Effects of a nurse-led therapeutic conversations intervention in stroke patient-family caregiver dyads: A randomized control trial.

BACKGROUND: Few studies have evaluated the effectiveness of family functional care interventions among stroke caregiver dyads. This study aimed to examine the effect of a nurse-led therapeutic conversation intervention on resilience, family function, self-efficacy in managing the disease, and quality of life (QoL) in stroke family caregiver dyads. AIMS: This study aimed to examine the effect of a nurse-led therapeutic conversation intervention on resilience, family function, self-efficacy in managing the disease, and QoL in stroke-family caregiver dyads. DESIGN: This study was a single-blind (evaluator) randomized controlled trial. The planned execution time was from August 2021 to December 2022, in the rehabilitation ward of a medical university hospital. METHODS: A total of 82 dyads were included in this analysis. Dyads randomized to the intervention group received nurse-led therapeutic conversations intervention one at four weeks after the patient's hospitalization for a stroke. The family caregiver dyads of stroke survivors in the control group received routine care. An effectiveness analysis that included patients' resilience, self-efficacy, and patient-family caregiver dyads' family function and QoL was conducted at one month. We used the CONSORT Checklist for reporting parallel group randomized trials in this study. RESULTS: The patients in the intervention group showed improvement in resilience and self-efficacy after one month. Furthermore, the effects on resilience (Cohen's d = 0.49) and self-efficacy (Cohen's d = 0.46) were significantly higher than in the control group. Family functioning was significantly higher in patient-family caregiver dyads in the intervention group than in the control group (Cohen's d = 0.55; Cohen's d = 0.50). However, no significant difference in QoL was found between patients and caregivers in either group. CONCLUSIONS: The intervention was effective in promoting family functioning and can also promote patient resilience and self-efficacy in disease management. However, the intervention did not have a significant effect on the QoL of patient-family caregiver dyads.

Workplace Resilience and Stress Among Certified Nursing Assistants in Long-Term Care Institutions During the COVID-19 Pandemic.

PURPOSE: To explore the relationship among resilience, stress, and demographic factors in certified nursing assistants (CNAs) who worked in long-term care institutions during the coronavirus disease 2019 pandemic. METHOD: A cross-sectional correlation-based research design was used. Data were collected using a demographic questionnaire, Connor-Davidson Resilience Scale, and Occupational Stress Scale. CNAs from 21 long-term care institutions in Taiwan were recruited. RESULTS: This study included 118 female and 26 male CNAs (response rate = 80%). Mean age was 46.8 years. A moderately negative correlation was found between workplace resilience and stress. Overall, being a woman and parent were found to be significantly correlated with CNAs' resilience. Furthermore, resilience and shift work were important predictors of stress. CONCLUSION: We suggest that leadership and management pay more attention to CNAs' basic demographic background information. Furthermore, timely, relevant strategies can be provided to enhance resilience and reduce workplace stress. [Journal of Gerontological Nursing, 50(7), 19-26.].

Development of the ethical decision-making competence scale.

BACKGROUND: Developing confident capacity for ethical decision-making is vital in nursing education. However, no tool examines nursing students' competence in ethical decision-making. AIM: This study aimed to develop an Ethical Decision-Making Competence Scale (EDM-CS) to assess ethical care decision-making competencies in nursing students. PARTICIPANTS AND RESEARCH CONTEXT: Original items were obtained by employing a focus group and the Delphi method. A cross-sectional design was used to confirm the items remained on the scale. Additionally, the scale's reliability and validity were assessed. The EDM-CS was completed by 498 nursing students. An exploratory factor analysis (EFA) was used to examine the factor structure based on data from group 1 (n = 250). A second-order confirmatory factor analysis (CFA) was used to examine the model's fitness based on data from group 2 (n = 248). This study was conducted between August 2022 and July 2023. ETHICAL CONSIDERATIONS: The Institutional Review Board of Chung Shan Medical University Hospital approved this study's design and procedure. RESULTS: From the original 34 items, nine were deleted in the EFA. Thus, the EDM-CS had 25 items and a four-factor structure (ethical judgement, ethical sensitivity, ethical motivation, and ethical action), which explained 60.97% of the total variance. A second-order CFA identified a second-order factor termed 'ethical decision-making competence' with 18 items (root mean square residual = 0.052). The EDM-CS scores correlated significantly and positively with the scores on the Scale of Protective Factor-24 (r = 0.47, p < .001), which indicated good convergent validity. Cronbach's alpha coefficient of the final EDM-CS was 0.90 and ranged from 0.73 to 0.80 for the four subscales. DISCUSSION AND CONCLUSION: The EDM-CS was validated to fit the data adequately. It can be used to evaluate clinical nursing students' ethical decision-making abilities and to develop education strategies to improve their ethical care competence.

The effect of action modules on resilience and psychological health of stroke patients: A pilot non-randomised control trial.

AIMS AND OBJECTIVES: To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC-AM) platform improve patients' psychological health over a two-month period. BACKGROUND: Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post-stroke mental health concerns and the need for care information. DESIGN: A non-randomised controlled pilot study was conducted. METHODS: Participants included 44 post-stroke patients at a medical university hospital, between 1 August 2019-28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC-AM). Data were analysed on an intention-to-treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case-control studies) for this study. RESULTS: There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p < .05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. CONCLUSION: This preliminary trial suggests that, although action modules may be associated with a decrease in depression post-stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. RELEVANCE TO CLINICAL PRACTICE: The STNC-AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible.

Effect of cryotherapy on paclitaxel-induced peripheral neuropathy of the hand in female breast cancer patients: A prospective self-controlled study.

AIMS: The purpose of this study was to examine the efficacy of cryotherapy with frozen gloves for the prevention of the chemotherapy-induced peripheral neuropathy of the hand. BACKGROUND: Most breast cancer patients receive chemotherapy; consequently, patients frequently experience adverse effects of chemotherapy-induced peripheral neuropathy. METHODS: A quasi-experimental and prospective self-controlled study was conducted. Breast cancer patients wore frozen glove on the dominant hand for 90 min during their weekly treatment with paclitaxel (80 mg/m2 ). Treatment of the dominant hand, the intervention group, was continued for 12 weeks. The non-dominant hand was considered the control group. RESULTS: A total of 22 patients participated in this study, and only one patient did not reach the cumulative dose (960 mg/m2 ). Findings show that the incidences of sensory and motor symptoms of chemotherapy-induced peripheral neuropathies at the following times (Time 1 to Time 4) were significantly lower in the intervention group than in the control group. However, although the incidences of motor symptoms were lower in the experimental group than in the control group, a significant difference was shown only at Time 4. Additionally, both groups of patients reported that their incidence of sensory symptoms were higher than those of motor symptoms. CONCLUSION: Cryotherapy with frozen gloves is useful in reducing both the sensory and motor symptoms of the chemotherapy-induced peripheral neuropathy of the hands.

Factors associated with facial pressure injury in patients receiving non-invasive positive pressure ventilation mask: A retrospective case-control study.

AIMS AND OBJECTIVES: This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non-invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. BACKGROUND: Non-invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal-oral NIPPV masks and discomfort in contact with the skin surface. DESIGN: A retrospective case-control study. METHODS: From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under-mask prophylactic dressings during hospitalisation. Patients were divided into the non-FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case-control study. RESULTS: There were significant differences between the groups in age, serum albumin, C-reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176-2.260)], BMI [OR = 0.396 (0.210-1.784)] and corticosteroids [OR = 0.394 (0.159-1.811)], which were predictors of FPI in patients with NIPPV. CONCLUSIONS: Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high-risk and timely preventive measures to reduce FPI. RELEVANCE TO CLINICAL PRACTICE: Addressing FPI-related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks.

The effect of gender-friendliness barriers on perceived image in nursing and caring behaviour among male nursing students.

AIMS AND OBJECTIVES: To examine the relationships among nursing students' perceived nursing image, caring behaviours and gender-friendliness barriers to determine whether gender-friendliness barriers affect nursing image and caring behaviour among male nursing students. BACKGROUND: Because caring is typically seen as a feminine trait, male nurses face gender-role strains in the current nursing environment. Gender-friendliness barriers may have an impact on the vital relationship between professional nursing image and caring behaviour. DESIGN: This study used a quantitative and cross-sectional research design. METHODS: Participants were 141 male students who had obtained at least 1 month of clinical practice experience. We collected data using three instruments: The Caring Assessment Report Evaluation Q-sort (CARE-Q), Gender-Friendliness Barriers in Nursing Programs (GFB-NP), and Nursing Image-as a Profession Questionnaire (NIPQ). Data were collected from August 2016-July 2017. Partial least squares structural equation modelling (PLS-SEM) with bootstrapping was used to test the hypothesis model. RESULTS: The full model results indicated a direct positive and significant path from professional nursing image to caring behaviour (ß = 0.47, 95% CI = 0.32 to 0.61, t = 6.19, p < 0.001). Gender-friendliness barriers had a direct and significant negative relationship between professional nursing image (ß = -0.31, 95% CI = -0.49 to -0.12, t = 3.17, p < 0.01) and caring behaviour (ß = -0.18, 95% CI = -0.35 to -0.02, t = 2.18, p < 0.05). In addition, the variable of student-perceived barriers to gender-friendliness was indirectly and significantly negatively related to caring behaviour (ß = -0.15, 95% CI = -0.27 to -0.05, t = 2.57, p < 0.05) through professional nursing image. CONCLUSION: Male nursing students with a higher nursing image engage in greater caring behaviour. Gender-friendliness barriers, however, decrease students' nursing image and caring behaviour. RELEVANCE TO CLINICAL PRACTICE: As applied to nursing education, the goal should be to improve male nursing students' caring behaviours and professional nursing image and decrease gender-friendliness barriers.

Change in Activities of Daily Living in the Year Following a Stroke: A Latent Growth Curve Analysis.

BACKGROUND: Early prediction of future functional capability is crucial for stroke survivors' care management. OBJECTIVES: The purposes of this study were to test the trajectory of change across time in activities of daily living (ADLs) and to determine whether the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours poststroke, gender, and age predict ADLs at 1, 3, 6, and 12 months poststroke. METHODS: A prospective cohort design was used. Baseline characteristics and neurological deficits were measured in 1,021 stroke survivors. The 13-item NIHSS was used to examine neurological status within 24 hours poststroke. ADLs were measured with the Barthel index at 1, 3, 6, and 12 months poststroke. A latent growth curve model was used to analyze how the dynamic changes in ADLs were related to NIHSS score, gender, and age. RESULTS: The latent growth curve model analyses revealed that, as the time following a stroke increases, survivors tend to gradually improve with regard to ADLs. In addition, lower levels of initial ADLs were associated with higher growth in ADLs over time. However, after 6 months poststroke, further gains in ADLs slowed. Based on further analysis, the findings indicate that a lower NIHSS score, being male, and a young age at time of stroke were associated with higher initial levels of ADLs. Having a higher NIHSS score, being female, and a young age at time of stroke predicted an increase in ADLs over time. DISCUSSION: To promote ADLs of stroke patients, NIHSS score at admission, gender, and age should be included as important predictors of stroke care management. The results highlight that the rehabilitation of stroke patients should be focused more on ADLs at 1-6 months poststroke.

Caring behaviours directly and indirectly affect nursing students' critical thinking.

OBJECTIVES: The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self-reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self-reflection and critical thinking. METHODS: For this descriptive, correlational, cross-sectional study, we recruited 293 fifth-year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self-reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q-sort, and a Chinese version of the Self-Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. RESULTS: The results showed that caring behaviours significantly positively affected critical thinking (ß = 0.56, t = 12.37, p < 0.001) and self-reflection with insight (ß = 0.54, t = 11.99, p < 0.001). Self-reflection and insight significantly positively affected critical thinking (ß = 0.34, t = 6.48, p < 0.001). Further, self-reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self-reflection (ß = 0.001, t = 0.021, p > 0.05) and critical thinking. CONCLUSION: Caring behaviours directly affect self-reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self-reflection and insight.

Illness Representations of Injury: A Comparison of Patients and Their Caregivers.

PURPOSE: This study examined the differences between illness representations of injured patients and those of their caregivers. DESIGN: A comparative descriptive survey was used. METHODS: The study setting was the surgical wards of a teaching hospital in Taiwan. Data were collected at 3 to 6 months after hospital discharge. Participants were 127 pairs of injured patients and their caregivers. The participants completed sociodemographic data and completed the Chinese Illness Perception Questionnaire Revised-Trauma, which is composed of eight subscales. Clinical data of the injured patients was obtained from medical records. RESULTS: Injured patients and their caregivers were pessimistic about the injury. Patients perceived significantly more physical symptoms than caregivers did. Caregivers for patients who were severely injured or admitted to an intensive care unit (ICU) had more negative perceptions than did those who were providing care for moderately injured patients or those not admitted to an ICU. Caregivers who did not share their caring responsibilities had more negative perceptions than did those who shared their caring responsibilities with others. CONCLUSIONS: This study found that patients and caregivers had negative illness representations several months after injury. Caregivers who provided care for severely injured patients or who did not share caring responsibilities perceived different extents of illness perceptions about the injury. The interventions should highlight the need to assist patients and caregivers after injury. CLINICAL RELEVANCE: Exploring the discrepancies in illness perceptions between injured patients and their caregivers can help clinicians to provide individualized care, and to design interventions that meet patients' and caregivers' needs.

Development and validation of the Simulation Learning Effectiveness Scale for nursing students.

AIMS AND OBJECTIVES: To develop and validate the Simulation Learning Effectiveness Scale, which is based on Bandura's social cognitive theory. BACKGROUND: A simulation programme is a significant teaching strategy for nursing students. Nevertheless, there are few evidence-based instruments that validate the effectiveness of simulation learning in Taiwan. DESIGN: This is a quantitative descriptive design. METHODS: In Study 1, a nonprobability convenience sample of 151 student nurses completed the Simulation Learning Effectiveness Scale. Exploratory factor analysis was used to examine the factor structure of the instrument. In Study 2, which involved 365 student nurses, confirmatory factor analysis and structural equation modelling were used to analyse the construct validity of the Simulation Learning Effectiveness Scale. RESULTS: In Study 1, exploratory factor analysis yielded three components: self-regulation, self-efficacy and self-motivation. The three factors explained 29·09, 27·74 and 19·32% of the variance, respectively. The final 12-item instrument with the three factors explained 76·15% of variance. Cronbach's alpha was 0·94. In Study 2, confirmatory factor analysis identified a second-order factor termed Simulation Learning Effectiveness Scale. Goodness-of-fit indices showed an acceptable fit overall with the full model (χ2 /df (51) = 3·54, comparative fit index = 0·96, Tucker-Lewis index = 0·95 and standardised root-mean-square residual = 0·035). In addition, teacher's competence was found to encourage learning, and self-reflection and insight were significantly and positively associated with Simulation Learning Effectiveness Scale. Teacher's competence in encouraging learning also was significantly and positively associated with self-reflection and insight. Overall, theses variable explained 21·9% of the variance in the student's learning effectiveness. CONCLUSION: The Simulation Learning Effectiveness Scale is a reliable and valid means to assess simulation learning effectiveness for nursing students. RELEVANCE TO CLINICAL PRACTICE: The Simulation Learning Effectiveness Scale can be used to examine nursing students' learning effectiveness and serve as a basis to improve student's learning efficiency through simulation programmes. Future implementation research that focuses on the relationship between learning effectiveness and nursing competence in nursing students is recommended.

Burden and Cognitive Appraisal of Stroke Survivors' Informal Caregivers: An Assessment of Depression Model With Mediating and Moderating Effects.

This study proposes and evaluates a model of depression that concerns the role of burden and cognitive appraisal as mediators or moderators of outcomes among stroke survivor caregivers. A total of 105 informal caregivers of stroke survivor completed the self-report measures of Caregiver Burden Inventory, Center for Epidemiologic Studies Depression Scale, and Cognitive Impact of Appraisal Scale. The Glasgow Coma Scale and Barthel Index were used by the researcher to examine the physical functional status of the survivor. Partial least squares (PLS) path modeling was used to estimate the parameters of a depression model that included mediating or moderating effects. The model shows that burden and impact of cognitive appraisal have a significant direct and indirect impact on depression, while survivor physical functional status does not have a direct impact. The model also demonstrates that burden and impact of cognitive appraisal separately play a mediating role between survivor physical functional status and caregiver depression. In addition, cognitive appraisal has a moderating influence on the relationship between burden and depression. Overall, survivor physical functional status, burden, and cognitive appraisal were the predictors of caregiver depression, explaining 47.1% of the variance. This study has shown that burden and cognitive appraisal are mediators that more fully explain the relationship between patient severity and caregiver depression.

The effect of cognitive appraisal in middle-aged women stroke survivors and the psychological health of their caregivers: a follow-up study.

AIMS AND OBJECTIVES: This study identified the factors that affect health-related quality of life at one and six months post-stroke in women who have undergone a mild stroke and that affect their informal caregivers' psychological health status. BACKGROUND: Middle-aged women perform the main care roles in a family. When they suffer a stroke, it upsets the equilibrium of their family life. DESIGN: This is a longitudinal design. METHODS: This prospective follow-up study recruited 41 middle-aged women stroke survivors (mean age = 54.95, SD = 9.63) and their informal caregivers (mean age = 41.56, SD = 15.93). The Short-Form Health Survey (SF-36) was used to assess stroke survivor's health-related quality of life, and the Chinese Health Questionnaire was used to measure the level of depression of the stroke survivor's informal caregiver. Data were analysed through descriptive statistics, Wilcoxon signed-rank tests and the generalised estimating equation approach for modelling repeatedly measures. RESULTS: All stroke survivors showed significant improvement in the physical component summary of the health-related quality of life at one and six months after stroke, but there was no significant difference in the mental component summary. In addition, there was no significant difference in the health of the informal caregivers of the women over time. Generalised estimating equation analysis showed that the most important determinant of mental component summary of health-related quality of life among women stroke survivors was cognitive appraisal. The informal caregivers' most important determinants of health status, as measured by level of depression, were their sense of coherence, burden and patients' mental component summary of the health-related quality of life. CONCLUSION: This study highlights the impact of cognitive appraisal in determining health-related quality of life of women stroke survivors and how it affects their caregivers' mental health. RELEVANCE TO CLINICAL PRACTICE: The findings of this study may contribute to home care nurses' understanding the importance of the psychosocial impact of the stroke for the survivor and their ability to help the surviving women to promote the confidence needed for self-care, which will contribute to their quality of life and affect their caregivers' health.

Predictive Factors of Apathy in Stroke Survivors During the Recovery Period.

ABSTRACT: BACKGROUND: Apathy may be an important predictor of depression and significantly negatively affect the quality of life and functional recovery of stroke survivors. However, the evidence reflects the inconsistent findings of studies on the impact of individual-related variables on apathy in patients with stroke. OBJECTIVES: This study examines the relationships among stroke survivors' individual characteristics, background variables, disease-related variables, and apathy; furthermore, we identify predictors of apathy. METHODS: In this cross-sectional correlational study, the participants were recruited from a medical university hospital. Three measurement tools were used: individual and background variables, the modified Rankin Scale, and the Apathy Evaluation Scale. Hierarchical multiple regression analysis was used to identify the predictors of apathy. RESULTS: Participants included 100 stroke survivors with a mean age of 59.9 (12.1) years. The prevalence of apathy among stroke survivors was 27%. Stroke survivors' economic sources (ß = 0.430, P = .001), perceived family support (ß = -0.163, P = .048), and modified Rankin Scale (ß = 0.283, P = .001) accounted for 43.7% of the variance in survivor apathy. CONCLUSION: The results of this study clarified which individual characteristics, background variables, and disease-related variables are key predictors of apathy in patients with stroke.

Examining the Factors Affecting Psychological Well-Being in Certified Nurse Aides Working at Long-Term Care Institutions.

BACKGROUND: The demand for certified nurse aides (CNAs) in long-term care institutions is gradually increasing. Factors such as well-being that positively influence the work of CNAs have been inadequately explored in the literature. PURPOSE: This study was designed to examine the relationships among social support, self-efficacy, demographics, and psychological well-being in CNAs during the recent COVID-19 pandemic and to assess the moderating role of social support on self-efficacy and well-being in this population. METHODS: In this quantitative correlational study, CNAs from 24 legally registered long-term care institutions were recruited as participants. Data were collected using a demographic questionnaire, the General Self-Efficacy Scale, the Social Support Scale, and the Chinese Happiness Inventory. Partial least squares structural equation modeling was used to test the research hypotheses model. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was followed in this cross-sectional study. RESULTS: A total of 148 CNAs were enrolled as participants. The mean age of the participants was 46.48 years. Social support and having children were identified as being significantly and positively correlated with well-being, and self-efficacy was identified as having no significant impact on well-being. Importantly, social support was found to moderate the relationship between self-efficacy and well-being. Overall, social support and having children were important predictors of well-being, with a combined explanatory power of 41.6% ( Q2 = .28, f2 = 0.40). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Self-efficacy was found to be less predictive of well-being in the presence of higher levels of social support. Being a parent was also identified as an important factor affecting the well-being of CNAs under stress. Managers of long-term care institutions should intervene to improve the CNA's social support. Also, CNAs who do not have children should pay more attention to their well-being.

Association Between Family Functioning and Health-related Quality of Life in Stroke Survivor-Informal Family Caregiver Dyads.

PURPOSE: Stroke survivors and their informal family caregivers may share the impact of the disease, which may affect family functioning and quality of life (QoL) for both. This study compared the perceptions of stroke survivors and informal family caregivers regarding family functioning and QoL and examined the QoL of those reporting effective versus ineffective family functioning. METHODS: A cross-sectional study design and convenience sampling were used. Stroke survivor-informal family caregiver dyads were recruited from a medical university hospital. We assessed participants' demographic and clinical variables, including disease severity, family functioning, and QoL. Independent t-test, paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to analyze the data. RESULTS: Seventy-one stroke survivor-informal family caregiver dyads participated in the current study. Most stroke survivors and informal family caregivers reported effective family functioning, with no significant differences. However, significant differences existed in the seven domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, and role-emotional) of QoL, except emotional health. Stroke survivors reporting ineffective family functioning had a significantly lower mental component summary score, unlike informal family caregivers. CONCLUSIONS: Our findings suggest that family functioning is crucial to ensure stroke survivors' QoL, particularly regarding their mental health. Health professionals should prioritize mental health assessments and provide appropriate care interventions for stroke survivors in the first 1-6 months after stroke onset.

Alcohol consumption is inversely associated with stage 3 chronic kidney disease in middle-aged Taiwanese men.

BACKGROUND: Chronic kidney disease (CKD) is a major global public health burden, but there is limited understanding of the relationship of alcohol consumption with CKD. METHODS: In this cross-sectional multivariable study, all participants of a health check-up program in Ditmanson Medical Foundation Chia-Yi Christian Hospital in Taiwan from 2003 to 2009 (15,353 women and 11,900 men) were included for analysis. Estimated glomerular filtration rate was used to define CKD stage and history of alcohol consumption was obtained by self-reporting. Multivariable logistic regression analyses of gender-specific association of alcohol drinking with stage 3 CKD were conducted. A trend tests was conducted to check the dose-response relationship of alcohol consumption with renal disease. A sensitivity test was conducted to rule out the likelihood of reverse causality. RESULTS: The prevalence of stage 3 CKD was lower in drinkers than non-drinkers (p < 0.001) and the percentage of drinkers with stage 3 CKD was less than that of non-drinkers. Multivariable analysis indicated that alcohol consumption was negatively associated with the presence of stage 3 CKD in men (adjusted odds ratio [aOR] for occasional drinking: 0.68, 95% CI: 0.59 ~ 0.78, p < 0.001; aOR for frequent drinking: 0.47, 95% CI: 0.35 ~ 0.63, p < 0.001). Advanced age, hypertension, anemia, BMI of at least 24, hyperuricemia, and proteinuria were also associated with stage 3 CKD in men. Trend tests indicated lower odds of having stage 3 CKD with increased alcohol consumption in both genders. Subgroup analyses and sensitivity tests also indicated the reverse association between alcohol consumption and stage 3 CKD in men regardless of age, diabetes status, and other risky behaviors. CONCLUSIONS: Alcohol consumption was inversely associated with stage 3 CKD in Taiwanese men. However, considering the potential of other health damage with alcohol consumption, the current results should be interpreted cautiously.

The association between hyperuricemia and betel nut chewing in Taiwanese men: a cross-sectional study.

BACKGROUND: Studies have associated betel nut chewing with cancers, metabolic syndrome, cardiovascular disorders, chronic kidney disease, and proteinuria. This study investigated whether hyperuricemia is associated with betel nut chewing in men who participated in a health check-up program. METHODS: From hospital records, we identified a total of 11,991 men who participated in the health check-up program from 2003 to 2009. They were divided into hyperuricemic group and non-hyperuricemic group. Laboratory tests, medical history, and status of cigarette smoking, alcohol consumption, and betel nut chewing were compared between the 2 groups. We calculated odds ratio (OR) and 95% confidence interval (CI) of hyperuricemia in association with betel nut consumption and other factors. RESULTS: Compared with the non-hyperuricemic group, the hyperuricemic group was slightly older (59.4 vs. 58.6 years) but less prevalent with betel nut use (11.8 vs. 13.6%, p = 0.003). Multivariable logistic regression analysis showed that hyperuricemia was negatively associated with betel nut chewing (OR 0.75, 95% CI 0.66-0.84), older age (OR 0.84, 95% CI 0.77-0.93), and diabetes mellitus (OR 0.57, 95% CI 0.50-0.64). On the other hand, hyperuricemia was positively associated with body mass index (OR 1.75, 95% CI 1.62-1.90), drinking (OR 1.36, 95% CI 1.25-1.49), hypertension (OR 1.41, 95% CI 1.30-1.52), mixed hyperlipidemia (OR 1.84, 95% CI 1.33-2.54), chronic kidney disease (OR 3.28, 95% CI 2.94-3.65), and proteinuria (OR 1.22, 95% CI 1.08-1.38). Smoking, hypercholesterolemia, and hypertriglyceridemia had no significant association with hyperuricemia. CONCLUSION: Our data suggest that betel nut chewing is negatively associated with hyperuricemia.

Testing of the factor structure of the Sexual Health Knowledge Measure with young adolescent Taiwanese girls.

Knowledge of sexual health is an important indicator of the development of healthy adolescent sexuality. An evaluation instrument in nursing school practice, whose results can lead to improved sexual health in adolescents, is needed. We conducted this study to undertake rigorous testing of the Sexual Health Knowledge Scale (SHKS) as a means to ensure a reliable and valid quantitative measure of sexual health knowledge among young adolescent females. A panel of experts assessed the content validity of the 40-item measure. Initial testing involved 481 female adolescents (12-14 years old), using principal component factor analysis with varimax rotation and the determination of Cronbach's alpha coefficients. Confirmatory factor analysis (CFA) was conducted using data from an additional sample of 234 female adolescents (12-14 years old). Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 43.40% of the variance. As a result of the analysis of the scale, 22 items were deleted, resulting in an 18-item scale. The CFA identified a second-order factor termed "sexual health knowledge." Goodness-of-fit indices showed an acceptable fit overall with the full model (χ(2)/df (131) = 1.69, RMSEA = 0.054, RMR = 0.013, CFI = 0.92, and GFI = 0.99). We determined that the SHKS is a reliable and valid measure, with good composite reliabilities and goodness-of-fit indices.

Factors Affecting the Relationship Between Stress and Anxiety in Critically Ill Patients: A Partial Least Squares Structural Equation Modeling Approach.

This study aimed to examine the factors affecting the relationship between stress and anxiety in critically ill patients. A cross-sectional research paradigm was employed to enroll patients admitted to the medical intensive care unit (ICU) of a medical university hospital. Partial least squares structural equation modeling (PLS-SEM) was used to examine the data. A total of 90 ICU patients were included in this study; 56 were men and 34 were women. The patients' mean age was 65.3 years. Only the emotional responses dimension of illness was significantly positively correlated with stress. However, the emotional responses dimension of illness representation, acute physiology and chronic health evaluation system (APACHE) score, age, and education level were significantly positively correlated with anxiety. Nevertheless, treatment control was significantly negatively correlated with anxiety. Overall, illness representations (emotional responses and treatment control), APACHE score, age, and education were important predictors of anxiety, with an explanatory power of 37.9%. We recommend that for clinically relevant practice, besides focusing on ICU patients' illness representation, attention should also be paid to their individual characteristics, such as differences in age and education levels.