate the association between visual trajectories and cognitive impairment. METHODS: Four thousand two hundred eight community-dwelling elder adults were identified from Waves IV-VII (1999-2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive function was determined using the Short Portable Mental Status Questionnaire (SPMSQ) scores. Visual impairment was self-reported and visual trajectories were assessed in at least two waves of the survey. Ordinal logistic regression was performed to estimate adjusted odds ratios (adjORs) and 95% confidence intervals (CIs). RESULTS: Participants with visual trajectory from no VI to VI had significantly higher risk of cognitive impairment with an adjOR of 1.69 (95% CI 1.12-2.57) than participants without VI. Compared to participants without VI, participants with persistent VI (adjOR 1.32; 95% CI 0.89-1.96) and with visual trajectory from VI to no VI (adjOR 1.25; 95% CI 0.83-1.88) were not associated with cognitive impairment. A protective association between eyeglasses use and cognitive impairment (adjOR 0.69; 95% CI 0.55-0.87) was found in this study. Importantly, cataract was associated with higher risk of cognitive impairment (adjOR 1.34; 95% CI 1.10-1.62). However, nonsurgical cataract treatment did not show protective effect on cognitive impairment in patients with cataract. CONCLUSIONS AND DISCUSSION: Visual trajectory from no VI to VI is a significant risk factor for cognitive impairment that physicians should pay special attention during community screening.

Reduced Cancer-Related Fatigue after Tablet-Based Exercise Education for Patients.

AIM: Exercise can be an effective treatment for cancer-related fatigue, but exercise is not prescribed for many cancer patients. Our specific aim was to compare usual care and a tablet-based fatigue education and prescription program for effects on level of fatigue (primary outcome) and satisfaction with fatigue and amount of exercise (secondary outcomes). METHODS: In a four-week pretest/posttest randomized study, 279 patients with cancer completed a touch screen fatigue assessment and daily paper-based activity logs. The experimental group also had access to FatigueUCope, a tablet-based multimedia education intervention focused on exercise as therapy for fatigue. RESULTS: In total, 94% of intervention group accessed FatigueUCope. Controlling for baseline fatigue, compared to the usual-care group, the experimental group reported lower fatigue scores (P = .02). Neither satisfaction with fatigue nor exercise level was significantly different between groups, but not all activity logs were returned. None of the patients reported adverse effects. CONCLUSION: Objective indicators of exercise are warranted in future studies to examine whether exercise is indeed the mechanism of the FatigueUCope effect and determine the clinical utility of this intervention. This brief, engaging tablet-based multimedia education and prescription program has promise to help patients recognize the benefits of exercise to manage cancer-related fatigue.

The effect of multimedia health education on pain and anxiety in women undergoing mammography in Taiwan.

OBJECTIVE: Breast cancer is the most common cancer among women in Taiwan. However, the discomfort of receiving mammograms reduces the willingness to screen. MATERIALS AND METHODS: This study using a quasi-experimental design and recruited 150 participants in a medical center, Taiwan. In the control group, only provided traditional health education sheets, the experimental group has joined the intervention of multimedia health education. State-Trait Anxiety Inventory and Visual Analogue Scale, respectively, were used to compare the differences in anxiety and pain between the two groups before and after receiving mammography. RESULTS: After the intervention, the experimental group's state anxiety score was significantly lower than that of the control group (30.63 ± 8.43 vs. 33.77 ± 10.74, p < .05). However, there was no significant difference in pain scores (4.13 ± 2.37 vs. 4.57 ± 2.31; p = .25). CONCLUSIONS: Younger, prior experience with mammography, and high trait anxiety affect pain and state anxiety of women undergoing mammography. The multimedia health education intervention could reduce anxiety effectively, but it does not significantly relieve the pain undergoing mammography.

Electronic Device Use before Bedtime and Sleep Quality among University Students.

Using electronic devices before bedtime impacts sleep quality and has become a major public health issue. This study aims to investigate the associations between electronic devices (EDs) use before bedtime and sleep quality in Vietnamese university students. A total of 369 university students from three departments were recruited. Participants completed self-report surveys, including demographic characteristics, lifestyle, ED-use behaviors, the Pittsburgh Sleep Quality Index, and the Center for Epidemiologic Studies Depression Scale. A total of 48.8% of the students experienced poor sleep quality, and 98.1% reported using at least one type of ED every day within two hours before bedtime. Smartphones are the most used devices (92.3%). ED usage within two hours before bedtime (p = 0.031), lack of exercise (p = 0.006), alcohol consumption (p = 0.025), and coffee intake after 4 pm (p = 0.018) were associated with poor sleep quality. ED use near bedtime for a duration longer than 30 min (p = 0.001) and depression (p < 0.001) were associated with poorer sleep quality among university students. ED use near bedtime more than 30 min was significantly associated with poorer sleep quality after adjusting depression status, exercise, and caffeine/alcohol intake in the latter part of the day. This study emphasizes the importance of adequate sleep and restriction of ED use near bedtime, which are necessary for better sleep in university students.

Exploring the Relationship of Health Beliefs and Self-Care Behaviors Related to Diabetic Foot Ulcers of Type II Diabetes Mellitus Patients: A Cross-Sectional Study.

OBJECTIVE: Diabetic foot ulcers are an invasive complication of diabetes and are increasing. This study investigates the relationship between health beliefs and foot self-care behaviors, among people with type II diabetes. METHODS: A cross-sectional design was adopted, and 98 patients were recruited from outpatient clinics of the endocrine department. The questionnaires of Demographic, Diabetes Foot Ulcer Health Belief Scale (Health Beliefs, DFUHBS), and Diabetes Foot Self-Care Behavior Scale (Self Care, DFSBS) were used to collect data. RESULTS: Among the subjects living alone or who had diabetes less than ten years, the score of DFSBS was significantly lower than among those living with families or who had diabetes for ten years or more. The frequency of performing diabetes foot self-care behavior, among males was lower than among females significantly. Although there was no significant difference in the Health Belief total score, there were differences in the benefit subscale. Those who had junior high school level or less or had diabetes less than ten years, their score was significantly lower than those with senior high school level or more or had diabetes ten years or more. In a multivariable regression model, living with family, diabetes duration, and health beliefs explained 42.9% of the variance of diabetic-foot self-care behaviors. CONCLUSIONS: Living alone, shorter duration of diabetes, male gender, and lower health belief scores predict less adequate diabetic foot self-care behavior. Health care providers should assess these factors when designing individual care plans.

Sleep Quality and Associated Factors in Adults with Type 2 Diabetes: A Retrospective Cohort Study.

Purpose: Sleep disturbance is one of the major complaints among patients with diabetes. The status of diabetes control and associated complications may contribute to sleep disturbance. This study explored night time sleep and excessive daytime sleepiness in adults with type 2 diabetes and examined the association of diabetes control and associated complications on their sleep quality. Methods: A retrospective cohort study design was used. Type 2 diabetic patients (87 females and 79 males, aged 63.1 ± 10.5 years) were recruited from the outpatient clinics of the endocrine department. Sleep quality was assessed by the Pittsburg Sleep Quality Index and the Epworth Sleepiness Scale. Diabetes control and complications were obtained by retrospectively reviewing patients' medical records over 1 year prior to study enrollment. Results: 72.3% of recruited patients had poor glycemic control, and 71.1% had at least one diabetic complication. 56.0% of patients experienced poor sleep quality, and 24.1% had excessive daytime sleepiness. Those who were female (OR = 3.45) and who had ophthalmological problems (OR = 3.17) were associated with poor night time sleep quality, but if they did exercise to the point of sweating (OR = 0.48) reduced the risk of poor sleep quality. Furthermore, poor sleep quality (OR = 4.35) and having nephropathy (OR = 3.78) were associated with a higher risk of excessive daytime sleepiness. Conclusions: Sex, ophthalmological problems, nephropathy, and no exercise to the point of sweating are associated with sleep problems in patients with type 2 diabetes. Both lifestyle behaviors and diabetic complications affect sleep disturbances in patients with diabetes.

Randomized clinical trial of preoperative skin preparation with 2% chlorhexidine versus conventional hair shaving in percutaneous coronary intervention.

BACKGROUND: Preoperative skin preparation is associated with surgical site infection (SSI). Traditional preoperative shaving fails to reduce the risk of SSI. The efficacy of 2% chlorhexidine for preoperative skin preparation in percutaneous coronary intervention (PCI) is sketchy. The aim of this trial was to evaluate whether preoperative skin preparation performed with chlorhexidine was not inferior to a conventional hair removal method. METHODS: Seventy-eight patients undergoing PCI were randomized into 2 groups of 39 patients, receiving either single sterilization with 2% chlorhexidine or hair shaving respectively between July 2016 and October 2016. The primary endpoints were wound infection rate and bacterial counts. Secondary endpoints were rate of SSI and adverse effects of 2% chlorhexidine. RESULTS: The results showed that 2% chlorhexidine significantly reduced the colonization of Staphylococcus aureus (P = .032), S epidermidis (P = .000), and miscellaneous bacteria (P = .244) in comparison with hair shaving, respectively. Redness in 24 hours after surgery was observed in 6 patients in the control group (15.4%) and 5 patients (12.8%) in 2% chlorhexidine group. There was no statistically significant difference in SSI rate between 2 skin preparations. CONCLUSION: In PCI, preoperative skin preparation with 2% chlorhexidine was not inferior to conventional hair shaving in terms of the wound infection rate and SSI rate.

Habitual Physical Activity and Diabetes Control in Young and Older Adults with Type II Diabetes: A Longitudinal Correlational Study.

This study aimed to determine whether daily physical activity in young and older adults with T2DM is associated with diabetes control. A prospective correlational study involving 206 young (≤65 years) and older (>65 years) adults was conducted. The International Physical Activity Questionnaire was used to assess their daily physical activity levels. Patients' mean HbA1c level was 7.8% (±1.4), and 95.9% of patients had unsatisfactory diabetes control. Performing more minutes per week of moderate-intensity daily physical activity was associated with a lower risk of glycemia in both young and older adults. Furthermore, moderate daily physical activity significantly lowered the risk of glycemia. Health personnel must encourage patients to engage in moderate daily physical activities to improve diabetes control.

Physical Activity of ≥7.5 MET-h/Week Is Significantly Associated with a Decreased Risk of Cervical Neoplasia.

Cervical cancer is one of the most prevalent malignant neoplasms worldwide. We investigated whether leisure-time physical activity is sufficient to decrease the cervical neoplasia risk and provide suggested guidance of metabolic equivalents of task-hours per week (MET-h/week) spent on leisure-time physical activity to prevent cervical neoplasia. Ultimately, 433 participants, including 126 participants with cervical intraepithelial neoplasia I or higher disease (≥CIN 1) and 307 healthy controls, were recruited. All participants completed a standardized questionnaire about leisure-time physical activity engagement (MET-h/week) and a general health questionnaire and had cervical specimens taken to detect human papillomavirus (HPV) infection. CIN 1 staging was identified from the specimens. Participants with physical activity of ≥3.75 MET-h/week had a significantly lower CIN risk compared to those with physical activity of <3.75 MET-h/week (p = 0.01). However, among participants with HPV infection or smokers, the minimal requirement of leisure-time physical actively to lessen the CIN risk was ≥7.5 MET-h/week. Lifetime leisure-time physical activity of ≥0.12 MET-h/week-year also significantly decreased the CIN risk, but women with HPV infection needed ≥13.2 MET-h/week-year to protect them from a CIN risk. We concluded that regular leisure-time physical activity of ≥7.5 MET-h/week and sustained lifetime leisure-time physical activity ≥13.2 MET-h/week-year are vital factors for protecting women against cervical neoplasia risk.

The Development and Psychometric Properties of the Children's Sleep Assessment Questionnaire in Taiwan.

To develop and examine the validity and reliability of the Children's Sleep Assessment Questionnaire (CSAQ) for school-aged children in Taiwan. DESIGN AND METHODS: We used a cross-sectional study design with stratified random sampling. Pairs of children and parents were recruited from a school-based sample of third- and fourth-grade students, enrolling 362 child and parent pairs. The content validity, construct validity, convergent validity, internal consistency, and inter-rater reliability of the CSAQ were assessed. RESULTS: The CSAQ comprised three parts: sleep hygiene, sleep quality, and sleep disturbance. Sleep hygiene showed a moderate intra-class correlation coefficient (0.37-0.66) between children and parents. Results of exploratory factor analysis suggested a four-factor structure model for sleep quality with 64.9% of variance and a two-factor structure for sleep disturbance with 57.7% of variance. These two models also demonstrated good fit with the confirmatory factor analysis. CONCLUSIONS: The CSAQ is a valid and reliable instrument for assessing sleep problems in school-aged children. PRACTICE IMPLICATIONS: Both clinicians and researchers can use the CSAQ to screen or elucidate the children' sleep problems.

Late-career unemployment and all-cause mortality, functional disability and depression among the older adults in Taiwan: A 12-year population-based cohort study.

OBJECTIVE: To evaluate whether late-career unemployment is associated with increased all-cause mortality, functional disability, and depression among older adults in Taiwan. METHOD: In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was conducted from 1996 to 2007. The complete data from 716 men and 327 women aged 50-64 years were retrieved. Participants were categorized as normally employed or unemployed depending on their employment status in 1996. The cumulative number of unemployment after age 50 was also calculated. Logistic regression analysis was used to examine the effect of the association between late-career unemployment and cumulative number of late-career unemployment on all-cause mortality, functional disability, and depression in 2007. RESULTS: The average age of the participants in 1996 was 56.3 years [interquartile range (IQR)=7.0]. A total of 871 participants were in the normally employed group, and 172 participants were in the unemployed group. After adjustment of gender, age, level of education, income, self-rated health and major comorbidities, late-career unemployment was associated with increased all-cause mortality [Odds ratio (OR)=2.79; 95% confidence interval (CI)=1.74-4.47] and functional disability [OR=2.33; 95% CI=1.54-3.55]. The cumulative number of late-career unemployment was also associated with increased all-cause mortality [OR=1.91; 95% CI=1.35-2.70] and functional disability [OR=2.35; 95% CI=1.55-3.55]. CONCLUSION: Late-career unemployment and cumulative number of late-career unemployment are associated with increased all-cause mortality and functional disability. Older adults should be encouraged to maintain normal employment during the later stage of their career before retirement. Employers should routinely examine the fitness for work of older employees to prevent future unemployment.

Psychometric Testing of Behavior Assessment for Children.

PURPOSE: The purpose of this study was to test the reliability and validity of the Behavior Assessment for Children (BAC) in a community of school-aged children in Taiwan. METHOD: A school-based sample comprising third grade and fourth grade students was recruited from Taichung City in Taiwan. The parents (n = 248) and teachers (n = 15) of these students completed structured questionnaires, including the Child Behavior Checklist (CBCL) and the proposed BAC. Content validity, concurrent validity, construct validity, internal consistency, and inter-rater reliability of the BAC were assessed. RESULTS: The BAC comprised three subscales (attention, emotion, and self-control) that included 17 items. The content validity index (CVI) score was 0.98. The result of the confirmatory factor analysis (goodness of fit = .90, root mean square of residual = .03, root mean square error of approximation = .06, and comparative fit index = .94) supported the construct validity of the three BAC subscales. The concurrent validity of the BAC subscales significantly correlated with the compatible CBCL subscales (r = .59-.78, p < .001). Cronbach α of the subscales of the BAC ranged from .78 to .92. The intraclass correlation coefficient between the parents and teachers ranged from .31 to .44, and the joint probability of agreement ranged from 31.4% to 92.2%. CONCLUSIONS: The BAC is a valid and reliable instrument for evaluating behavioral problems in school-aged children.

Modifiable Lifestyle Behaviors Are Associated With Metabolic Syndrome in a Taiwanese Population.

PURPOSE: To explore associations between metabolic syndrome and modifiable lifestyle behaviors among the adult population in Taiwan. DESIGN: This cross-sectional study analyzed data from a nationally representative sample that participated in the 2005-2008 Nutrition and Health Survey in Taiwan. The sample (2,337 participants older than 19 years) provided data on demographic characteristics, modifiable lifestyle behaviors, anthropometric measurements, and blood chemistry panel. METHODS: These data were analyzed by descriptive statistics, univariate logistic regression, and multivariate logistic regression to determine factors associated with metabolic syndrome. FINDINGS: Metabolic syndrome had a prevalence of 25.2%, and this prevalence increased with age. In univariate regression analysis, metabolic syndrome was associated with age, living with family members, educational level, and modifiable lifestyle behaviors (smoking, drinking, betel quid chewing, and physical activity). Individuals with a smoking history and currently chewing betel quid had the highest risk for metabolic syndrome. CONCLUSIONS: The risk for metabolic syndrome might be reduced by public health campaigns to encourage people to quit smoking cigarettes and chewing betel quid. Implementing more modifiable lifestyle behaviors in daily life will decrease metabolic syndrome in Taiwan. CLINICAL RELEVANCE: Considering that betel quid chewing and tobacco smoking interact to adversely affect metabolic syndrome risk, public health campaigns against both behaviors seem to be a cost-effective and efficient health promotion strategy to reduce the prevalence rate of metabolic syndrome.

Increased plasma soluble CD40 ligand concentration in pelvic inflammatory disease.

BACKGROUND: The role of soluble CD40 ligand (sCD40L) in pelvic inflammatory disease (PID) remains unclear. We sought to determine whether sCD40L was an efficient serum marker as with WBC and CRP in PID patients. METHODS: Enzyme-linked immunosorbent assay was used to measure the plasma levels of sCD40L before and after routine protocol treatments in sixty-four PID patients and seventy healthy controls. RESULTS: The level of plasma sCD40L (pg/ml) was significantly elevated in PID patients (1632.83±270.91) compared to that in normal controls (700.33±58.77; p=0.001) and decreased significantly as compared to that in the same patients (928.77±177.25; p=0.0001) after they received treatment. The concentration of sCD40L was significantly correlated with the level of plasma C-reactive protein (CRP) in the blood (r=0.202, p=0.01, n=134). When the cutoff level of plasma sCD40L levels was determined to be 1612.26pg/ml based on ROC, the sensitivity, specificity, and the area under the curve of plasma sCD40L level for predicting PID were 0.26, 0.97, and 0.58 (95% confidence interval: 0.48-0.68), respectively, while the adjusted odds ratio (AOR) with their 95% CI of plasma sCD40L for PID risk was 7.09 (95% CI=1.14-43.87, p=0.03). CONCLUSIONS: The expression of plasma sCD40L was increased in patients with PID and detection of plasma sCD40L could be useful for the diagnosis of PID.

Social support and mortality among the aged people with major diseases or ADL disabilities in Taiwan: a national study.

OBJECTIVE: To determine the effects of social support on mortality among the aged people with major diseases or ADL disabilities. METHOD: In this prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging from 1996 to 2007. Data for 1297 males and 1666 females aged ≥65 years were collected. The participants were divided into having major diseases or ADL disability or none. Subjects received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others. The effect of the association between providing and receiving social support on mortality was examined using Cox regression analysis after adjusting several covariates. RESULTS: Results showed a significant finding that providing instrumental support can lower mortality rates in the aged people [Hazard ratio (HR)=0.77; 95% confidence interval (CI)=0.66-0.90; p=0.0009] and those with major diseases or impairment of activities of daily living [Hazard ratio (HR)=0.62; 95% confidence interval (CI)=0.50-0.78; p≤0.0001] after adjusting for several covariates. Providing instrumental social support to others may prolong life expectancy in the aged people and even those with major diseases or those facing difficulties performing ADL. CONCLUSION: Based on the finding, we should encourage older adults who have major diseases or ADL disabilities to be supporting providers especially in providing instrumental social support.