Long-term care planning and the influencing factors among sexual minority older women: A qualitative study.

AIMS: The aim of the study was to explore plans, considerations and factors influencing long-term care among older sexual minority (SM) women. DESIGN: Qualitative interview study. METHODS: Semi-structured in-depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio-ecological model and constant comparative analysis. RESULTS: The most frequently reported long-term care plans were housing and institutions, private medical or long-term care insurance, financial planning and medical decisions. Factors associated with women's long-term care plans were categorized using the socio-ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal-level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community-level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal-level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources. CONCLUSION: This study identified multi-level factors related to long-term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long-term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women. IMPACT: This study assists nurses in understanding older SM women's long-term care concerns and worries when accessing long-term care and healthcare services and helps nurses provide SM-sensitive services and care for women. PATIENT OR PUBLIC CONTRIBUTION: SM older women were recruited from LGBT organizations, LGBT-friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling.

Enhancing cultural competence in caring for lesbian, gay, bisexual, and transgender patients: An online training program for Taiwanese student nurses and nurses.

BACKGROUND: Health disparities exist among lesbian, gay, bisexual, and transgender (LGBT) populations worldwide. However, student nurses and nurse staff have limited knowledge and skills in providing culturally competent nursing care for LGBT patients in Taiwan. OBJECTIVES: This paper describes the development, implementation, and evaluation of an online training program for the cultural competence of student nurses and nurses in Taiwan. DESIGN: A one-group pre-/post-test study design. SETTINGS: The study was conducted in five nursing schools, 10 nursing associations, and 37 long-term care facilities. Two prominent online bulletin boards (PTT Nurse and Dcard Nurse) and one Taiwanese nursing group on Facebook were used to recruit participants. PARTICIPANTS: In total, 301 student nurses and nurses participated in the study and responded to pre- and post-test questionnaires. METHODS: An online training program for culturally competent nursing care was developed and implemented. The pre- and post-test questionnaires contained three sections: (1) demographics, (2) knowledge of LGBT health, and (3) the Sexual Orientation Counselor Competency Scale. Three open-ended questions were included in the post-test questionnaire to evaluate the online training program. RESULTS: The online training program significantly improved the participants' knowledge and cultural competence skills. However, their attitudes towards cultural competence did not change after the program was implemented. Regarding qualitative feedback of the online training program, feedback on the strengths and limitations of the program was summarized under three themes: program content, website design, and online modules. CONCLUSIONS: The results suggest the importance of an online training program which may contribute to reducing health disparities among the LGBT population.

Resilience process in individuals with colorectal cancer: a qualitative study.

PURPOSE: Resilience is a positive outcome in giving individuals strength to adapt to cancer and have better various aspects of health-related quality of life. However, research focusing on resilience in relation to colorectal cancer (CRC) is limited. Therefore, the aim of this study was to explore the process of resilience in individuals with CRC. METHOD: Sixteen individuals diagnosed with stage Ι to III CRC within the last five years were recruited from a CRC surgical outpatient department in a medical center in Northern Taiwan. Semi-structured interviews were used to explore the resilience process of living with CRC. Recorded interviews were transcribed verbatim and were analyzed using modified grounded theory. FINDINGS: Resilience is a dynamic three-phase process, including impact of CRC, adaptation or maladaptation following CRC, and growth from CRC experience. Resilience strategies (i.e., attitude adjustment, developing personal strategies to conquer CRC and side effects, setting new goals in life, and viewing death as a normal process), avoidance behaviors, and passive waiting strategy were shown across the resilience process. CONCLUSIONS: All individuals showed negative impacts during CRC diagnosis and treatments, but some individuals used the resilience strategies in helping to promote positive adjustment and redirect to develop their resilience process. Furthermore, resilient and maladaptive individuals may change the situation depending on which strategies are used and on the progression of CRC because resilience is dynamic. Oncology clinicians should help individuals use resilience strategies to smoothly go through the resilience process.

Factors associated with providers' culturally competent care for sexual and gender minority older adults in Taiwan: A qualitative study applying the social ecological model.

BACKGROUND: Sexual and gender minority older adults receive less social support than does the general population, leading to reliance on long-term care services. On May 24, 2019, Taiwan became the first country in Asia to legalise same-sex marriage. Sexual and gender minority older adults are becoming more visible in Taiwanese society. However, healthcare providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults and factors affecting their behaviour and intention in Asian culture remain unclear. OBJECTIVE: This study determined factors associated with healthcare providers' behaviour and intention to offer culturally competent care to Taiwanese sexual and gender minority older adults and identified related training requirements. DESIGN: A qualitative descriptive study was conducted. SETTING(S): This study recruited participants from 14 lesbian, gay, bisexual, and transgender organisations; long-term care facilities; and community healthcare centres. This study was approved by the Research Ethics Committee of National Taiwan University Hospital (Ref. 201811049RIND). PARTICIPANTS: A total of 25 providers were interviewed: 12 nurses, 10 social workers, and 3 staff members from lesbian, gay, bisexual, and transgender organisations. METHODS: Semistructured interviews were conducted between May 2019 and September 2019. Interview data were analysed using the socio-ecological model and the constant comparative technique. FINDINGS: Factors associated with the providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults were categorised by the socio-ecological model level: 1) intrapersonal factors, namely providers' attitudes towards sexual and gender minority older adults, knowledge regarding sexual and gender minority populations, and experiences of providing care for sexual and gender minority older adults; 2) interpersonal factors, namely providers' concerns regarding interactions among staff, sexual and gender minority older adults, nonsexual and gender minority residents, and nonsexual and gender minority residents' families; 3) community factors, namely resources, training courses, and support from managers and organisations; and 4) societal factors, namely social environment and policies. CONCLUSIONS: This study identified multilevel factors associated with the providers' cultural competence in caring for sexual and gender minority older adults in Taiwan. These factors may lead to disparities in quality of life and health for sexual and gender minority older adults. Recommendations to address multilevel barriers to reduce health disparities and improving quality of life in sexual and gender minority older adults have been provided.

Attitudes toward, knowledge of, and beliefs regarding providing care to LGBT patients among student nurses, nurses, and nursing educators: A cross-sectional survey.

BACKGROUND: Studies have assessed attitudes toward, knowledge of, and beliefs regarding providing care for lesbian, gay, bisexual, and transgender (LGBT) patients among student nurses, nurses, and nursing educators individually, but few studies have compared these aspects among these groups. OBJECTIVES: To examine the attitudes toward, knowledge of, and beliefs regarding providing care for LGBT patients among student nurses, nurses, and nursing educators in Taiwan. DESIGN: Cross-sectional survey. SETTINGS: The study was advertised in 8 nursing schools, 14 nursing associations, 209 nursing homes, and 2 online chatrooms in Taiwan. PARTICIPANTS: A total of 1150 participants were recruited: 447 student nurses, 475 nurses, and 228 nursing educators. METHODS: Data were collected between August 2021 and January 2022 through a questionnaire with five sections: demographics, knowledge of LGBT health, the Knowledge about Homosexuality Questionnaire, the Attitude Toward Lesbian and Gay Men Scale, and the Gay Affirmative Practice Scale. RESULTS: The results suggest that the participants had limited knowledge of LGBT health. The nursing educators had the lowest scores for knowledge of LGBT health and homosexuality and the most negative attitudes toward lesbians and gay men among the groups; however, they were most likely to report their beliefs regarding providing nursing care to LGBT patients than the other two groups. CONCLUSIONS: The results indicate the importance of providing nursing educators with training courses and resources related to culturally competent care to improve education for nursing students and care for LGBT patients.

Suicide attempts among Taiwanese lesbian, gay, bisexual, and transgender adults during the 2018 Taiwan referendum on same-sex issues.

PURPOSE: To examine suicide attempts and the influencing factors among Taiwanese lesbian, gay, bisexual, and transgender (LGBT) adults during the 2018 Taiwanese referendum on same-sex issues. RESEARCH DESIGN AND METHODS: The 2018 Taiwanese referendum was held on November 24. A cross-sectional online survey was conducted between October 2018 and February 2019. A total of 1012 self-identified LGBT adults were included in the final sample. RESULTS: Among the 1012 Taiwanese LGBT adults, the rates of suicide attempts ranged from 9.1% to 24.4%. A younger age, being a student, having low income, having mental health issues, and having a high level of depressive symptoms were associated with a significantly higher risk of suicide attempts in the participants. Conversely, having a postgraduate degree, having high self-esteem, and perceiving support from friends and family were associated with a lower risk of suicide attempts. CONCLUSION: This is the first study to investigate suicide attempts among LGBT individuals and the influencing factors within the context of a same-sex marriage referendum in an Asian country. The results of this study demonstrate the importance of suicide prevention measures for the LGBT community, particularly during times of increased social stress and conflict between social groups with diverse sexual and gender identities. CLINICAL RELEVANCE: The results of this study suggest that nurses' and health-care providers' sensitivity toward LGBT patients and their knowledge and skills in providing culturally competent care are key factors in suicide prevention for LGBT adults. Therefore, nurses and health-care providers must be provided with training courses on culturally competent care.

Health Status and Quality of Life of Middle-Aged and Older Taiwanese Sexual and Gender Minorities.

PURPOSE: To examine the health status and quality of life of middle-aged and older sexual and gender minority adults in Taiwan. RESEARCH DESIGN AND METHODS: A cross-sectional online survey was conducted between May and December 2019. A total of 535 self-identified lesbian, gay, bisexual, and transgender (LGBT) men and women ≥40 years of age were included in the final sample. An online questionnaire, which included the following three sections, was used to collect data in this study: (a) demographics, (b) the World Health Organization Quality of Life-Brief Taiwan version, and (c) physical and psychological health status. RESULTS: Middle-aged and older Taiwanese LGBT adults who were single, were unemployed, and earned monthly incomes of <20,000 New Taiwan Dollars reported poorer quality of life. Participants with one or more physical or psychological health problems also reported poorer quality of life than those who had no health problems. In addition, singlehood, unemployment, and poor quality of life and health were positively associated with mental health issues. CONCLUSIONS: It is important to attenuate health disparities and mitigate discrimination within Taiwanese society to enhance the quality of life and mental health of middle-aged and older Taiwanese LGBT adults. CLINICAL RELEVANCE: Healthcare providers should be attuned to and knowledgeable about the health issues and specific healthcare needs of middle-aged and older LGBT adults, and they should also provide culturally competent care to reduce health disparities of the LGBT adults.

Internalized homophobia, self-esteem, social support and depressive symptoms among sexual and gender minority women in Taiwan: An online survey.

WHAT IS KNOWN ON THE SUBJECT?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals. Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non-western countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best our knowledge, this is the first study examining internalized homophobia, self-esteem, social support and depressive symptoms among sexual minority women in Taiwan. Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self-esteem and fewer support from partners, friends, and families. Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self-esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation. LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. ABSTRACT: Introduction Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non-western countries. Aim This study examined internalized homophobia, self-esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method A total of 581 Taiwanese sexual minority women (Age range 20-48 years old, Mean 26.96, SD 5.718) completed an online survey. Results Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self-esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion Mental health interventions are essential for sexual minority women with internalized homophobia and low self-esteem. Implications for Practice Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms.

Taiwanese Nurses' Attitudes Towards and Knowledge About Sexual Minorities and Their Behavior of Providing Care to Sexual Minority Patients: Results of an Online Survey.

PURPOSE: To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients. DESIGN: A cross-sectional descriptive design was employed. METHODS: A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care. RESULTS: Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self-identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space. CONCLUSIONS: Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities. CLINICAL RELEVANCE: This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients.

The Role of Butch versus Femme Identity in Body Image and Breast Health Among Lesbians in Taiwan: Results of an Online Survey.

PURPOSE: The views of butch- and femme-identified lesbians toward their own breasts, breast cancer, breast cancer screenings, and their behavior and intentions toward breast health care were examined and compared in this study. METHODS: A total of 208 Taiwanese lesbians (134 butch-identified lesbians and 78 femme-identified lesbians) completed an online survey. RESULTS: Butch-identified lesbians were more likely to hold negative views regarding their own breasts, which were found to be significantly and negatively associated with their actions in performing breast self-examinations when compared with femme-identified lesbians. CONCLUSIONS: Healthcare providers should be aware of and provide culturally competent care to lesbians with different identities. CLINICAL RELEVANCE: The results can be employed as evidence for promoting lesbians' breast health, particularly butch-identified lesbians. Healthcare providers should provide a supportive environment in order to promote a positive body image and improve breast health among lesbians.

Factors associated with Taiwanese lesbians' breast health-care behavior and intentions: Qualitative interview findings.

This article presents the qualitative findings of a mixed-methods study that explored factors influencing lesbians' breast health-care behavior and intentions. A total of 37 semi-structured face-to-face interviews were conducted among women who self-identified as lesbians or women who partnered with the same gender who were aged 20 years or above in four areas of Taiwan (North, Central, South, and East Taiwan) between August 2012 and October 2012. Interviews were audio recorded with participants' consent. The interviews were analyzed using constant comparative analysis with Nvivo audio-coding support. Four themes were identified to be strongly associated with the lesbians' breast health-care behavior and their intentions, namely, gender identity, gender role expression, partners' support, and concerns about health-care providers' reactions. Important barriers to the women's breast health-care behavior and intentions were masculine identity ("T-identity" in Taiwan), masculine appearance, concerns about health-care providers' lack of knowledge of multiple gender diversity, and their attitudes toward lesbians. Conversely, their partners' support was a factor facilitating the women's breast health-care behavior and intentions, particularly for the T-identity lesbians. These findings suggest the significance of and need for culturally competent care and are important for improving Taiwanese lesbians' breast health.

Design and synthesis of pyrrolobenzodiazepine-gallic hybrid agents as p53-dependent and -independent apoptogenic signaling in melanoma cells.

A new class of pyrrolo[2,1-c][1,4]benzodiazepine-Gallic hybrid agents (PBD-GA) conjugated through alkyl spacers has been designed and synthesized. The combination of these two core pharmacophores with modification in the C-8 position of the PBD ring with alkyl spacers afforded oxygen-tethered compounds 5a-5d and amide-tethered analogues 11a-11d with improved anticancer activity for two melanoma cell lines, A375 and RPMI7951, differing in their p53 status. The agents 5a-5d were cytotoxic in melanoma compared to agents 11a-11d. In particular, compounds 5b and 5c were found to possess the most potent activity compared with other hybrid agents and were proved with the help of quantitative structure activity relationship studies (QSAR). These PBD conjugates caused S phase arrest for the A375 cell line via increased reactive oxygen species (ROS) generation, deoxyribonucleic acid (DNA) damage, ataxia telangiectasia mutated (ATM)/ATM-Rad3-related (ATR) and checkpoint kinases 1 (Chk1) activation. Moreover, the PBD-GA induced A375 apoptotic cell death followed through p53 (ATM downstream target) increase, B-cell leukemia-xL (Bcl-xL) and mitochondrial membrane potential (ΔΨmt) decrease, cytochrome c release, and caspase-3/Poly Adp Ribose Polymerase (PARP) cleavage. On the other hand, mutant p53 RPMI7951 cell death occurred by PBD-GA-mediated mitochondria- and caspase-dependent pathways via lysosomal membrane permeabilization (LMP), but not through p53 signaling. Finally, compound 5b was shown to reduce murine melanoma size in a mouse model. These results suggest that the PBD-GA could be used as a useful chemotherapeutic agent in melanoma with activated p53 or mutant p53.

Bis(phenylidenebenzeneamine)-1-disulfide Derivatives Induce Autophagy in Melanoma Cells Through a Mitochondria-mediated Pathway.

We have previously reported the efficient synthesis of bis(phenylidenebenzeneamine)-1-disulfide derivatives 1-8. In the present article, we delineated the signaling pathways involved in the anticancer effects of compound 2 on melanoma cells. The treatment of melanoma cells with compound 2 resulted in ROS generation, a decrease in ΔΨmt, ATP, and protein expression of mitochondrial respiratory chain subunits. In addition, no significant apoptotic or necrotic effect was seen following compound 2 treatment using an annexin V and propidium iodide (PI) double-staining. Nevertheless, autophagy-related proteins LC3 and Beclin 1 were enhanced by compound 2. Furthermore, compound 2 was also shown to reduce murine melanoma size in a mouse model. We revealed a novel bio-evaluation of bis(phenylidenebenzeneamine)-1-disulfide derivatives anti-tumor proliferation mechanism and suggest that these agents may have potential chemotherapeutic activity for melanoma cells.

Taurine homeostasis requires de novo synthesis via cysteine sulfinic acid decarboxylase during zebrafish early embryogenesis.

Cysteine sulfinic acid decarboxylase (Csad) is the rate-limiting enzyme in the de novo biosynthesis of taurine. There are a number of physiological roles of taurine, such as bile salt synthesis, osmoregulation, lipid metabolism, and oxidative stress inhibition. To investigate the role of de novo synthesis of taurine during embryonic development, zebrafish csad was cloned and functionally analyzed. Semi-quantitative RT-PCR showed that csad transcripts are maternally deposited, while whole-mount in situ hybridization demonstrated that csad is expressed in yolk syncytial layer and various embryonic tissues such as notochord, brain, retina, pronephric duct, liver, and pancreas. Knockdown of csad significantly reduced the embryonic taurine level, and the affected embryos had increased early mortality and cardiac anomalies. mRNA coinjection and taurine supplementation rescued the cardiac phenotypes suggesting that taurine originating from the de novo synthesis pathway plays a role in cardiac development. Our findings indicated that the de novo synthesis pathway via Csad plays a critical role in taurine homeostasis and cardiac development in zebrafish early embryos.

Naturalistic exploration of the effect of osmotic release oral system-methylphenidate on remission rate and functional improvement in Taiwanese children with attention-deficit-hyperactivity disorder.

AIM: To determine the differences in the remission rate, recovery rate, functional improvement, and treatment adherence related to treatment with short-acting immediate-release methylphenidate (IR-MPH) and long-acting osmotic-release oral system-methylphenidate (OROS-MPH) in a naturalistic setting among Taiwanese children with attention-deficit-hyperactivity disorder (ADHD). METHODS: A total of 757 children with ADHD, aged 6-18 years, was evaluated using the following in order determine functional improvement and treatment adherence: the Chinese version of the Swanson, Nolan, and Pelham, version IV scale (SNAP-IV-C), Clinical Global Impression-ADHD-Severity (CGI-S) to measure remission and recovery rates, the Chinese version of the Social Adjustment Inventory for Children and Adolescents (CSAICA), and caregiver's satisfaction rate, treatment adherence, and frequency of adverse effects. RESULTS: According to the SNAP-IV-C scores, the remission rate was 30.72%, and the recovery rate was 16.38%. Compared to short-acting IR-MPH, OROS-MPH was associated with greater functional improvement and treatment adherence among children with ADHD. CONCLUSION: OROS-MPH treatment at the adequate dosage can achieve higher remission and recovery rates, produce greater functional improvement, and result in better treatment adherence than IR-MPH treatment.