Use of traditional medicine and complementary and alternative medicine in Taiwan: a multilevel analysis.

As the selection of a medical modality is not completely independent, environmental and sociocultural contexts of ecological validity are desired. This study aimed to apply a multilevel analysis using the Hierarchical Linear Modeling software to examine predictors of traditional medicine (TM)/complementary and alternative medicine (CAM) use in Taiwan on both individual and division levels. Individual-level data were obtained from the government database involving TM/CAM use and its impact on the population, whereas division-level data were obtained from a government annual report. A total of 2310 individuals from 22 administrative divisions of Taiwan were evaluated in the data analysis, of which 86.9% had used at least 1 TM/CAM modality in the past year. The average division of TM/CAM use was 2.86 modalities in the null model and 4.15 in the full model. Significant relationships were found between TM/CAM use and individual-level variables of gender, educational level, monthly income, perceived health status, experience with Western medical treatment, and the cost, effect, and degree of satisfaction with TM/CAM. At the division level, TM/CAM use was significantly related to aging population, employment status, and the number of medical institutions. With a simultaneous evaluation of the individual-level and division-level influences, it was found that the average division of TM/CAM use increased significantly. The place of residence is an important predictor of TM/CAM use. The age factor in predicting TM/CAM use in this study may be overestimated in the population of 26 to 60 years of age, whereas an aging population is important in the average division of TM/CAM use. Efforts to reform health insurance to completely cover the costs of TM/CAM and to better facilitate equality of access of health care in rural and remote areas are deemed necessary.

Acupoint stimulation to improve analgesia quality for lumbar spine surgical patients.

Lumbar spine surgery has a high incidence of postoperative pain, but this pain is treatable through many methods, including patient-controlled analgesia (PCA). Acupoint stimulation could be considered an adjunct to PCA, improving the effectiveness of analgesia for patients recovering from lumbar spine surgery. The current study aimed to examine the effect of acupoint stimulation with PCA on improving analgesia quality after lumbar spine surgery. A single-blinded, sham-controlled design was used for the experimental, not control, groups. Data collection for the control group was completed first, followed by data collection for the other 2 groups. Participants were randomly assigned to the acupoint stimulation (AS) (n = 45) or sham group (n = 45). All participants received structural PCA multimedia information before lumbar surgery. The AS group received auricular acupressure combined with transcutaneuos electric acupoint stimulation (TEAS) at the true acupoint; the sham group received acupoint stimulation in the same manner but at a sham acupoint and without embedding seeds; and the control group received no acupoint stimulations. The analgesia quality, analgesic consumption, and postoperative nausea and vomiting (PONV) were used as measure of effects for the interventions. Significant differences were found between the AS and control groups in pain intensity but not in the belief and satisfaction subscales of analgesia quality. Also found a significant difference among the 3 groups in analgesic consumption and the severity of PONV in the first 72 hours after surgery. The current study shows that the combination of auricular acupressure and TEAS reduced pain intensity, morphine consumption, and PONV severity. Acupoint stimulation could be considered a multimodal analgesia method and an adjunct to PCA for lumbar spine surgery patients.

Measuring reliability and validity of a newly developed stress instrument: Newly Diagnosed Breast Cancer Stress Scale.

AIMS AND OBJECTIVES: To assess the reliability and validity of a developed instrument entitled Newly Diagnosed Breast Cancer Stress Scale. BACKGROUND: Distress, clinical anxiety and depression are evident in patients with cancer, leading to poor psychosocial and quality-of-life outcomes. DESIGN: Instrument development study with norm-referenced measurements. METHODS: Content validity was determined by expert review. Cronbach's α was used to assess internal consistency reliability and product-moment correlations were conducted. Exploratory factor analysis measured validity of items using varimax rotation method. Criterion-related validity testing used the Perceived Stress Scale and the convergent validity test of construct validity used the Hospital Anxiety and Depression Scale. A total of 125 women pathologically diagnosed with breast cancer were interviewed on the day prior to initial breast surgery. RESULTS: After testing, the Newly Diagnosed Breast Cancer Stress Scale consisted of four main factors with 17 items with acceptable reliability and good validity, and its length and time to complete the questionnaire were appropriate. Internal consistency reliability of the scale was shown by Cronbach's α = 0·84, the criterion validity of Perceived Stress Scale-10 was r = 0·46 (p < 0·001), the convergent validity of Hospital Anxiety and Depression Scale-14 was r = 0·57 (p < 0·001) for anxiety and r = 0·35 (p < 0·001) for depression. CONCLUSIONS: The Newly Diagnosed Breast Cancer Stress Scale has acceptable reliability and good validity to measure stress in newly diagnosed patients with breast cancer. RELEVANCE TO CLINICAL PRACTICE: The Newly Diagnosed Breast Cancer Stress Scale can provide healthcare workers with an instrument to better identify stress levels in newly diagnosed breast cancer patients and provide valuable information when defining psychosocial care interventions.

Acupoint electrical stimulation reduces acute postoperative pain in surgical patients with patient-controlled analgesia: a randomized controlled study.

OBJECTIVES: The purpose of this study was to evaluate the effect of acupoint electrical stimulation with patient-controlled analgesia (PCA) on reducing acute pain, nausea, and vomiting after surgery for nontraumatic spinal cord injury. METHODS: A randomized, controlled, repeated measures research design was used. Ninety-nine patients undergoing lumbar spinal surgery were randomly assigned to one of three groups. Patients in experimental group 1 (EG1) received true acupoint electrical simulation three times, whereas those in experimental group 2 (EG2) received sham acupoint manually. Patients in the control group (CG) received no acupoint intervention. All patients were measured for pain, initial demand for PCA, demand for opiates, opiate dose, vital signs, and postoperative nausea and vomiting (PONV). RESULTS: Significant differences were found in postoperative pain, respiratory rate, blood pressure, and opiate doses across time in the three groups with better outcomes observed in EG1 than in EG2. However, no between-group difference was found in initial demand for PCA or in PONV. CONCLUSIONS: The study demonstrates that acupoint electrical stimulation improves acute postoperative pain management without adversely affecting vital signs after surgery for nontraumatic spinal injury. More studies are needed to evaluate the effects ofacupoint electrical stimulation on PONV and postoperative pain following other surgical procedures.

A six-week acupoint stimulation intervention for quitting smoking.

This study creates a six-week acupoint stimulation program for quitting smoking by conducting an experimental research design and then evaluating its effects. A total of 59 smokers, 28 +/- 7.6 years of mean age, volunteered to participate and were randomly assigned to the experimental or sham group. The current investigation administered anti-smoking acupoints to the experimental group for six weeks, whereas the sham group used sham acupoints for six weeks. Before and after the six-week intervention, the participants completed questionnaires and offered blood samples. This research collected data of demographic factors, serum cotinine, carbon monoxide exhalation, daily tobacco consumption, and quit smoking rate of participants before and after the six-week intervention. After the intervention, it showed no significant differences in the serum level of cotinine and carbon monoxide exhalation between the two groups. The quit rate in the experimental group was 13.3% and 13.7% in the sham group. However, daily tobacco consumption was 10 cigarettes in the experimental group and 11.21 cigarettes in the sham group. This experimental study used the sham group as the control, resulting in no statistically significant findings. Future studies need more evidence-based research on the exact effect or placebo effect of acupoint stimulation and the appropriate design for sham acupoint, to examine quitting effect using acupoint stimulation in adult smokers.

A comparison of diabetes learning with and without interactive multimedia to improve knowledge, control, and self-care among people with diabetes in Taiwan.

OBJECTIVE: Given the increased popularity of complementary and alternative medicine (CAM) and traditional Chinese medicine (TCM), this study aimed to evaluate the effects of interactive media on self-directed learning in patients' knowledge of diabetes and related CAM/TCM strategies, the ability to control blood sugar levels, and self-care in people with diabetes. DESIGN: An experimental study design was used. The experimental group received patient education through interactive multimedia about diabetes for 3 months, while the control group received a routine 3-month patient education. SAMPLE: On completion, 60 subjects from Taiwan were evaluated-30 in an experimental group and 30 in a control group. MEASUREMENTS: Data were collected from both groups at baseline and at the completion of the patient education. The findings were then compared to evaluate the effects of the intervention on the subjects' knowledge of diabetes, blood sugar control, and self-care. RESULTS: The experimental group showed greater improvement in understanding diabetes than the control (t=3.29, p<.001). There was no significant difference in control of blood sugar levels (t=-1.72, p=.10) and self-care (F=1.03, p=.32). CONCLUSIONS: The use of an interactive multimedia device to intervene in diabetes self-care was effective only in raising the subjects' knowledge about the disease. Additionally, the subjects may need more time to implement more effective blood sugar control and self-care activities after receiving instruction.

Qigong improving physical status in middle-aged women.

Regular exercise has been shown to benefit its practitioners and prevent and control diseases. Muscle/Tendon Change Classic (MTCC) qigong, characterized by simple, slow, and full-body exercise, is appropriate for the middle-age population. This study aims to evaluate the effect of the MTCC qigong program in improving physical status for middle-aged women. A quasi-experimental design was used. The experimental group (n = 37) received an 8-week MTCC qigong program, whereas the control group (n = 34) received none. Physiological parameters of muscular performance, body composition, and bone strength were measured before and after the program. The average age was 49 +/- 4.13 years for the experimental group and 50 +/- 4.74 years for the control group. The demographic characteristics were homogeneous between the two groups. There were statistically significant differences between the two groups in muscular endurance, body fat, waist-to-hip ratio, and body mass index at the completion of 8-week MTCC qigong program. The MTCC qigong could improve muscle endurance and body composition but not bone strength for middle-aged women, thereby demonstrating the qigong practice has certain health-preserving effects on women in this stage of life.

Developing and evaluating a smoking cessation program combined with an Internet-assisted instruction program for adolescents with smoking.

OBJECTIVE: The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction (IAI) program to help youth smokers quit smoking, and to evaluate the effectiveness of the program in changing youth's attitudes toward smoking, smoking behavior, and self-efficacy for smoking cessation. METHODS: To achieve this goal, a comparative study of 77 senior high students divided into two groups was conducted. One group, designated as the experimental group, accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group. All participants completed questionnaires before and after the program. RESULTS: The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth's attitude towards smoking, smoking behavior, and self-efficacy. There was a highly positive correlation between the participants' attitude toward smoking and self-efficacy. In contrast, cigarette consumption was in a strongly negative correlation with self-efficacy. CONCLUSION: Most of all participants in the experimental group recognized the effectiveness of the program, and thought the smoking cessation program with an IAI program was helpful and welcomed by youth. This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation.

The influences of Chan-Chuang qi-gong therapy on complete blood cell counts in breast cancer patients treated with chemotherapy.

After surgery, breast cancer patients are offered adjuvant chemotherapy to avoid cancer cell spread. During chemotherapy process, neutrophils could fall relatively, and side effects could spike to the peak. Therefore, the medical care personnel should prevent the progression of the side effects. This study aimed to examine the effects of Chan-Chuang qi-gong therapy on complete blood counts in breast cancer patients treated with chemotherapy. This study used a quasi-experimental design. The experiment group (n = 32) received a 21-day Chan-Chuang qi-gong therapy, whereas the control group (n = 35) did not. White blood cells, platelet, and hemoglobin were measured on the day before chemotherapy and on days 8, 15, and 22 during chemotherapy. According to this study, there were significant differences in white blood cells (F = 115.76, P <.001), platelets (F = 25.29, P <.001), and hemoglobin (F = 15.39, P <.001) over the 3-week therapy between the experiment and control groups. Chan-Chuang qi-gong therapy may decrease leukopenia in breast cancer patients treated with chemotherapy. It is recommended conducting more studies on qi-gong and then introducing it in clinical nursing practice at an appropriate time to promote quality of nursing care and quality of patient life.

Comparing effects of auricular acupressure with and without an internet-assisted program on smoking cessation and self-efficacy of adolescents.

OBJECTIVES: This study aimed to develop an Internet-assisted smoking cessation program accompanied with auricular acupressure, and compare the quit rate and self-efficacy of youth smokers receiving auricular acupressure with and without the Internet-assisted smoking cessation program. DESIGN: A Website was constructed on IBM Websphere 5.0 and DB2 database using HTML, Javascript, and JSP. A quasiexperimental research design was adopted. Subjects were assigned nonrandomly to two groups. Group 1 received auricular acupressure plus the Internet-assisted smoking cessation program, whereas group 2 received auricular acupressure only. MEASUREMENTS: The data of demographic factors, serum cotinine, quitting rate, nicotine dependence, and self-efficacy of subjects were collected before and after a 4-week intervention. RESULTS: After intervention, the quit rate was 15.78% in group 1 and 2.56% in group 2. Nicotine dependence was significantly lowered in group 1, but remained unchanged in group 2. The improvement of self-efficacy between groups 1 and 2 was significantly different. CONCLUSIONS: The combination of auricular acupressure and Internet-assisted smoking cessation program was more efficacious than auricular acupressure alone in terms of quit rate.

Effects of chan-chuang qigong on improving symptom and psychological distress in chemotherapy patients.

The purpose of this study was to explore the effect of Chan-Chuang qigong on symptoms distress and psychological distress of breast cancer patients who underwent chemotherapy. A quasi-experimental design was adopted. Subjects were recruited from breast cancer outpatients receiving chemotherapy at an 1800-bed medical center in Taipei, Taiwan. Of these subjects, 35 were assigned to the control group and 32 to the experimental group in which Chan-Chuang qigong was administered. Assignment was not random. The instruments included a 21-item symptom distress scale and psychological distress with the symptom checklist-90-revised. Data of the symptoms and psychological distress were collected on the day before chemotherapy as baseline values, and also collected on days 8, 15 and 22 of chemotherapy. The results showed that the overall severity of symptom distress in the experimental group was significantly lower than the control group on day 22 (p < 0.05). The symptoms with significant improvement included pain, numbness, heartburn and dizziness (p < 0.05). With regard to psychological distress, the difference of overall severity between the two groups was not statistically significant (p > 0.05). However, the items of "unwillingness to live" (p < 0.05) and "hopelessness about the future" (p < 0.05) were significantly improved in the experimental group. In conclusion, Chan-Chuang qigong had the effect of attenuating the symptom distress and probably some part of the psychological distress of chemotherapy patients.

Effects of multimedia with printed nursing guide in education on self-efficacy and functional activity and hospitalization in patients with hip replacement.

This study aimed to examine the effects of multimedia with printed nursing guides in patient education on the improvement of self-efficacy, functional activity and length of hospitalization in patients with hip replacement. A quasi-experimental design was used. Control group received a routine care, whereas experimental group was given the multimedia with printed nursing guides. In the multimedia, CD is a collection of nursing instructions in the format of multimedia such as video and audio recorded into a CD. The result showed there are statistically different between experimental and control groups on self-efficacy (t = -7.93, P < 0.001), functional activities (t = 4.33, P < 0.001), and length of hospitalization (t = 2.54, P < 0.05). The findings indicated experimental group achieved higher self-efficacy with the help of multimedia with printed nursing guides. Control group needed more assistance in performing functional activities. Length of hospitalization was significantly shorter in experimental group than in control group. To better adapt to continual human resource reduction and to improve nursing service quality, wider applications of multimedia with printed nursing guides in patient education may be worthwhile.

Testing the impact of a multimedia video CD of patient-controlled analgesia on pain knowledge and pain relief in patients receiving surgery.

OBJECTIVES: This study aimed to develop a multimedia video CD (VCD) of patient-controlled analgesia (PCA) and test its effects on pain knowledge and pain relief in patients receiving surgery. This multimedia VCD of PCA was created to convey fundamental knowledge to both patients and their family members and help patients properly utilize PCA devices to relieve pain and improve recovery. The content of multimedia VCD of PCA included pre-admission pain education, introduction of PCA, nursing care procedures, and questions and answers. METHODS: This study used a quasi-experimental research design to test effects of the multimedia education program in the experimental group of 30 subjects compared to the control subjects of equal number (without the multimedia VCD of PCA). RESULTS: (1) The intervention of multimedia VCD of PCA resulted in a statistically significant difference in pain knowledge between the experimental and control groups. (2) Subjects in the experimental group obtained a better outcome of pain relief compared to control subjects. (3) Subjects in the experimental group indicated that the multimedia VCD of PCA indeed helped them effectively operate their PCA devices to relieve surgery pain. CONCLUSIONS: The clinical application of the multimedia VCD of PCA could help patients improve knowledge on pain, learn how to use PCA devices, achieve proper pain relief, and increase effectiveness of recovery activities.

A new multimedia-based instruction for hip arthroplasty in clinical practice.

With the aging of the population, patients with degenerative osteoarthritis are growing. Until now, artificial joint arthroplasty (HA) is the final treatment for such joint-related disease. Because of the implementation of case payment insurance policy, patients with artificial HA in Taiwan have higher post-operative infection, dislocation and readmission than those in other countries. It is more important, nowadays, to provide patients and their family appropriate care guide for operative preparation and post-operative rehabilitation. Therefore, the purpose of this study was to develop a multimedia-based instruction (MBI) videodisc and then apply it in the care guide instruction for HA patients. The MBI videodisc in this study created combined texts, pictures, film, animations, sound, etc. by using Ulead PhotoImpact package and CyberLink PowerDirector. Thirty-three subjects in the experimental group and an equal number of subjects in the control group were recruited to evaluate the efficacy of the HA MBI videodisc in patients' learning. The results demonstrated that the HA MBI videodisc could improve patient self-care cognition in operative preparation and functional activity in post-operative rehabilitation.

Effects of an educational program with interactive videodisc systems in improving critical thinking dispositions for RN-BSN students in Taiwan.

The purpose of this study was to examine the effects of an educational program with interactive videodisc systems (IVS) in improving affective dispositions toward critical thinking for RN-BSN students in Taiwan. A pre-/post-test quasi-experimental design was used. The IVS program was provided. A sample of 126 students was obtained from one nursing college. The California Critical Thinking Dispositions Inventory was used. The results showed significant differences in all dispositions toward critical thinking, except inquisitiveness, between before and after the IVS program. With the IVS program, the subjects are educated in situations simulating real scenarios prior to clinical practice so that they not only have opportunities to learn how to approach the problem, formulate thinking, participate in discussions, and solve the problem, but they also are willing to keep thinking critically during clinical practice.

A study of serum malondialdehyde and interleukin-6 levels in young women with dysmenorrhea in Taiwan.

The purpose of this study was to examine whether the symptoms of dysmenorrhea in young women were related to serum malondialdehyde (MDA) and interleukin-6 (IL-6) levels. Ninety-four non-smoking and non-drinking female subjects without serious disease from a nursing college in Taiwan were divided into two groups. Group 1 consisted of 51 subjects without dysmenorrheal, and Group 2 of 43 subjects with dysmenorrheal symptom. All subjects were provided informed consent. Results showed that the serum levels of MDA and of IL-6 were significantly different between the two groups (P < 0.05) and (P < 0.005), respectively. We conclude that the pathological mechanism of dysmenorrhea is mediated by oxidative stress caused by the action of cytokine.

Comparison affective dispositions toward critical thinking across Chinese and American baccalaureate nursing students.

The purpose of this cross-cultural study is to understand and compare affective dispositions toward critical thinking across Chinese and American cultures. Two convenience samples of 214 and 196 undergraduate nursing students were obtained in Taiwan and the USA, respectively. The California Critical Thinking Dispositions Inventory (CCTDI) was used to measure critical thinking dispositions. The ages of the students in these samples ranged from 19 to 28 ( M = 22, SD = 1.87) for the Chinese sample, and from 20 to 51 (M = 28, SD = 6.08) for the American. For the Chinese sample, all means of the seven subscale scores were above 40, except for truth seeking, systematicity and maturity. For the American sample, all means of the seven subscale scores were above 40, except for truth seeking. The mean item responses for each subscale were significantly different between the two samples [F (1, 408) = 54.11, p <.01] and across the subscales [F (6, 2448) = 905, p <.01]. Significant differences between the two samples were also found in truth-seeking, t(408) = 14.70 (p <.001), open- mindedness, t(408) = 6.17 (p <.001), systematicity, t(408) = 4.73 (p <.001) and maturity, t(408) = 10.46 (p <.001). The findings provide information to understand affective dispositions toward critical thinking in either Chinese or American students. The differences may contribute to the cultural differences shown in their dispositions.

Integrative acupoint stimulation to alleviate postoperative pain and morphine-related side effects: a sham-controlled study.

BACKGROUND: Although it can be reduced, postoperative pain remains a problem. Acupressure with electric stimulation may be more effective for postoperative pain management than acupressure alone. OBJECTIVES: This study aimed to evaluate the effects of integrative acupoint stimulation (IAS) on the relief of postoperative pain and on the reduction of morphine-related side effects. DESIGN: A single-blinded, sham-controlled study with three groups. SETTING: An orthopedic ward in a 2900-bed teaching medical center. PARTICIPANTS: Forty-five subjects in each of three groups. METHODS: Each subject received a multimedia course on patient-controlled analgesia (PCA) before surgery to learn about the use of narcotic analgesics and the operation of the PCA device. Treatment was as follows: (1) for the IAS group, auricular acupressure combined with transcutaneous electric acupoint stimulation (TEAS) at the true acupoint; (2) for the sham group, acupoint stimulation in the same manner but at a sham acupoint or without embedding seeds and pressure; (3) for the control group, no IAS intervention. RESULTS: Pain scores were significantly lower in the IAS group than the other two groups at 2h and 4h after returning to the ward, and 24h after surgery. The analgesic requirement during the 72h after surgery and the overall incidence of morphine-related side effects were significantly lower in the IAS group. CONCLUSION: The study demonstrates that combined auricular acupressure and TEAS decreased postoperative pain, the use of equianalgesic morphine, and morphine-related side effects. IAS provides better analgesia when used in conjunction with PCA after lumbar spine surgery and can be regarded as a component of multimodal analgesia.

The smoking behaviors of indigenous Taiwanese: individual and family/community factors of influence.

BACKGROUND: Smoking, a self-selected behavior, is the sixth leading cause of death worldwide. Factors related to smoking in Taiwan's indigenous Malayo-Polynesian population should be elicited and addressed. PURPOSE: This study examined the relationship between smoking behavior and individual and family/community factors in indigenous Taiwanese. METHODS: This study was a secondary analysis of data obtained from household visits in central Taiwan that included a population of 562 indigenous adults aged 20-50 years. Data were analyzed using the chi-square test and hierarchical logistic regression to determine individual and family/community relevant factors of smoking behaviors. RESULTS: The smoking rate in the population studied was 57.48% (39.15% men, 18.33% women). The odds ratio for smoking was markedly higher in men than in women. Smokers were 0.45 times more likely to have fixed sexual partners. The OR for smoking was 2.68 times in households with smokers and 7.03 times in people living in mountainous areas. CONCLUSIONS: The issue of smoking in indigenous Taiwanese deserves further attention and concern. Further interventions for the harmful effects of tobacco can focus on younger indigenous people living in mountain regions and on smokers' sexual partners. In addition, male adults, female adults, and heads of households should take a greater role in changing the smoking behaviors of smokers and their family members.

Auricular acupressure combined with an internet-based intervention or alone for primary dysmenorrhea: a control study.

Background. Primary dysmenorrhea is prevalent in adolescents and young women. Menstrual pain and distress causes poor school performance and physiological damage. Auricular acupressure can be used to treat these symptoms, and Internet-based systems are a flexible way of communicating and delivering the relevant information. Objective. This study investigates the effects of auricular acupressure (AA) alone and combined with an interactive Internet-based (II) intervention for the management of menstrual pain and self-care of adolescents with primary dysmenorrhea. Design. This study adopts a pretest/posttest control research design with a convenience sample of 107 participants. Results. The outcomes were measured using the short-form McGill pain questionnaire (SF-MPQ), visual analogue scale (VAS), menstrual distress questionnaire (MDQ), and adolescent dysmenorrheic self-care scale (ADSCS). Significant differences were found in ADSCS scores between the groups, and in SF-MPQ, VAS, MDQ, and ADSCS scores for each group. Conclusion. Auricular acupressure alone and a combination of auricular acupressure and interactive Internet both reduced menstrual pain and distress for primary dysmenorrhea. Auricular acupressure combined with interactive Internet instruction is better than auricular acupuncture alone in improving self-care behaviors.