Evaluating the role of heart rate variability in monitoring stress and sleep quality among nurses in the aftermath of the COVID-19 pandemic.

AIM: To assess heart rate variability (HRV) as a measure to assess job stress and sleep quality among nurses in the post-COVID-19 period. BACKGROUND: The COVID-19 pandemic significantly affected nurses, with heightened job stress and impaired sleep quality impacting their well-being and effectiveness in patient care. HRV could offer insights for supporting strategies in the pandemic aftermath. DESIGN: A quantitative cross-sectional study. METHODS: This study involved 403 clinical nurses recruited from a teaching hospital in Taiwan. Data on job stress, work frustration, sleep quality and HRV were collected and analysed. RESULTS: Among the nurses surveyed during the COVID-19 pandemic, 72.7% reported poor sleep quality (PSQI = 9.369). Job stress emerged as a strong predictor of work frustration. High stress levels and poor sleep quality were correlated with significantly decreased HRV, indicating a potential physiological impact of stress on the nurses' health and well-being. CONCLUSIONS: HRV is a valuable and cost-effective measure for monitoring and managing nurses' well-being in the post-COVID-19 era. Targeted interventions can be implemented to support nurses' overall performance and promote their well-being by identifying those at high risk of job stress and poor sleep quality.

Nurses' perceived health and occupational burnout: A focus on sleep quality, workplace violence, and organizational culture.

AIM: This study investigates the mediation of sleep quality between perceived health and occupational burnout in hospital nurses, considering the moderation of workplace violence and organizational culture. BACKGROUND: Occupational factors lead to physical and mental distress, burnout, and sleep issues in nurses. Approximately two-thirds of nurses experience burnout, impacting patient care quality and safety. Cultivating a positive organizational culture is essential for nursing workforce stability. METHODS: This cross-sectional study employed convenience sampling to recruit 346 nurses from a teaching hospital in southern Taiwan in July-August 2020 (response rate: 87.3%). Self-administered questionnaires containing validated instruments were employed, including an adapted occupational burnout scale, the Chinese version of an organizational culture scale, a Perceived Health Questionnaire, a Workplace Violence Experience Scale, and the CPSQI; all instruments were reliable and valid. The analysis involved descriptive statistics, linear regression, and the Johnson-Neyman technique. RESULTS: Nurses with better perceived health exhibited significantly lower occupational burnout (p < 0.001). Perceived health indirectly impacted burnout through sleep quality (p < 0.01) with organizational culture as a partial moderator. Bureaucratic organizational culture exacerbated this relationship. Additionally, decreased workplace violence moderated the connections among perceived health, sleep quality, and occupational burnout among nurses. CONCLUSIONS: Given the inverse correlation between nurses' perceived health and occupational burnout and considering factors such as workplace violence, organizational culture, and sleep quality, healthcare institutions can proactively take steps to enhance nurses' overall well-being and mitigate burnout. IMPLICATIONS FOR NURSING AND HEALTH POLICY: By implementing wellness programs, mental health support, security training, robust reporting, and a zero-tolerance approach to violence, healthcare stakeholders can foster a safe and supportive work environment for nurses, thus improving well-being, patient outcomes, and healthcare quality.

Heart rate variability as an indicator of the beneficial effects of Qigong and mindfulness training on the mind-body well-being of cancer survivors.

BACKGROUND: Cancer-related fatigue (CRF) and fear of recurrence (FOR) are frequently experienced by cancer patients. This study aimed to improve cancer survivors' CRF, FOR, quality of life (QOL), and heart rate variability (HRV) through Qigong and mindfulness interventions. METHODS: A quasi-experimental design was adopted, and 125 cancer survivors were recruited using snowball sampling. The participants were assigned to 1 of 3 groups (Qigong, mindfulness, and control) based on their needs and preferences. All groups received 4 h of nutrition education at the pretest (T0). CRF, FOR, and QOL questionnaires and HRV parameters were used as the measurement tools. Data were collected at the pretest (T0), posttest (T1), and follow-up (T2). RESULTS: Qigong had a better effect on improving CRF (ΔT1-T0 = - 0.108, ΔT2-T1 = - 0.008) and FOR (ΔT1-T0 = - 0.069, ΔT2-T1 = - 0.150) in the long term, while mindfulness improved QOL (ΔT1-T0 = 0.096, ΔT2-T1 = 0.013) better in the long term. Both Qigong and mindfulness had a short-term effect in improving SDNN (Q: ΔT1-T0 = 1.584; M: ΔT1-T0 = 6.979) and TP (Q: ΔT1-T0 = 41.601; M: ΔT1-T0 = 205.407), but the improvement in LF (Q: ΔT2-T1 = - 20.110; M: ΔT2-T1 = - 47.800) was better in the long term. CONCLUSION: HRV evaluation showed that Qigong and the mindfulness interventions had short-term effects in significantly improving overall physical and mental health, self-emotional regulation, and QOL and relieving fatigue and autonomic dysfunction. HRV may serve as an observational indicator of interventions to improve physical and mental health. The consistent practice of mind-body interventions is the primary means of optimizing overall health and well-being.

Health insurance coverage and access to care in China.

OBJECTIVE: The study examined the relationship between health insurance coverage and access to needed healthcare including preventive, primary, and tertiary care among Chinese adult population. DATA AND METHODS: Data for this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a population-based probability sample survey. Key measures included insurance coverage (high-, moderate-, low- and no-insurance), access to care (physical examination, physician visit, office visit, inpatient care, and satisfaction with care), and personal sociodemographics. Multiple-factor generalized linear mixed model was applied to estimate the odds ratio (OR) and the 95% confidence interval (CI) of HI coverage for the four indicators of access to care, after controlling for individual characteristics and aggregation among different villages. RESULTS: The majority of Chinese adults had some health insurance with only 3.15% uninsured. However, most had low-coverage insurance (64.82%), followed by moderate-coverage insurance (16.70%), and high-coverage insurance (15.33%). Health insurance was significantly and positively associated with access to needed healthcare (preventive, primary, and tertiary). There was also a significant gradient association between extent of insurance coverage and access to care. CONCLUSION: Not only health insurance mattered in enhancing access to care but that there was a significant gradient association between extent of insurance coverage and access to care with higher coverage relating to better access.

The convergence of racial and income disparities in health insurance coverage in the United States.

OBJECTIVE: This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. DATA SOURCE: The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. STUDY DESIGN: Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. DATA COLLECTION/EXTRACTION METHODS: We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. PRINCIPAL FINDINGS: While income was a significant predictor of health insurance coverage (a difference of 6.1-7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. CONCLUSION: Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

Cancer screening among racial/ethnic groups in health centers.

BACKGROUND: Underserved and low-income population are placed at a disadvantage for receiving necessary cancer screenings. This study aims to measure the rates of receiving three types of cancer screening services, Pap test, mammogram and colorectal cancer screening, among patients seen at U.S. health centers (HCs) to investigate if cancer screening among patients varies by race/ethnicity. METHODS: We analyzed data from the 2014 U.S. Health Center Patient Survey, and included samples age 21 and above. We examined three cancer screening indicators as our dependent variables including cervical, breast, and colorectal cancer screening. Logistic regressions were used to assess the racial/ethnic disparities on cancer screening, while controlling for potentially confounding factors. RESULTS: The rates of receiving three types of cancer screening were comparable and even higher among HC patients than those for the U.S. general population. Both bivariate and multivariate results showed there were racial/ethnic differences in the likelihood of receiving cancer screening services. However, the differences did not favor non-Hispanic Whites. African Americans had higher odds than Whites (OR: 1.92, 95% CI: 1.44-2.55, p < 0.001) of receiving Pap tests. Similar results were also found in measures of the receipt of mammogram (OR = 1.96, 95% CI: 1.46-2.64, P < 0.001) and colorectal cancer screening (OR = 1.28, 95% CI: 1.02-1.60, p < 0.05). CONCLUSION: The current study presents U.S. nationally representative estimates and imply that HCs are helping fulfill an important role as a health care safety-net in reducing racial/ethnic disparities in the delivery of cancer screening services.

Influence of work excitement and workplace violence on professional commitment and turnover intention among hospital nurses.

AIM AND OBJECTIVES: This study aimed to determine the influence of work excitement, workplace violence and the violence prevention climate on professional commitment and turnover intention. BACKGROUND: Workplace violence can easily cause the quality of nursing care to decline. Improvements in the working environment and working conditions can improve nurses' professional commitment and satisfaction. DESIGN: A cross-sectional multicentre study with convenience sampling was conducted. We have complied with the guidelines of STROBE Checklist in presenting this research. METHODS: Out of 900 questionnaires, 696 were deemed valid for analysis (77.33%). This study collected data on sociodemographic information, experiences of workplace violence, professional commitment, work excitement, violence prevention climate and turnover intention. RESULTS: The results show that professional commitment has a significant effect on turnover intention. Professional commitment positively influences work excitement, especially when the work is challenging and varied. It also indirectly influences turnover intention by generating work excitement. Workplace violence introduces an interactive moderating effect on the relationship between professional commitment and work excitement. A violence prevention climate changes the interactive moderating effect of workplace violence on professional commitment, which in turn influences turnover intention. CONCLUSIONS: Positive work experience, institutional organisational policies and support systems are the mediating and moderating factors in the relationship between professional commitment and turnover intention. Nurses expect organisations to maintain good staff relations, provide a positive working environment and learning opportunities and strengthen communication channels, all of which affect nurse retention. RELEVANCE TO CLINICAL PRACTICE: Workplace violence is a serious crisis that can lead to turnover intention among hospital nurses. To enhance interpersonal relationships in the workplace and improve nurse retention, hospitals should schedule an adequate amount of staff and provide sufficient equipment and supplies to create a safe and positive work environment.

The Association of Patient-centered Medical Home Designation With Quality of Care of HRSA-funded Health Centers: A Longitudinal Analysis of 2012-2015.

OBJECTIVES: (1) To evaluate the relationship between Patient-centered Medical Home (PCMH) recognition and quality of clinical care among health centers, and (2) to determine whether the duration of recognition is positively associated with cumulative quality improvement over time. METHODS: Data came from the 2012 to 2015 Uniform Data System, health centers' PCMH recognition status, and the Area Resource File. Health center was the unit of observation. The outcome variables included 11 measures of clinical quality. We pooled all years of data and modeled longitudinal data with generalized estimating equations to examine the degree of improvement in health care quality in health centers with and without PCMH recognition over the years 2012-2015. RESULTS: Health centers with PCMH recognition generally performed better on clinical quality measures than health centers that did not have PCMH recognition for all years studied. After accounting for health center and county-level potential confounders, health centers with longer periods of PCMH recognition were more likely to have improved their clinical quality on 9 of 11 measures, than health centers with fewer years of PCMH recognition. CONCLUSIONS: Health centers' length of time with PCMH recognition was positively associated with additive quality improvement. Adoption of the PCMH model of care may serve as a strategy to enhance quality of primary care services.

Violence-prevention climate in the turnover intention of nurses experiencing workplace violence and work frustration.

AIMS: To determine the moderating effect of a violence-prevention climate and the mediating effect of work frustration on the relationship between workplace violence (WPV) and the turnover intention of nurses. BACKGROUND: To maintain the stability and work quality of nurses, WPV should be studied to provide effective prevention measures. METHODS: A cross-sectional study with a convenience sample was adopted. Participants were nurses from three hospitals in Taiwan. Of 1,531 questionnaires, 973 were valid for analysis (63.6%). RESULTS: A total mediating effect of work frustration on nurses' own experiences of WPV increased turnover intention. Witnessing WPV toward coworkers caused a significant partial mediating effect on work frustration that further increased turnover intention. A violence-prevention climate had a significant moderating effect on the work frustration and turnover intention of nurses after they had witnessed violence against others. CONCLUSION: Effective policies and an incentivized reporting system can foster a safe and friendly work environment not only for nurses who experience violence but also for those who witness violence. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and leaders must create a positive consultative pipeline to ensure a safe climate and environment for both the victims of WPV and the nurses who witness violence against others.

Insurance-related disparities in primary care quality among U.S. Type 2 diabetes patients.

BACKGROUND: This study explored insurance-related disparities in primary care quality among Americans with type 2 diabetes. METHODS: Data came from the household component of the 2012 Medical Expenditure Panel Survey (MEPS). Analysis focused on adult subjects with type 2 diabetes. Logistic regressions were performed to investigate the associations between insurance status and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, while controlling for confounding factors. RESULTS: Preliminary findings revealed differences among three insurance groups in the first contact domain of primary care quality. After controlling for confounding factors, these differences were no longer apparent, with all insurance groups reporting similar primary care quality according to the four domains of interest in the study. There were significant differences in socioeconomic status among different insurance groups. CONCLUSION: This study reveals equitable primary care quality for diabetes patients despite their health insurance status. In addition to insurance-related differences, the other socioeconomic stratification factors are assumed to be the root cause of disparities in care. This research emphasizes the crucial role that primary care plays in the accessibility and quality of care for chronically ill patients. Policy makers should continue their commitment to reduce gaps in insurance coverage and improve access as well as quality of diabetic care.

Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012.

INTRODUCTION: Racial and ethnic disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications and mortality rates, and the quality of diabetes care among Americans. We explored racial and ethnic disparities in primary care quality among Americans with type 2 diabetes. METHODS: We analyzed data on adults with type 2 diabetes derived from the household component of the 2012 Medical Expenditure Panel Survey. Multiple regression and multivariate logistic regressions were used to examine the association between race/ethnicity and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, and clusters of confounding factors were added sequentially. RESULTS: Preliminary findings indicated differences in primary care quality between racial/ethnic minorities and whites across measures of first contact, longitudinality, comprehensiveness, and coordination. After controlling for confounding factors, these differences were no longer apparent; all racial/ethnic categories showed similar rates of primary care quality according to the 4 primary care domains of interest in the study. CONCLUSION: Results indicate equitable primary care quality for type 2 diabetes patients across 4 key domains of primary care after controlling for socioeconomic characteristics. Additional research is necessary to support these findings, particularly when considering smaller racial/ethnic groups and investigating outcomes related to diabetes.

Patient-centered Medical Home capability and clinical performance in HRSA-supported health centers.

OBJECTIVES: To evaluate the relationship between Patient-centered Medical Home (PCMH) model adoption in health centers (HCs) and clinical performance measures and to determine if adoption of PCMH characteristics is associated with better clinical performance. RESEARCH DESIGN: Data came from the Health Resources and Services Administration's 2009 Uniform Data System and the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers. Clinical performance measures included 2 process measures (childhood immunization and cervical cancer screening) and 2 outcome measures (hypertension control and diabetes control). Total and subscale PCMH scores were regressed on the clinical performance measures, adjusting for patient, provider, financial, and institutional characteristics. RESULTS: The findings showed different directional relationships, with some PCMH domains (care management, test/referral tracking, quality improvement, and external coordination) showing little or no effect on outcome measures of interest, 1 domain (access/communication) associated with improved outcomes, and 1 domain (patient tracking/registry) associated with worse outcomes. CONCLUSIONS: This study is among the first to examine the association between PCMH transformation and clinical performance in HCs, providing an understanding of the impact of PCMH adoption within safety-net settings. The mixed results highlight the importance of examining relationships between specific PCMH domains and specific clinical quality measures, in addition to analyzing overall PCMH scores which could yield distorted findings.

Integrated care delivery and health care seeking by chronically-ill patients - a case-control study of rural Henan province, China.

OBJECTIVE: This study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China. METHODS: A case-control study was carried out in six health care organizations from two counties in Henan province, China. 371 patients aged 50 years or over with hypertension or diabetes who visited either community health centers or hospitals in the Intervention or Control Counties were systematically selected and surveyed on health care seeking behavior, quality of care, and pathway of care for their major chronic condition. Bivariate analyses were performed to compare quality and value of care indicators between patients from the Intervention and Control Counties. Multivariate analyses were used to confirm these associations after controlling for patients' demographic and health characteristics. RESULTS: Patients in both the Intervention and Control Counties chose their current health care providers primarily out of concern for quality of care (provider expertise and adequate medical equipment) and patient-centered care. Compared with the patients from the Control County, those from the Intervention County performed significantly better on almost all the quality and value of care indicators even after controlling for patients' demographic and health characteristics. Significant associations between types of health care facilities and quality as well as value of care were also observed. CONCLUSION: The study showed that the Integrated Care Delivery Model was critical in guiding patients' health care seeking behavior and associated with improved accessibility, continuity, coordination and comprehensiveness of care, as well as reducing health inequities and mitigating disparities for older patients with chronic conditions.

Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

OBJECTIVE: Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. METHODS: The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. RESULTS: Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers. CONCLUSION: The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as 'gate-keepers') seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.

Chronic conditions and medical expenditures among non-institutionalized adults in the United States.

INTRODUCTION: This study sought to examine medical expenditures among non-institutionalized adults in the United States with one or more chronic conditions. METHOD: Using data from the 2010 Medical Expenditure Panel Survey (MEPS) Household Component (HC), we explored total and out-of-pocket medical, hospital, physician office, and prescription drug expenditures for non-institutionalized adults 18 and older with and without chronic conditions. We examined relationships between expenditure differences and predisposing, enabling, and need factors using recent, nationally representative data. RESULTS: Individuals with chronic conditions experienced higher total spending than those with no chronic conditions, even after controlling for confounding factors. This relationship persisted with age. Out-of-pocket spending trends mirrored total expenditure trends across health care categories. Additional population characteristics that were associated with high health care expenditures were race/ethnicity, marital status, insurance status, and education. CONCLUSIONS: The high costs associated with having one or more chronic conditions indicates a need for more robust interventions to target population groups who are most at risk.

Usual source of care and access to care in the US: 2005 vs. 2015.

INTRODUCTION: The study examined the association of usual source of care (USC) and healthcare access using a series of access indicators including both positive and negative measures for the US population in 2005 and 2015 while controlling for individual sociodemographic and socioeconomic characteristics. Results of the study would help advance the knowledge of the relationship between USC and access to care and assist decisionmakers in targeted interventions to enhance USC as a strategy to enhance access. METHODS: The household component of the US Medical Expenditure Panel Survey (MEPS-HC) in 2005 and 2015 were used for the study. To estimate the relative risk of having USC on access to care, odds ratios (ORs) and their 95% confidence intervals (CIs) were used with unconditional logistic regression and adjusted for socioeconomic and demographic characteristics. RESULTS: Those with USC were significantly more likely to have better access to care compared to those without USC. The USC-access connection remains significant and strong even after controlling for socioeconomic and demographic characteristics. Regarding subpopulations likely to lack USC, two notable findings are that racial/ethnic minorities (Black, Asian, and Hispanic) are more likely than White to lack USC and that those uninsured are more likely to lack USC. CONCLUSION: The study contributes to the literature on USC and access to care and has significant policy and practical implications. For example, having a USC is critical to accessing the health system and is particularly important as a tool to addressing racial disparities in access.

Participation in Intergenerational Food and Agriculture Education Programs Effectively Promotes Place Attachment.

This study adopted an empirical approach to examine the effectiveness of integrating intergenerational education with food and agricultural education to increase students' affection for their learning environment. The intergenerational food and agricultural education program in this study consisted of various courses promoting educational dialogue between students and their parents and grandparents at home. The bidirectional learning process allowed the three generations to better understand each other's dietary and life experiences and pass on the relevant knowledge and culture. The 51 participants in this quantitative study were rural elementary schoolchildren who were divided into an experimental group and a control group. Place attachment was evaluated through the two sub-dimensions of place identity and place dependence. The results revealed that food and agricultural education implemented as intergenerational education strengthens learners' affective attachment to their school environment.

Exploring the relationships among training needs, willingness to participate and job satisfaction in disaster nursing: The mediating effect of achievement motivation.

OBJECTIVES: Disaster nursing competencies and their willingness to participate are essential for the success of disaster relief nurses. This study investigates the correlations among emergency room and intensive care unit nurses' training needs, willingness to participate, achievement motivation and job satisfaction as well as their mutual influences on disaster relief efforts. METHODS: A convenience sampling cross-sectional study was conducted, where 488 emergency room and intensive care unit nurses from five hospitals in Taiwan participated (response rate: 84.4%). The relationships among the variables were verified using structural equation modelling. RESULTS: Training needs in disaster nursing were found to be positively correlated with willingness to participate and job satisfaction. Moreover, willingness to participate was found to be positively correlated with achievement motivation and job satisfaction. Achievement motivation was found to be positively correlated with job satisfaction. Furthermore, willingness to participate in disaster relief was found to indirectly mediate job satisfaction through achievement motivation. CONCLUSIONS: The fulfilment of training needs for disaster nursing and willingness to participate may have an impact on nurses' job satisfaction through the mediating effect of achievement motivation. Nurses' learning needs should be the foremost consideration in disaster nursing training to alleviate human resource shortages and improve disaster responses. These findings can serve as a reference for increasing preparedness training for nurses in disaster management. RELEVANCE TO CLINICAL PRACTICE: Nurses substantially contribute to the progression of disaster relief and postdisaster reconstruction. Successful and effective disaster management relies on sufficient nurse responses and training preparedness. Nurses' willingness to participate and achievement motivation in disaster nursing can have an impact on their job satisfaction and alleviate distress for both themselves and patients for the purpose of disaster relief.

Effects of multimedia-based fall prevention education on the knowledge, attitudes, or behaviors of patients.

OBJECTIVES: Patient safety is regarded as a critical quality monitoring indicator for medical institutions. The effects of a multimedia-based patient education intervention on knowledge, attitudes, and behaviors regarding fall prevention were observed. METHODS: The study had a quasi-experimental research design and enrolled 140 participants. Seventy participants in the experimental group received multimedia-based patient education and a health education leaflet, while those in the control group received only the health education leaflet. A structured questionnaire was used for data collection at baseline, and a posttest was applied after the intervention. RESULTS: The participants were predominantly treated in the gastroenterology department (45.7%), followed by the pulmonology department (33.6%). A total of 86.4% of patients had not experienced a fall within 3 months. After the intervention, the average scores for all variables in the experimental group were higher than those in the control group. The results indicate that attitudes, knowledge, and behaviors regarding fall prevention among patients in the pulmonology department were higher than those among patients in the gastroenterology department; the differences were statistically significant. CONCLUSION: The individualized health education content was of substantial significance for patients with different disease backgrounds and facilitated changes in their knowledge, attitudes, and behaviors regarding falls. RELEVANCE TO CLINICAL PRACTICE: Multimedia-based patient education influenced inpatients' knowledge, attitudes, and behaviors for preventing falls.

Improved urinary melatonin level as the perspective indicator that leads to better sleeping quality in bladder cancer patients.

BACKGROUND: Individuals with higher-than-average melatonin concentrations are less likely to develop cancer. In cancer patients, psychosomatic coping patterns and treatment side effects are important indicators of cancer prevention and immune system deterioration. This study focused on changes in the urinary melatonin concentration, life resilience, and sleep quality in bladder cancer patients before, and 3 months after, treatment. METHODS: A controlled before-and-after study was performed. The subjects were patients who were previously diagnosed with bladder cancer and had received treatment (transurethral resection of bladder tumor + intravesical chemotherapy). Data from 23 subjects were analyzed. RESULTS: The results showed a significant difference in the melatonin concentration before and after treatment (Wilcoxon signed-rank test, Z = -2.220, p = 0.026). The melatonin concentration in 16 patients (70%) increased after treatment. The mean Pittsburgh Sleep Quality Index (PSQI) score before treatment was 7.348 (SD = 4.030), which was associated with poor sleep quality. The mean PSQI score after treatment was 6.435 (SD = 3.300; Z = -2.071; p = 0.038). These results represent the improved sleep quality in patients post-treatment. CONCLUSIONS: After treatment, the urinary melatonin concentration and sleep quality (PSQI) improved, both of which were statistically significant in bladder cancer patients. Consequently, bladder cancer treatment should be initiated as soon as possible. There was no significant difference in overall life resilience before and after treatment, possibly because elderly individuals have strong personality traits and emotional stability and are not easily affected by life events or stress.