Correlation of N-terminal-pro-brain natriuretic peptide with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement.

BACKGROUND: Patients undergoing transcatheter aortic valve replacement surgery (TAVR) are typically older adults with multiple chronic diseases and therefore have a high surgical risk. The N-terminal of brain natriuretic peptide (BNP) and pro-BNP, referred to as NT-pro-BNP, is an easily measurable biomarker of heart failure. Studies on correlation between higher NT-pro-BNP levels and adverse prognoses after TAVR have yielded inconsistent results. Here, we investigated whether preoperative NT-pro-BNP levels are correlated with outcomes among older adults undergoing TAVR. METHODS: This retrospective study included older adults with severe aortic stenosis (AS) who received TAVR from a medical center between January 2013 and June 2017. The patients' demographics, preoperative laboratory data, postoperative complications, and 1-year mortality were recorded. They were divided into two groups based on their preoperative NT-pro-BNP levels. The post-TAVR outcomes in the two groups were analyzed using a multivariate logistic regression analysis of the binary results. RESULTS: Of the 132 patients included (mean age: 81.5 ± 8.1 years; 47% men), 96 (72.7%) had preoperative NT-pro-BNP levels ≤ 4853 ng/L, and 36 (27.3%) had preoperative NT-pro-BNP levels > 4853 ng/L. The postoperative outcomes were significantly better in the NT-pro-BNP≤4853 group than in the NT-pro-BNP>4853 group: postoperative extracorporeal membrane oxygenation fittings (4.2% vs 16.7%, p = 0.025), number of days in hospital (17.5 ± 21.0 vs 27 ± 17.0, p = 0.009), in-hospital mortality (4.2% vs 16.7%, p = 0.025), and 1-year mortality (11.5% vs 38.9%, p = 0.001); the significant differences persisted after controlling for other variables. CONCLUSION: For older patients undergoing TAVR with NT-pro-BNP levels > 4853 ng/L, their postoperative outcomes and 1-year mortality were correlated. Thus, NT-pro-BNP is useful for the risk assessment of patients undergoing TAVR and should be regarded as a biomarker in future risk assessments.

A Nationwide Study of Myopia in Taiwanese School Children: Family, Activity, and School-Related Factors.

The purpose of the study was to explore how fixed and modifiable family, activity, and school factors affect a student's myopia risk and severity. We used national cross-sectional data from Taiwanese children in Grades 4-6. Bivariate and multivariate analyses, including logistic and ordinary least squares regression, examined factors related to children's myopia status and severity. Age, parent myopia, and school district were associated with risk of myopia. One hour or more per day of near work (OR = 1.26) increased the odds of myopia. The same amount of time in outdoor activities (OR = 0.85) or moderate or vigorous physical activities (OR = 0.82) was associated with lower risk. Near work (ß = 0.06), outdoor activity (ß = -0.04), and outdoor recess (ß = -0.03) predicted myopia severity. To promote healthy vision, nurses should advocate for and implement interventions that increase school children's time outdoors and in physical activities and reduce their time on near work.

The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: A randomized controlled study.

BACKGROUND: Fatigue is the most common symptom experienced by cancer patients during treatment and can last long after completing treatment. Fatigue in cancer patients who have completed treatment is well known to be reduced by exercise, but the effect of exercise on reducing fatigue in patients under treatment has been inconsistent. OBJECTIVES: The purposes of this study were to examine short-term and long-term effects of an individually tailored, home-based brisk walking program on reducing fatigue in breast cancer patients under chemotherapy. DESIGN, SETTING, PARTICIPANTS: For this randomized controlled trial, women were recruited from a medical center in northern Taiwan if they were diagnosed with stages I-III breast cancer and experienced insomnia, fatigue, pain, or depressive symptoms after their first cycle of chemotherapy. Consenting participants (N = 159) were randomly assigned to either an exercise (12-week home-based walking program) group (n = 81) or an attention-control group (n = 78). METHODS: The 12-week, home-based brisk walking program started on the first day of the third chemotherapy cycle. Fatigue was measured by the Brief Fatigue Inventory. Covariates, i.e., functional performance, sleep disturbance, anxiety, depression, and exercise-related variables, were also measured. Data were collected at baseline, two times during the exercise intervention, and five times after the exercise intervention (eight times in total). The effects of time-varying and time-invariant predictors on fatigue were analyzed by multilevel modeling. RESULTS: Fatigue levels increased over time for both groups, even after completing treatment. At the end of the 12-week exercise program, the exercise group had less fatigue than the attention-control group, and this group difference was maintained for the whole study period. At the end of exercise program, women who had spent more time exercising before diagnosis had less fatigue than those who had exercised less often. In addition, patients' fatigue levels at various time points fluctuated along with their functional performance, sleep disturbance, and depression. CONCLUSIONS: Our tailored, home-based brisk walking program effectively reduced fatigue in breast cancer patients under chemotherapy, and this effect lasted after completing treatment.

Effects of physical activity counselling in women with systemic lupus erythematosus: A randomized controlled trial.

BACKGROUND: Low physical activity is common in systemic lupus erythematosus populations. AIM: To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. METHODS: A randomized, controlled, single-blind trial was conducted from March 2015 to August 2016. Seventy-six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow-ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. RESULTS: The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. CONCLUSIONS: Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier.

The effects of Baduanjin exercise on fatigue and quality of life in patients with heart failure: A randomized controlled trial.

AIMS: The purpose of this study was to examine the effects of Baduanjin exercise on fatigue and quality of life in patients with heart failure. METHODS: The study was a randomized controlled trial. Participants diagnosed with heart failure were recruited from two large medical centers in northern Taiwan. Participants were randomly assigned to the intervention ( n=39) or control ( n=41) groups. Patients in the intervention group underwent a 12-week Baduanjin exercise program, which included Baduanjin exercise three times per week for 12 weeks at home, a 35-minute Baduanjin exercise demonstration video, a picture-based educational brochure, and a performance record form. The control group received usual care and received no intervention. Fatigue and quality of life were assessed using a structural questionnaire at baseline, four weeks, eight weeks, and 12 weeks after the intervention. RESULTS: Participants in the Baduanjin exercise group showed significant improvement in fatigue ( F=5.08, p=0.009) and quality of life ( F=9.11, p=0.001) over time from baseline to week 12 after the intervention. Those in the control group showed significantly worse fatigue ( F=3.46, p=0.033) over time from baseline to week 12 and no significant changes in quality of life ( F=0.70, p=0.518). Compared to the control group, the exercise group demonstrated significantly greater improvement in fatigue and quality of life at four weeks, eight weeks, and 12 weeks. CONCLUSIONS: This simple traditional exercise is recommended for Taiwanese patients with heart failure in order to improve their fatigue and quality of life.

Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials.

BACKGROUND: Exercise interventions apparently reduce the risks of and prevent coronary artery disease (CAD). Developing an exercise intervention for patients with CAD is a rapidly expanding focus worldwide. The results of previous studies are inconsistent and difficult to interpret across various types of exercise programme. AIM: This study aimed to update prior systemic reviews and meta-analyses in order to determine the overall effects of endurance exercise training on patients with CAD. METHODS: The databases (PubMed, Medline, CINAHL, EMBASE and Cochrane Library) were searched for the interventions published between January 1, 2000, and May 31, 2015. Comprehensive meta-analysis software was used to evaluate the heterogeneity of the selected studies and to calculate mean differences (MDs) while considering effect size. RESULTS: A total of 18 studies with 1286 participants were included. Endurance exercise interventions at a moderate to high training intensity significantly reduced resting systolic blood pressure (MD: -3.8 mmHg, p = 0.01) and low-density lipoprotein cholesterol (MD: -5.5 mg/dL, p = 0.02), and increased high-density lipoprotein cholesterol (MD: 3.8 mg/dL, p < 0.001). There were also significant positive changes in peak oxygen consumption (MD: 3.47 mL/kg/min, p < 0.001) and left ventricular ejection fraction (MD: 2.6%, p = 0.03) after the interventions. Subgroup analysis results revealed that exercise interventions of 60-90 minutes per week with a programme duration of >12 weeks had beneficial effects on functional capacity, cardiac function and a number of cardiovascular risk factors. CONCLUSIONS: Endurance exercise training has a positive effect on major modifiable cardiovascular risk factors and functional capacity. Nurses can develop endurance exercise recommendations for incorporation into care plans of clinically stable CAD patients following an acute cardiac event or revascularisation procedure.

The Effectiveness of Exercise in Adults With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice.

BACKGROUND: Fatigue is the most common and unpleasant symptom of patients with systemic lupus erythematosus (SLE). However, there is limited information regarding how exercise affects fatigue. AIMS: The purpose of this study is to review and synthesize the current knowledge concerning the effectiveness of exercise training for treating fatigue among adults with SLE. The characteristics of beneficial exercise training are further evaluated. METHODS: We conducted a systematic review and meta-analysis. The databases searched were MEDLINE, CINAHL, PEDro, Cochrane Library, Scopus, and PQDT from their inception to February 3, 2016. The quality of each selected study was assessed using the PEDro scale. A between-group analysis was performed to evaluate the effectiveness of the exercise training. Data were analyzed using the Cochrane Collaboration's RevMan 5.3 (Copenhagen, Denmark). RESULTS: Two randomized controlled trials and one quasiexperimental study were included in this systematic review and meta-analysis. Aerobic exercise, three times a week and of moderate intensity, was a common component of the three studies. Two studies were conducted in a supervised setting and one study was based at home. One study lasted 8 weeks and two studies lasted 12 weeks. The meta-analysis showed that aerobic exercise could decrease fatigue (MD = -.52, 95% confidence interval [CI] [-.91, -.13], p = .009) and increase vitality (MD = 14.98, 95% CI [7.45, 22.52], p < .001). The subgroup analysis indicated that 12 weeks of exercise training and exercise under a supervised setting significantly benefited fatigue. LINKING EVIDENCE TO ACTION: The pooled data indicate that 12 weeks of an aerobic exercise program that is supervised by health professionals could reduce fatigue and increase vitality for patients with SLE. SLE patients with mild disease should begin with moderate intensity for at least 20 minutes, 3 days a week.

Lycopene inhibits cyclic strain-induced endothelin-1 expression through the suppression of reactive oxygen species generation and induction of heme oxygenase-1 in human umbilical vein endothelial cells.

Lycopene is the most potent active antioxidant among the major carotenoids, and its use has been associated with a reduced risk for cardiovascular disease (CVD). Endothelin-1 (ET-1) is a powerful vasopressor synthesized by endothelial cells and plays a crucial role in the pathophysiology of CVD. However, the direct effects of lycopene on vascular endothelial cells have not been fully described. This study investigated the effects of lycopene on cyclic strain-induced ET-1 gene expression in human umbilical vein endothelial cells (HUVECs) and identified the signal transduction pathways that are involved in this process. Cultured HUVECs were exposed to cyclic strain (20% in length, 1 Hz) in the presence or absence of lycopene. Lycopene inhibited strain-induced ET-1 expression through the suppression of reactive oxygen species (ROS) generation through attenuation of p22(phox) mRNA expression and NAD(P)H oxidase activity. Furthermore, lycopene inhibited strain-induced ET-1 secretion by reducing ROS-mediated extrace-llular signal-regulated kinase (ERK) phosphorylation. Conversely, lycopene treatment enhanced heme oxygenase-1 (HO-1) gene expression through the activation of phosphoinositide 3-kinase (PI3K)/Akt pathway, followed by induction of the nuclear factor erythroid 2-related factor 2 (Nrf2) nuclear translocation; in addition, HO-1 silencing partially inhibited the repressive effects of lycopene on strain-induced ET-1 expression. In summary, our study showed, for the first time, that lycopene inhibits cyclic strain-induced ET-1 gene expression through the suppression of ROS generation and induction of HO-1 in HUVECs. Therefore, this study provides new valuable insight into the molecular pathways that may contribute to the proposed beneficial effects of lycopene on the cardiovascular system.

Adherence to prescribed exercise time and intensity declines as the exercise program proceeds: findings from women under treatment for breast cancer.

PURPOSE: Adherence to prescribed exercise is a challenge for cancer patients undergoing treatment. The changing pattern of exercise adherence over time cannot be fully understood by an overall measure of adherence. This study was aimed to identify the trajectory of exercise adherence and its predictors for women with breast cancer during their chemotherapy. METHODS: Participants were 78 women with breast cancer assigned to the exercise arm of a randomized control trial. Based on the weekly adherence rates in time and intensity, patients were classified as good (>100%), acceptable (80-100%), and poor (<80%) adherents. Data were analyzed using ordinal logistic hierarchical linear modeling. RESULTS: The trajectories for both time and intensity adherence declined significantly. The decline in exercise-time adherence was significantly slower in women who reported higher interest in exercise. Women with higher perceived importance of exercise, early disease stage, and employed were more likely to be classified as good intensity adherents. Poorer weekly adherence for both exercise time and intensity was associated with higher fatigue level for that week. CONCLUSIONS: Adherence to exercise adherence in breast cancer patients declined as the dose of exercise prescription increased. Factors influencing overall adherence and adherence trend were identified.

Early morning awakening and nonrestorative sleep are associated with increased minor non-fatal accidents during work and leisure time.

BACKGROUND: The relationship between a composite measure of insomnia and occupational or fatal accidents has been investigated previously; however, little is known regarding the effect of various insomnia symptoms on minor non-fatal accidents during work and leisure time. OBJECTIVE: We investigated the predicting role of insomnia symptoms on minor non-fatal accidents during work and leisure time. METHODS: Data from the 2005 Taiwan Social Development Trend Survey of 36,473 Taiwanese aged ≥18 years were analyzed in 2013. Insomnia symptoms, including difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS) were investigated. A minor non-fatal accident was defined as any mishap such as forgetting to turn off the gas or faucets, accidental falls, and abrasions or cuts occurring during work and leisure time in the past month that do not require immediate medical attention. Multivariable logistic regression was performed to assess the odds ratios (ORs) and associated 95% confidence interval (CI) of minor non-fatal accidents (as a binary variable) for each insomnia symptom compared with those of people presenting no symptoms, while controlling for possible confounders. RESULTS: EMA and NRS increased the odds of minor non-fatal accidents occurring during work and leisure time (adjusted OR=1.19, 95% CI=1.08-1.32 and adjusted OR=1.27, 95% CI=1.17-1.37, respectively). CONCLUSION: EMA and NRS are two symptoms that are significantly associated with an increased likelihood of minor non-fatal accidents during work and leisure time after adjusting for of a range of covariates.

Effects of endurance exercise training on risk components for metabolic syndrome, interleukin-6, and the exercise capacity of postmenopausal women.

We conducted this study to investigate how an exercise program affects the risk components of metabolic syndrome (MS), serum interleukin (IL)-6 levels, and exercise capacity in postmenopausal women. A randomized clinical trial design was used. Women in an exercise group participated in a treadmill-exercise program for 12 weeks, whereas women in a control group maintained their customary lifestyle. Data on variables were collected at baseline and after 12 weeks of the study, which was completed by 46 women (mean age, 56.0 ± 7.0 y). Our results indicate endurance exercise exerted significant beneficial effects on waist circumference, serum high-density lipoprotein cholesterol (HDL-C) and IL-6 levels, and exercise capacity (all P < 0.05). The beneficial effects on IL-6 and exercise capacity were correlated with improvements in HDL-C levels (r = -0.33, P = 0.03 and r = 0.31, P = 0.04, respectively). Our results suggest that health-care providers can incorporate an exercise program in treatments to improve the health of postmenopausal women.

Development and preliminary validation of a questionnaire on regular exercise beliefs among patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVES: To develop a Regular Exercise Belief Questionnaire and test its psychometric properties for patients with chronic obstructive pulmonary disease. BACKGROUND: Regular exercise has been shown to significantly improve physical capacity and the quality of life of patients with chronic obstructive pulmonary disease. However, their adherence to long-term exercise is low. To develop an effective strategy for promoting good exercise behaviours, it is important to have a validated instrument to evaluate factors related to engaging in exercise. DESIGN AND METHODS: A cross-sectional design was used for the study. Construction of the Regular Exercise Belief Questionnaire was based on the Theory of Planned Behaviour Reliability and validity were assessed using a sample of 136 male patients with chronic obstructive pulmonary disease. The construct validity of the questionnaire was confirmed through exploratory factor analysis and known group technique. RESULTS: Exploratory factor analysis resulted in an eight-factor solution that explained 70·4% of the total variance. The internal consistency of the Regular Exercise Belief Questionnaire was 0·83-0·93. The Regular Exercise Belief Questionnaire was preliminarily found to be reliable and exhibited satisfactory validity for patients with chronic obstructive pulmonary disease. CONCLUSION: The Regular Exercise Belief Questionnaire is the first theory-based measure of exercise beliefs among patients with chronic obstructive pulmonary disease. The questionnaire provides an effective method to examine behaviour beliefs, normative beliefs and control beliefs about regular exercise. CLINICAL RELEVANCE: The measure can be used to periodically evaluate the exercise beliefs in clinics and to examine the effectiveness of exercise programmes in patients with chronic obstructive pulmonary disease. The result of the evaluation could also apply to identify strategies related to promoting exercise behaviours.

An exploration of beliefs regarding exercise among Taiwanese patients with chronic obstructive pulmonary disease.

OBJECTIVES: To explore the beliefs regarding regular exercise among patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: Low adherence to exercise has been observed in patients with COPD. It is important to identify factors regarding exercise from the patients' viewpoint. METHODS: Thirty-one patients were recruited from a medical center in Taiwan. Semi-structured, in-depth, one-on-one interviews were conducted to collect data. The narratives of the interviews were analyzed via content analysis. RESULTS: The majority of the participants affirmed the benefits of regular exercise; however, concerns about personal comfort and safety affected their actual exercise behavior. Five normative references were found to support exercise behavior, and several exercise promoters were identified. CONCLUSION: This study provides an understanding of exercise beliefs of Taiwanese patients with COPD stage II-IV and suggests several ideas for their exercise maintenance. There is a need to provide individualized exercise guides and reinforced programs for patients with chronic obstructive pulmonary disease.

[Symptom experience, causal attribution and adherence to therapeutic regimens: patients with hypertension].

Symptoms are the most important factor leading patients to seek medical help from health professionals. However, symptoms not directly supported by physiological and pathological evidence are often classified as being of emotional or psychological origin. Symptoms reflect an individual's subjective experience of physical-psycho-social functions, perception or cognition. Prior to implementing symptom management strategies, nurses should clarify patient symptom experiences and the meaning of such to patients. Individuals naturally seek symptoms based on physician diagnoses. When experiencing uncomfortable physical symptoms, individuals seek to label symptoms and accept medical advice based on their personal illness perception. In light of such, non-adherence to treatment recommendations may reflect inconsistencies between medical advice and patient symptom or illness diagnosis perception. In this paper, the author addresses relationships among symptom experience, symptom/illness attributions and therapeutic regimen adherence. Results identify the significant role that symptom experience plays in adherence to therapeutic regimens in patients with hypertension and suggests recommended revisions to clinical education in order to reflect such.

Fatigue and physical activity levels in patients with liver cirrhosis.

AIMS AND OBJECTIVES: This study aimed to explore the correlation between fatigue and physical activity in patients with liver cirrhosis. BACKGROUND: Many patients with liver cirrhosis perceive lower physical functioning and more fatigue than non-cirrhotic individuals. To date, however, few studies have examined the relationship between fatigue and physical activity in this patient population. DESIGN: This study used a correlation design. Participants were patients with liver cirrhosis recruited from the gastroenterology clinic of a teaching medical centre in Taiwan. METHODS: Data were collected using a structured questionnaire, consisting of a fatigue scale and a seven-day Physical Activity Recall scale. spss version 13.0 software was used to analyse the data through statistical methods, including one-way analysis of variance, independent t-test and Pearson's correlations. RESULTS: Patients participating in this study suffered from moderate-to-severe fatigue, and their engagement in physical activity of moderate or higher intensity was decreased. On average, fatigue had a moderate level of influence on physical activity. A significant negative correlation was found between the fatigue level and average seven-day physical activity level. CONCLUSIONS: Patients with liver cirrhosis can experience severe fatigue, which may reduce their level of physical activity. RELEVANCE TO CLINICAL PRACTICE: Early evaluation of the fatigue level and physical activity constraints in patients with liver cirrhosis should be conducted in the clinic or community. Individualised instructions for patient's physical activity should be provided.

Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy.

AIM: This paper is a report of a study analysing the effect of a home-based walking exercise program on symptoms and mood distress among breast cancer women receiving chemotherapy postoperatively. BACKGROUND: Treatment-related symptoms, mood distress and decline in physical activity have been identified as major complaints among cancer patients. Studies on the efficacy of home-based walking exercise for symptoms and mood did not fully describe the exercise prescriptions that could be safe and beneficial for women with breast cancer, especially these receiving adjuvant chemotherapy. METHOD: This is a prospective, randomized clinical trial. In 2008-2009, participants were recruited from the oncology outpatient clinic of a medical center in Taiwan, and were assigned to either the exercise group (n=19) or the control group (n=21). Women in the exercise group participated in a moderate-intensity home-based walking program for 12 weeks during their chemotherapy treatments. Symptoms, mood status and physical activity level were measured at baseline, 6- and 12-week follow-up. Data were analysed by two-way repeated-measures analysis of variance. RESULTS: Women in the exercise group reported significantly lower symptom severity scores and mood disturbance compared with those in the control group throughout the study period. CONCLUSION: Regular moderate-intensity exercise can play an important role in improving treatment-related symptoms and mood in women with breast cancer. A home-based walking exercise program can be easily incorporated into care for women with breast cancer undergoing chemotherapy.

Illness perceptions and adherence to therapeutic regimens among patients with hypertension: a structural modeling approach.

BACKGROUND: Patients' lay views of illness are influential on adherence to therapeutic regimes. However, factors associate with non-adherence are not examined simultaneously. OBJECTIVES: The purpose of the study was to test a hypothetical model of the relationships between illness perception and adherence to prescribed medication and self-management recommendations of hypertensive patients based on theoretical assumptions of the Common-Sense Model. DESIGN: A cross-sectional, descriptive, correlational design. SETTINGS: Cardiovascular clinics of three teaching hospitals in central Taiwan. PARTICIPANTS: Three hundred and fifty-five hypertensive patients. METHODS: Data were collected through face-to-face interviews using structured questionnaires, including the Illness Perception Questionnaire-Revised, the Medication Adherence Inventory, and the Inventory of Adherence to Self-Management. Data were analyzed by structural equation modeling using LISREL. RESULTS: The findings suggested that the illness identity may directly affect patient adherence to prescribed medications or indirectly affect patient adherence via control of the disease and cause. Control of the disease exhibited direct effects on adherence to prescribed medications and self-management, while the cause of the illness only showed direct effects on adherence to prescribed medications. The relationships were independent of systolic blood pressure, age, the total number of antihypertensive medication, and comorbidity. CONCLUSIONS: The findings of the study extend the utility of the Common-Sense Model, suggesting that adherence to therapeutic regimens may be enhanced by improving a sense of controllability. For patients who experience symptoms related to high blood pressure, barriers to adherence may be reduced by assessing and clarifying the meaning of illness identity and causal attributions.

Cardiac conductive disturbance in patients with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality of reproductive-aged women and increases the risk of cardiovascular disease. However, the effects of PCOS on electrocardiograms (ECGs) are not fully elucidated. The aim of this study was to evaluate the characteristics of ECGs in patients with PCOS. METHODS: This study included 24 patients with PCOS and 12 patients without PCOS. The heart rate, PR interval, QRS duration, Sokolow-Lyon voltage (SV1 + RV5/6), Cornell voltage (RaVL + SV3), QT interval and QTc interval were measured in 12-lead ECGs. RESULTS: The QRS duration was wider in patients with PCOS than those without PCOS (91 ± 8 vs. 81 ± 10 ms, p < 0.05). The heart rate, PR interval, Sokolow-Lyon voltage, product of the QRS duration times Cornell voltage combination, QT interval, QTc interval, QT dispersion and QTc dispersion were similar between the two groups. CONCLUSIONS: PCOS is associated with a widening QRS duration, which may contribute to its increased cardiovascular risks.

Religiosity influences on bereavement adjustments of older widows in Taiwan.

AIMS: To describe difficulties encountered by older widows in Taiwan and the impact of intrinsic or extrinsic religiosity on their coping strategies during early widowhood. BACKGROUND: There is very limited information about how Taiwan's widows cope with their bereavement and no studies reporting the relationship between religious beliefs and healthy adjustment during this distressing period. DESIGN: Between-method qualitative and quantitative triangulation was used. Semi-structured interviews were conducted and transcribed data were analysed by critical thematic analysis. RESULTS: Twenty women in Taiwan, >65 years old, (mean = 72.95) were interviewed within three years of being widowed. There were two informant groups: those with intrinsic religious beliefs and those with extrinsic religious beliefs. They all reported intrapersonal and interpersonal problems. Several major coping strategies arose: 'practising positive or negative attitudes for adaptation'; 'using person-focused actions'; and 'taking the initiative or passively seeking help from others or helping others'. Informants with intrinsic religious beliefs reported fewer coping problems by holding positive attitudes and taking multiple actions for adaptation. The extrinsic religious group had more negative adaptation attitudes, such as withdrawal and low self-esteem and practised less faith religious activities in worshipping ancestors, experiencing fatalism and using divination. They reported more coping problems than the intrinsic religious group. CONCLUSION: Widows in Taiwan have different coping problems and strategies in postbereavement adjustment, affected by their different religious beliefs systems. More research is required to establish the generalisabilty of these findings. RELEVANCE TO CLINICAL PRACTICE: Widows in Taiwan need to be assessed for their religious belief systems and how this affects their ability to cope during bereavement. Clinicians should actively provide grief support and encourage new methods of social adaptation, especially with widows with extrinsic religious beliefs who may have less self-esteem and negative adaptation behaviours.

Physical activity levels of school-age children with congenital heart disease in Taiwan.

Congenital heart disease (CHD) is a common childhood health problem. The incidence of CHD is estimated between 8 and 10 per 1,000 children in Taiwan. Evidence indicates that exercise capacity for children with CHD can reach the level of children with no CHD after surgical repair. However, it is necessary to further investigate if their physical activity is comparable to their peers who have no CHD to prevent chronic disease caused by physical inactivity. This study aimed to investigate the differences of physical activity level (PAL) between Taiwanese children with no CHD and children after total correction for CHD. A case control design was used in this study. During the study period, 68 schoolchildren were recruited: 34 children with CHD and 34 age- and gender-matched children who have no CHD. The data collection tools included three-day physical activity record (3DPAR) and RT3 triaxial accelerator. The average total energy expenditure (TEE) measured by both 3DPAR and RT3 triaxial accelerator were lower for boys with CHD than boys with no CHD (t = -3.39, p = .002; t = -3.43, p = .002). PAL was also lower for boys with CHD than for boys with no CHD (t = -2.29, p = .03). Whereas, TEE did not differ between girls with CHD and girls with no CHD (t = 0.58, p = .57; t = -0.27, p = .79). Overall, the level of moderate-to-vigorous physical activity (MVPA) was similar between children with CHD and children with no CHD. These results suggest that boys with CHD engage in less physical activity than do boys with no CHD. Both children with CHD and children with no CHD should be encouraged to engage in more physical activity especially MVPA.