The experiences of public health nurses during the COVID-19 in Taiwan: A qualitative study.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has had a substantial effect on frontline health care workers and caused public health nurses (PHNs) to come under various forms of pressure. PHNs face high-risk challenges in their work environment, and their professional commitment and adaptability are key concerns. The aim of this qualitative study was to describe the experiences of PHNs during the COVID-19 outbreak. METHODS/DESIGN: Twenty PHNs who worked during the COVID-19 outbreak were recruited from seven public health centres through posters. Data were collected through in-depth interviews that comprised semi-structured and open-ended questions; subsequently, the data were analysed through content analysis. RESULTS: Three themes emerged from the study findings, namely (1) the disorderliness of COVID-19 pandemic prevention work, (2) managing stress and fear, and (3) the establishment of a new normal. Because of the severity of the pandemic, the workload and stress associated with epidemic prevention policies continue to increase. PHNs may infect their family members and experience a sense of alienation and distance. They must also deal with irrationality and reactions in the people within their community. CONCLUSION: Health department directors and policymakers should provide the necessary support and assistance to frontline pandemic prevention workers to increase the efficiency of pandemic prevention efforts. PATIENT OR PUBLIC CONTRIBUTION: The participants agreed to participate in the qualitative study during the study period.

Self-management experience of first-time diagnosed gestational diabetes mellitus: A focus group interview.

AIM: Gestational diabetes mellitus (GDM) has become the most common complication in women during pregnancy in Taiwan. Since several clinical trials have demonstrated benefits of aggressive treatment, which rely heavily on self-management. The present study was conducted to explore the self-management experience of women with first-time diagnosed GDM. DESIGN: A qualitative descriptive approach was applied to conduct this study. METHODS: Purposive sampling was used to recruit patients with first-time diagnosed GDM from the maternity outpatient clinics of medical centre in Taiwan. A total of three focus groups interviews with 22 women were conducted to collect the data. Content analysis was applied to analyse the data. RESULTS: Four themes were identified: (1) unexpectedly having a high-risk pregnancy, (2) different perceptions for self-management, (3) implementation predicament of self-management and (4) maternal duty to ensure the safety of mother and child.

Estimating the incidence rate ratio of common cold among patients with non-apnea sleep disorders: a retrospective cohort study.

The purpose was to explore the potential effects of nonapnea sleep disorders (NSDs) and hypnotic use on the incidence of common cold. This study adapted population-based retrospective cohort study designed. We used the data from the Taiwan National Health Insurance Research Database between 1998 and 2011. In total, 59,476 patients with NSDs were included in the study cohort, and the reference cohort comprised 59,476 propensity score-matched patients. We conducted a Poisson regression analysis to assess the incidence of common cold. The overall incidence of common cold was significantly higher than that in the reference cohort. Compared with the patients of the reference cohort without hypnotic use, those of the NSDs cohort with benzodiazepines and zolpidem use had higher incidence of common cold. In conclusion, study cohort had a higher incidence of developing common cold, and particularly pronounced in NSDs with hypnotic use.

Obstructive sleep apnea and injury events in Taiwanese adults: A retrospective cohort study.

PURPOSE: The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries. DESIGN: This population-based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database. METHODS: 3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age- and sex-matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk. FINDINGS: Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person-years compared to the control cohort (2248 per 100,000 person-years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.64-1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls. CONCLUSIONS: Our study strongly supports the conclusion that adults with OSA are at increased risk of injury. CLINICAL RELEVANCE: The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention.

Effectiveness of a Nurse-Led Web-Based Health Management in Preventing Women With Gestational Diabetes From Developing Metabolic Syndrome.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are more likely to develop metabolic syndrome (MS). However, the effectiveness of web-based health management in preventing women at high risk of GDM from developing MS has rarely been studied. PURPOSE: The aim of this study was to evaluate the longitudinal effects of nurse-led web-based health management on maternal anthropometric, metabolic measures, and neonatal outcomes. METHODS: A randomized controlled trial was conducted from February 2017 to February 2018, in accordance with the Consolidated Standards of Reporting Trials guidelines. Data were collected from 112 pregnant women at high risk of GDM who had been screened from 984 potential participants in northern Taiwan. Participants were randomly assigned to the intervention group (n = 56) or the control group (n = 56). The intervention group received a 6-month nurse-led, web-based health management program as well as consultations conducted via the LINE mobile app. Anthropometric and metabolic measures were assessed at baseline (Time 0, prior to 28 weeks of gestation), Time 1 (36-40 weeks of gestation), and Time 2 (6-12 weeks of postpartum). Maternal and neonatal outcomes were assessed at delivery. Clinical trial was registered. RESULTS: Analysis using the general estimating equation models found that anthropometric and metabolic measures were significantly better in the intervention group than the control group and varied with time. At Time 1, the levels of diastolic pressure (ß = -4.981, p = .025) and triglyceride (TG; ß = -33.69, p = .020) were significantly lower in the intervention group than the control group, and at Time 2, the incidence of MS in the intervention group was lower than that in the control group (χ2 = 6.022, p = .014). The number of newborns with low birth weight in the intervention group was lower than that in the control group (χ2 = 6.729, p = .012). CONCLUSION/IMPLICATIONS FOR PRACTICE: This nurse-led, web-based health management was shown to be effective in improving MS outcomes and may play an important role and show feasible clinical value in changing the current pregnancy care model.

Study on the Promoter Region-149C＞T and-579G＞T Polymorphism of DNMT3B with Genetic Susceptibility to Esophageal Cancer of Han Population in Jiangsu Suqian / 现代检验医学杂志

Objective To investigate the association of DNA methyltransfcrase 3B (DNMT3B) promoter region single nucleo tide polymorphism (SNP)-149C＞T and-579G＞T with genetic susceptibility of esophageal cancer (EC) of Han population in Jiangsu Suqian.Methods Gcnotypes of the-149C＞T and 579G＞T locus in DNMT3B promoter region were examinedby polymerase chain reaction with restriction fragment length polymorphism (PCR RFLP) in 246 esophageal cancer patients and 240 healthy controls.Results In-149C＞T site,the distributions of genotypes TT compared with CT in the EC group and the controls were no significant difference (x2 =0.089,P＞0.05).In-579G＞T site,the distributions of genotypes TT compared with GT+GG in the EC group and the controls were no significant difference (x2 =0.649,P＞0.05).When strat ified by age and gender,there was no significant difference in the EC group and the controls in both two sites (x2 =0.044～0.876,all P＞0.05).Conclusion The DNMT3B promoter region-149C＞T and-579G＞T were not associated with the genetic susceptibility of esophageal cancer.

[The Design Requirements for an E-Health Management Platform: Addressing the Needs of Adolescent Girls at High Risk of Metabolic Syndrome].

BACKGROUND: The rising prevalence of metabolic syndrome among adolescents has not been effectively addressed by current campus-based health promotions. Using the Internet in these promotions may help health professionals achieve better healthcare management. PURPOSE: The purpose of the present study was to explore the design requirements of an e-health management platform from the subjective perspective of adolescent girls who were at a high risk of metabolic syndrome. The findings may provide a reference for designing nursing interventions that more effectively promote healthly lifestyle habits to adolescents. METHODS: This qualitative study employed a snowball approach and used a semi-structured interview guide to collect data. A total of 20 Taiwanese adolescent females who were at a high risk of metabolic syndrome, aged 16-20 years, able to speak Mandarin or Taiwanese, and willing to participate and to have their sessions tape-recorded were enrolled as participants and engaged individually in in-depth interviews. The constant comparative method was used to inductively analyze the interview data. RESULTS: Five main themes related to the e-health management platform emerged from the data. These themes included: an attractive and user-friendly website interface, access to reliable information and resources, provision of tailored health information, access to peer support, and self-monitoring and learning tools. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings highlight the key design needs of an e-Health management platform from the perspective of adolescent girls who are at a high risk of metabolic syndrome. The identified themes may be addressed in future revisions / developments of these platforms in order to better address the needs of this vulnerable population and to effectively reduce the incidence of metabolic syndrome. The authors hope that the results of the present study may be used to provide better healthcare and support for adolescent girls with metabolic syndrome.

Weight loss experiences of obese perimenopausal women with metabolic syndrome.

AIMS AND OBJECTIVES: To develop a descriptive theory for the weight loss experiences of obese perimenopausal women with metabolic syndrome. BACKGROUND: Obesity and metabolic syndrome both pose a threat to the health of perimenopausal women; therefore, understanding perimenopausal women's subjective feelings and experiences is beneficial to establishing effective prevention strategies. However, studies have rarely explored these relevant experiences. DESIGN: A qualitative study using the grounded theory method to establish a descriptive theory. METHODS: Eighteen obese perimenopausal women with metabolic syndrome aged 45-60 years participated in comprehensive interviews. RESULTS: 'Crossing the gaps to making life modifications' was the core category, and 'the awareness of weight gain and health alarm' was the antecedent condition. In the weight loss experience, the following three interaction categories were identified: (1) 'experiencing bad feelings,' (2) 'encountering obstacles' and (3) 'making efforts to transition to a new life.' Some women adhered to new life habits through perceiving social support and by using self-incentives. Finally, women enjoyed and mastered self-monitoring of their health in their new life, and practiced new changes as part of their life. However, some participants felt that making changes to their life was too time-consuming. Therefore, these women chose to live with their abnormal health without making changes. CONCLUSIONS: Obese perimenopausal women with metabolic syndrome experienced various gaps in their weight loss process. Although they struggled with many obstacles, these women were able to learn from their experiences and face their health challenges. RELEVANCE TO CLINICAL PRACTICE: These findings can guide healthcare professionals to provide appropriate interventions to understand the hidden health problems of this particular group of women. Healthcare professionals should develop a set of plans by which women receive a complete weight loss program and support from professionals and family.

The struggle against fat: weight loss experiences of overweight adolescent girls in Taiwan.

BACKGROUND: Weight loss is an important health issue for overweight girls. Understanding their subjective feelings and experiences regarding weight loss may help healthcare professionals and hospitals develop an appropriate intervention for this population. However, there have been few studies done on the subjective weight loss experiences of overweight adolescent girls. PURPOSE: This study developed a descriptive theory framework to elicit the weight loss experiences of overweight adolescent girls in Taiwan. METHODS: This qualitative study used grounded theory to conduct in-depth interviews with 20 overweight adolescent girls aged 16-20 years. Data were analyzed using the constant comparative method. RESULTS: "Struggle against fat" was the core theme that described and guided the process of weight loss for participants. During this process, "obesity as a stigma" was identified as the antecedent condition with the subcategories: being teased, being blamed, being bullied, and lack of personal attractiveness. Participants struggled to practice a new lifestyle while continuing their previous lifestyle during the weight loss process. This process was categorized as "trying dieting shortcuts," "self-sabotage," "confronting weakness," and "adhere to a new life." During this process, some participants adhered to a new life by perceiving peer/family support, using incentive slogans, and sharing experiences. Finally, participants either continued to maintain their new lifestyle and gradually lost weight or resumed their previous lifestyle and regained weight by entering into a vicious cycle of combating fat through dieting shortcuts while practicing self-sabotage. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Weight loss is a difficult issue for most overweight and obese adolescent girls. Health providers should better understand adolescent psychology to provide this population with effective incentives to modify their lifestyles for health purposes. It is crucial that healthcare providers be good coaches to guide and positively support these girls in their struggle against fat.

[The efficacy of e-health management on weight control in adolescents: a systematic review].

BACKGROUND: Advances during the past decade have made it feasible to apply e-health methods to chronic disease management. Researchers have recently begun applying these methods to weight control. The application of e-health management methods to weight control in adolescents has yet to be investigated empirically. PURPOSE: This study conducted a systematic review of reports discussing the weight-control effects of e-health management in adolescents. METHODS: Researchers searched 6 electronic databases for relevant articles published between 1995 and April 2013. Data were collected using inclusion and exclusion criteria. A modified Jadad Scale was used to evaluate the quality of the identified articles. RESULTS: Seven studies met the inclusion criterion of targeting adolescent subject populations. A total of 3728 adolescents and 1394 parents participated in these studies. The majority of participants were overweight girls and median participant ages ranged from 12.52 (SD = 3.15) to 15.31 (SD = 0.69). All studies reported that e-health management reduced body mass index and body fat percentage. Four studies indicate that e-health management may improve physical activity knowledge and skills. However, diet control outcomes among the seven studies varied. CONCLUSIONS: Empirical results demonstrate that e-health management significantly affects weight control. However, the effectiveness of log-in versus primary outcome indicators was inconclusive. Future studies should consider the use of incentives, reminder systems, and other strategies to enhance website usage. The development of an Internet-based, computer-tailored weight-management intervention for overweight adolescents and the development of an appropriate care model are recommended.

Clinical evaluation of selective laser trabeculoplasty for residual primary angle-closure glaucoma / 中华实验眼科杂志

Background Selective laser trabeculoplasty(SLT)has been widely accepted for the treatment of open-angle glaucoma.However,there are few reports about its application in treating angle-closure glaucoma so far.Objective This study was to clinically evaluate the safety and efficacy of selective laser trabeculoplasty for primary angle-closure glaucoma with opened anterior angle follow-up surgery.Methods A case-observational design was adopted in this study.A total of 33 eyes from 23 angle-closure glaucomatous patients with opened 180° angle were enrolled.All the patients understood this trial and written informed consent was obtained prior to the medical treatment.The average preoperative intraocular pressure(IOP)and number of medication were(23.07±4.01)mmHg and 1.52±0.66,respectively.A frequency doubled Q-switched Nd:YAG laser was used to irradiate the trabecular meshwork with 70-80 laser spots over 180°.The same preoperative anti-glaucoma drugs were topically administered during the follow-up period.Visual acuity,IOP,slit lamp examination,gonioscopy and the coefficient of outflow facility were regularly assessed and performed after laser surgery.Results The IOP values of the 33 eyes were(18.78±4.87)mmHg,(18.83±3.95)mmHg,(19.78±4.48)mmHg,(19.63±3.68)mmHg,(19.11±3.36)mmHg,and(21.17±3.14)mmHg 1 day,l week,and 1,3,6,9 months after operation,showing significant decline in comparison with preoperation(P＜0.01).The mean drug uses were 1.63±0.85,1.23±1.01,1.25±0.98,1.21±1.02,1.22±0.86,and 1.69±0.53 at the same time point after operation,respectively,and significant differences were found 1 week,1,3,6 months in postoperation in comparison with preoperation(P =0.020,0.026,0.020,0.031).Ciliary congestion and aqueous flare naturally disappeared 1 week after surgery.The coefficients of outflow facility were 0.11±0.09 and 0.23±0.15,respectively at pretreatment and 3 months after SLT with a statistically significant difference (P=0.002).Conclusions Selective laser trabeculoplasty is effective and safe for angle-closure glaucoma.However,it is essential to have 1/2 circle of anterior chamber open for SLT in angle-closure glaucoma.

The longitudinal effects of a perimenopausal health education intervention on the mid-life women in Taiwan.

OBJECTIVES: The study purpose was to evaluate the longitudinal effects, after 3 months and 1-year, of a perimenopausal health education intervention for mid-life women in Taiwan. METHODS: This study was conducted at two hospitals and their neighborhood communities (each included three subgroups, traditional Chinese, gynecologic and neighborhood communities), using a parallel-design, control trial for mid-life women. There were three instruments: (1) the Perceived Uncertainty Scale, (2) the Perceived Perimenopausal Disturbances Scale and (3) the Practice of Health Behaviors Scale. The intervention effects from the study baseline to a 1-year follow-up were estimated using the mixed effect model (SAS-MIXED procedure) for repeated measures of health behaviors, perceived uncertainty and perceived perimenopausal disturbances. RESULTS: A total of 161 women were in the education group, while 174 women were in the control group. After a 1-year follow-up, health education intervention had significantly increased the practice of health behavior in both Chinese medicine subgroups (beta=15.39, P<0.001) and gynecologic clinics subgroup (beta=10.08, P<0.005). On the other hand, health education intervention had significantly decreased perceived uncertainty in subgroups of Chinese medicine (beta=-9.52, P<0.005). CONCLUSIONS: The perimenopausal health education had positive effects in reducing perceived uncertainty and increasing practice of health behavior among women from Chinese medicine clinics after a 1-year follow-up. Women from the gynecologic clinics showed the intervention effects of increasing health behavior after a three month and 1-year follow-ups. However, the women from neighborhood communities did not show any significant intervention effects at follow-ups. It is important to urge the women from communities to promote health practices for their perimenopausal transition instead of just living with their changing health.

[Multidimensional impacts of transitional mid-life healthcare].

Mid-life transition is a passage from young adulthood to old age, which can be expressed from transition concept--five attributes and four types of transitions. Mid-life changes that occur over several years, usually between the ages of 40 and 60. Common "disconnectedness" issues during this period such as menopause will occur during mid-life. Individuals become increasingly aware of the special nature of physiological and psychological changes that take place, and express a complex combination of feelings and response patterns in light of these changes. Middle-aged adults often face multidimensional issues related to developmental transition, changes in family structure related to organization transitions, life events related to situational transitions, and perimenopausal changes related to health transitions. Nurses who provide care to middle-aged clients need to consider transitional issues from a multidimensional and holistic perspective.