Physical function mediates the effects of sensory impairment on quality of life in older adults: Cross-sectional study using propensity-score weighting.

AIMS: To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life. DESIGN: A cross-sectional study. METHODS: Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function. RESULTS: After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults. CONCLUSION: Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function. IMPACT: The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.

Effects of maternal confidence and competence on maternal parenting stress in newborn care.

AIM: This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. BACKGROUND: Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. METHODS: A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants <4 months old. Data were collected between August 2007 and January 2008 using a self-report questionnaire on mothers' and infants' demographic variables, maternal confidence, maternal competence and self-perceived maternal parenting stress. RESULTS: After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. CONCLUSION: To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics.

Motivations and reasons for women attending a breast self-examination training program: A qualitative study.

BACKGROUND: Breast cancer is a major threat to Taiwanese women's health. Despite the controversy surrounding the effectiveness of breast self-examination (BSE) in reducing mortality, BSE is still advocated by some health departments. The aim of the study is to provide information about how women decide to practice BSE and their experiences through the training process. Sixty-six women aged 27-50 were recruited. METHODS: A descriptive study was conducted using small group and individual in-depth interviews to collect data, and using thematic analysis and constant comparison techniques for data analysis. RESULTS: It was found that a sense of self-security became an important motivator for entering BSE training. The satisfaction in obtaining a sense of self-security emerged as the central theme. Furthermore, a ladder motivation model was developed to explain the participants' motivations for entering BSE training. The patterns of motivation include opportunity taking, clarifying confusion, maintaining health, and illness monitoring, which were connected with the risk perception for breast cancer. CONCLUSIONS: We recognize that the way women decide to attend BSE training is influenced by personal and social factors. Understanding the different risk assessments women rely on in making their health decisions is essential. This study will assist researchers and health professionals to gain a better understanding of alternative ways to deal with breast health, and not to be limited by the recommendations of the health authorities.

Applicability of the Chinese version of the Prodromal Questionnaire.

BACKGROUND/PURPOSE: Early detection and intervention of psychosis is clinically important. This study aimed to test the applicability of the Chinese version of the Prodromal Questionnaire (CPQ) for identifying prodromal states of psychosis. METHODS: This is a two-group cross-sectional comparative study. The Prodromal Questionnaire (PQ) was translated into traditional Chinese based on Brislin's Revised Model. Like the PQ, the CPQ provides results on four subscales: (1) positive symptoms, (2) negative symptoms, (3) disorganized symptoms, and (4) general symptoms. An expert panel of five senior psychiatrists established the content validity of the CPQ. The experimental group was a sample of 100 first-visit patients to a psychiatric outpatient department (FVPOD). The comparison group comprised 98 nursing students without any history of psychiatric disturbances. Both the CPQ and the Chinese Health Questionnaire-12 were administered to all 198 subjects. Clinical psychosis was assessed using the Chinese version of the Diagnostic Interview for Genetic Studies, and 30 of the 100 FVPOD subjects were thus identified as psychotic patients and the remaining 70 were non-psychotic. RESULTS: Content validity of the CPQ was confirmed by an expert panel of five senior psychiatrists, achieving an overall reliability in the range of 0.86-0.93. The FVPOD group and comparison group had significantly different mean scores on all four subscales of the CPQ. In identifying psychotic cases, the 35-item positive symptom subscale had high sensitivity (97%) and low specificity (30%) with a cutoff value of 8. Due to the low specificity, patients identified as potential psychotic cases were referred for further clinical evaluation. CONCLUSION: Applicability of the CPQ was demonstrated by its high reliability and good ability to discriminate between clinical patients and a comparison group. The 35-item positive symptom subscale can be useful alone in general mental health settings for screening psychotic cases.

Discrepancy between physicians' perceptions and practices during pelvic examinations in Taiwan.

OBJECTIVE: This study explored (1) physicians' perceptions of pelvic examination (PE) procedures and (2) the discrepancy between physicians' perceptions and their practices as observed by their attending nurses. METHOD: Data were collected from 20 physician-completed questionnaires on the perceived importance of 23 PE procedures. Each physician's practice of the same 23 PE procedures was assessed by 4-6 attending nurses (100 nurse observations). Physicians and nurses were sampled by convenience from the obstetrics/gynecology outpatient departments of 3 teaching hospitals in central Taiwan. Discrepancies between physicians' perceptions and their practices as assessed by attending nurses were examined by the Mann-Whitney U test. RESULTS: Physicians' mean scores ranged from 3.15 to 4.00, indicating that PE procedures were generally perceived as important. The procedures were rank ordered according to the mean scores from highest to lowest. Physicians' 5 top-ranking procedures were wearing gloves during the PE, asking agreement for the examination, paying attention to privacy during the PE, protecting the woman's personal information, and protecting the woman's medical records. Physicians' 5 lowest ranking procedures were telling the woman before inserting the speculum that she will feel some pressure, explaining the procedure before the PE, proactively providing information, asking the woman how she feels during the PE, asking a woman's permission to examine prior to commencing the PE, and describing observations to the woman during the PE (the last two procedures were tied for 5th rank). For 15 of the 23 PE procedures, physicians' perceptions did not differ significantly from their practices as assessed by attending nurses. The remaining 8 procedures were statistically significant between physicians' perception and their practices, and were rated higher by physicians (perception) than by attending nurses (practice). CONCLUSION: The 5 top-ranking PE procedures in terms of perceived importance were related to procedural behaviors, whereas the 5 lowest ranking procedures were verbal statements with explicit affective content. During nurse-observed PEs, Taiwanese physicians consistently practiced the procedural aspects of PEs they perceived as important (e.g., communication and consultation, protection and skilled technique, and confidentiality). However, physicians' practices were less consistent in affective aspects (e.g., explanation and consent, information and instruction, and sensitivity). PRACTICE IMPLICATIONS: Our results suggest that physicians should concentrate not only on procedural behaviors, but also on affective behaviors. These findings could be incorporated in medical education, particularly for medical students training to become obstetric and gynecological physicians.

Validation of Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire with heart failure patients in Taiwan.

BACKGROUND: Dyspnea is a distressing and functionally limiting symptom that patients with heart failure commonly experience. A valid instrument to quantify dyspnea for comparison of groups and for illness management is important. OBJECTIVE: To validate the Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire. METHODS: The Chinese version was developed by using translation and back translation and was tested in Taiwan in 88 patients who had heart failure but no pulmonary disease or comorbid conditions limiting physical function. Data on a Taiwanese subsample (n=30) were compared with data on 30 patients in the United States matched by sex, age, and severity of disease to determine the equivalence of the Chinese and English versions. Construct validity was assessed by testing the hypothesis that health-related quality of life measured by using the Minnesota Living With Heart Failure Questionnaire is associated with the score on the dyspnea questionnaire. Reliability was assessed by using the Cronbach alpha and item-total correlations. RESULTS: Equivalence between the US and Taiwanese samples was high, from 0.67 to 0.91 for each item of the questionnaire and for the total score. Satisfactory correlations between the Chinese dyspnea and the Minnesota questionnaires, especially in the physical dimension (r=0.71, P<.001), provided support for the construct validity of the Chinese questionnaire. Reliability of the Chinese questionnaire was adequate (alpha=0.94). CONCLUSIONS: The Chinese Modified Pulmonary Functional Status and Dyspnea Questionnaire is a reliable and valid measure for dyspnea that can be used in Taiwanese patients with heart failure.

Irregular breakfast eating and health status among adolescents in Taiwan.

BACKGROUND: Regular breakfast eating (RBE) is an important contributor to a healthy lifestyle and health status. The aims of the present study were to evaluate the relationships among irregular breakfast eating (IRBE), health status, and health promoting behavior (HPB) for Taiwanese adolescents. METHODS: A cross-sectional, descriptive design was used to investigate a cluster sample of 1609 (7th-12th grade) adolescents located in the metropolitan Tao-Yuan area during the 2005 academic year. The main variables comprised breakfast eating pattern, body weight, and health promoting behaviors. Data were collected by a self-administered questionnaire. RESULTS: A total of 1609 participants were studied, 64.1% in junior high school and 35.9% in high school, boys (47.1%) and girls (52.9%) ranging in age from 12-20 years. Of the total participant population, 28.8% were overweight and nearly one quarter (23.6%) reported eating breakfast irregularly during schooldays. The findings indicated that adolescents with RBE had a lower risk of overweight (OR for IRBE vs. RBE = 1.51, 95% CI: 1.12, 2.04), and that the odds of becoming overweight were 51% greater for IRBE than for RBE even after controlling for demographical and HPB variables. IRBE also was a strong indicator for HPB. However, the profile of the high-risk IRBE group was predominantly junior high schoolchildren and/or children living without both parents. CONCLUSION: This study provides valuable information about irregular breakfast eating among adolescents, which is associated with being overweight and with a low frequency of health promoting behavior. School and family health promotion strategies should be used to encourage all adolescents to eat breakfast regularly.

Moderating effect of psychosocial factors for dyspnea in Taiwanese and American heart failure patients.

BACKGROUND: Dyspnea is the most common and distressing symptom of heart failure (HF). Evidence from empirical studies has shown that multiple factors apart from pathophysiological changes may influence this symptom. PURPOSE: This study explored the moderating effect of psychosocial factors between clinical characteristics and dyspnea in patients with HF. To assess the potential effects of cultural background, this study also compared differences in psychosocial factor moderating effects between HF patients in Taiwan and the United States. METHODS: We recruited patients with HF from outpatient clinics in Taiwan and the United States. Data were collected at clinics and research centers. Dyspnea was measured using the modified pulmonary function status and dyspnea questionnaire. Psychosocial factors considered were depression, anxiety, perceived control, and perceived social support. These factors were measured using the Brief Symptom Inventory, Revised Control Attitudes Scale, and Multidimensional Scale of Social Support Scale, respectively. Multiple regressions with interaction effect analysis tested the moderator effects across these two groups. RESULTS: Ninety-seven Taiwanese (mean age = 66.2 ± 12.1 years; 76% male; 28% NYHA [New York Heart Association] III/IV) and 96 American (mean age = 61.6 ± 11.7 years; 74% male; 42% NYHA III/IV) patients participated. In Taiwanese patients, only perceived social support (B = .08, p = .034) moderated the relationship between clinical variables and dyspnea. In American patients, depression (B = .75, p = .028) and anxiety (B = .85, p = .041) were moderators of the relationship between clinical status and dyspnea severity. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Depression, anxiety, and perceived social support moderated the relationship of clinical characteristics with dyspnea in Taiwanese and American HF patients, respectively. Attention to these psychosocial factors may improve dyspnea status in HF patients. Symptom management should include a focus on patients' psychological distress and social perspectives.