Nociception Effect on Frontal Electroencephalogram Waveform and Phase-Amplitude Coupling in Laparoscopic Surgery.

BACKGROUND: Electroencephalographic pattern changes during anesthesia reflect the nociception-analgesia balance. Alpha dropout, delta arousal, and beta arousal with noxious stimulation have been described during anesthesia; however, data on the reaction of other electroencephalogram signatures toward nociception are scarce. Analyzing the effects of nociception on different electroencephalogram signatures may help us find new nociception markers in anesthesia and understand the neurophysiology of pain in the brain. This study aimed to analyze the electroencephalographic frequency pattern and phase-amplitude coupling change during laparoscopic surgeries. METHODS: This study evaluated 34 patients who underwent laparoscopic surgery. The electroencephalogram frequency band power and phase-amplitude coupling of different frequencies were analyzed across 3 stages of laparoscopy: incision, insufflation, and opioid stages. Repeated-measures analysis of variance with a mixed model and the Bonferroni method for multiple comparisons were used to analyze the changes in the electroencephalogram signatures between the preincision and postincision/postinsufflation/postopioid phases. RESULTS: During noxious stimulation, the frequency spectrum showed obvious decreases in the alpha power percentage after the incision (mean ± standard error of the mean [SEM], 26.27 ± 0.44 and 24.37 ± 0.66; P < .001) and insufflation stages (26.27 ± 0.44 and 24.40 ± 0.68; P = .002), which recovered after opioid administration. Further phase-amplitude analyses showed that the modulation index (MI) of the delta-alpha coupling decreased after the incision stage (1.83 ± 0.22 and 0.98 ± 0.14 [MI × 10 3 ]; P < .001), continued to be suppressed during the insufflation stage (1.83 ± 0.22 and 1.17 ± 0.15 [MI × 10 3 ]; P = .044), and recovered after opioid administration. CONCLUSIONS: Alpha dropout during noxious stimulation is observed in laparoscopic surgeries under sevoflurane. In addition, the modulation index of delta-alpha coupling decreases during noxious stimulation and recovers after the administration of rescue opioids. Phase-amplitude coupling of the electroencephalogram may be a new approach for evaluating the nociception-analgesia balance during anesthesia.

The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study.

OBJECTIVE: This study aimed to examine the mediating effect of swallowing ability on hemoglobin levels and activities of daily living (ADL). DESIGN: Prospective longitudinal study. SETTING: Two rehabilitation wards in a national referral center for Northern Taiwan, followed by discharge. PARTICIPANTS: 101 participants were admitted for first or recurrent infarction or hemorrhagic stroke and transferred to the rehabilitation ward of a medical center (N=101). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Hemoglobin data were collected from medical records. Swallowing ability and ADL were measured using the Functional Oral Intake Scale and Barthel Index, respectively, with higher scores indicating better functioning. RESULTS: Mediation analysis performed using path analysis illustrated that hemoglobin at the time of transfer to the rehabilitation ward had a direct and positive effect on swallowing ability at 1-3 days before discharge (path coefficient=0.21, 95% confidence interval [CI]: 0.04-0.35, P=.018), and swallowing ability at 1-3 days before discharge had a direct and positive effect on ADL at 1 month after discharge (path coefficient=0.36, 95% CI: 0.13-0.57, P=.002). Hemoglobin level at the time of transfer to the rehabilitation ward did not directly influence ADL 1 month after discharge (path coefficient=0.12, 95% CI: -0.05-0.28, P=.166). These results indicate that swallowing ability substantially mediates the relation between previous hemoglobin levels and subsequent ADL. CONCLUSION: Low hemoglobin levels and poor swallowing ability should be concurrently addressed to improve ADL performance.

Bi-dimensional acculturation and depressive symptom trajectories from pregnancy to 1 year postpartum in marriage-based immigrant women in Taiwan.

BACKGROUND: Childbirth may pose many challenges to the psychological well-being of marriage-based immigrant mothers in interracial marriages, who must negotiate bi-dimensional acculturation - adaptation to the host culture and maintenance of her own heritage culture. We examined the temporal relationships between bi-dimensional acculturation and depressive symptoms from pregnancy to 1 year postpartum among marriage-based immigrant mothers in Taiwan using the cross-lagged structural equation modeling. METHODS: This study recruited 310 immigrant mothers, who were examined in the second and third trimesters, and again at 1 month, 3 months, 6 months, and 1 year postpartum from March 2013 to December 2015. Depressive symptoms and bi-dimensional acculturation were measured using the Edinburgh Postnatal Depression Scale and Bidimensional Acculturation Scale for Marriage-Based Immigrant Women, respectively. RESULTS: The study found that adaptation to the host culture followed a downward linear trajectory, while maintenance of the mother's own heritage culture followed an upward linear trajectory from pregnancy to 1 year postpartum. All but one cross-lagged path between bi-dimensional acculturation and depressive symptoms was statistically insignificant, though almost all cross-sectional associations were significant. Adaptation to host culture was negatively associated with depressive symptoms at all time points. The association between maintenance of heritage culture and depressive symptoms reversed from positive to negative after 6 months postpartum. CONCLUSIONS: Adaptation to the host culture and maintenance of the mother's heritage culture differed in their associations with maternal depressive symptoms. Health professionals should assist immigrant mothers in adapting to the host culture while supporting their heritage culture in the childbearing period.

Influence of hemoglobin on blood pressure among people with GP.Mur blood type☆.

BACKGROUND/PURPOSE: GP.Mur is a clinically important red blood cell (RBC) type. GP.Mur and band 3 interact on the RBCs. We previously observed that healthy adults with GP.Mur type present slightly higher blood pressure (BP). Because band 3 and Hb comodulate nitric oxide (NO)-dependent vasodilation and hemoglobin (Hb) is positively associated with BP, we aimed to test whether these could contribute to higher BP in GP.Mur+ people. METHODS: We recruited 989 non-elderly adults (21% GP.Mur) free of catastrophic illness and not on cardiovascular or anti-hypertensive medication. Their body indices, blood lab data and lifestyle data were collected for analyses of potential BP-related factors (BMI, age, smoking, Hb, and GP.Mur). RESULTS: BMI and age remained the most significant contributors to BP. GP.Mur slightly increased systolic BP (SBP). The direct correlation between Hb and BP was only found in Taiwanese non-anemic men, not women. After age and BMI adjusted, we estimated an increase of 1.8 mmHg and 2.6 mmHg of SBP by 1 g/dL Hb among men without and with GP.Mur type, respectively. Hb was generally lower among people expressing GP.Mur, which likely limited their larger impact on BP. CONCLUSION: GP.Mur contributed to BP in both Hb-dependent and Hb-independent fashion. A pronounced impact of hemoglobin on BP likely requires sufficient Hb, as GP.Mur increased the sensitivity of SBP to Hb only in non-anemic Taiwanese men, and not in Taiwanese women or anemic men. The mechanism through which GP.Mur affected BP independent of Hb is unknown.

Bi-dimensional acculturation and social support on perinatal depression in marriage-based immigrant women.

BACKGROUND: Sociocultural factors play critical roles in the mental health of marriage-based immigrant women. However, the effect of bi-dimensional acculturation ("adaptation to host culture" and "maintenance of heritage culture") and social support on perinatal depression across time was unknown among them. OBJECTIVE: To examine the effect of bi-dimensional acculturation and social support on perinatal depression among marriage-based immigrant women in Taiwan. METHODS: This longitudinal study recruited 310 immigrant mothers to complete structured questionnaires during pregnancy and postpartum periods. Depression was assessed using the Edinburgh Postnatal Depression Scale. Bi-dimensional acculturation was measured using the Bi-dimensional Acculturation Scale for Marriage-Based Immigrant Women. Social support was measured by a three-subscale instrument, namely emotional, instrumental, and informational support. RESULTS: Depression scores increased from pregnancy to three months postpartum, and decreased from six to twelve months postpartum. The generalized estimating equation results showed that lower adaptation to host culture, emotional support, and informational support were associated with higher maternal depression scores over time. Maintaining heritage culture has both positive (from pregnancy to three months postpartum) and negative associations (from six to twelve months postpartum) with maternal depression, further, increased emotional support enhanced the protective effect of adaptation to host culture, but decreased the positive effect of maintenance of heritage culture on depression. CONCLUSION: Strategies should be developed to assist perinatal immigrant women to adapt to the host culture, maintain their heritage culture, and resolve potential cultural conflicts to decrease their depression. Respect for immigrant mothers' heritage cultures should be accompanied by increased emotional support.

TLC388 Induces DNA Damage and G2 Phase Cell Cycle Arrest in Human Non-Small Cell Lung Cancer Cells.

TLC388, a camptothecin-derivative targeting topoisomerase I, is a potential anticancer drug. In this study, its effect on A549 and H838 human non-small cell lung cancer (NSCLC) cells was investigated. Cell viability and proliferation were determined by thiazolyl blue tetrazolium bromide and clonogenic assays, respectively, and cell cycle analysis and detection of phosphorylated histone H3 (Ser10) were performed by flow cytometry. γ-H2AX protein; G2/M phase-associated molecules ataxia-telangiectasia mutated (ATM), CHK1, CHK2, CDC25C, CDC2, and cyclin B1; and apoptosis were assessed with immunofluorescence staining, immunoblotting, and an annexin V assay, respectively. The effect of co-treatment with CHIR124 (a checkpoint kinase 1 [CHK1] inhibitor) was also studied. TLC388 decreased the viability and proliferation of cells of both NSCLC lines in a dose-dependent manner. TLC388 inhibited the viability of NSCLC cell lines with an estimated concentration of 50% inhibition (IC50), which was 4.4 and 4.1 µM for A549 and H838 cells, respectively, after 24 hours. Moreover, it resulted in the accumulation of cells at the G2/M phase and increased γ-H2AX levels in A549 cells. Levels of the G2 phase-related molecules phosphorylated ATM, CHK1, CHK2, CDC25C, and cyclin B1 were increased in TLC388-treated cells. CHIR124 enhanced the cytotoxicity of TLC388 toward A549 and H838 cells and induced apoptosis of the former. TLC388 inhibits NSCLC cell growth by inflicting DNA damage and activating G2/M checkpoint proteins that trigger G2 phase cell cycle arrest to enable DNA repair. CHIR124 enhanced the cytotoxic effect of TLC388 and induced apoptosis.

Infertility-related knowledge in childbearing-age women with breast cancer after chemotherapy.

AIM: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. METHODS: In this cross-sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face-to-face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility-related knowledge. RESULTS: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. CONCLUSION: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins.

Oncofertility to Evidence-Based Practice: Changes in Fertility Intention and Symptom Burden in Reproductive-Age Women With Breast Cancer.

BACKGROUND: Infertility is negatively related to the quality of life in reproductive-age women with breast cancer. The nurses who care for these patients lack a comprehensive understanding of the changes in fertility intention that patients undergo from the time of cancer diagnosis, throughout treatment, and after treatment. A fertility intention assessment is the first step in discerning the patient's ideas toward future pregnancy. AIMS: This study examined the changes in fertility intention and symptom burden in reproductive-age women with breast cancer before, during, and after treatment. We also explored predictors of fertility intention among the women. METHODS: The study was guided by the theory of planned behavior. A longitudinal and observational study was conducted with 151 women with breast cancer who were treated at a teaching hospital in Taipei. The participants were interviewed using a structured questionnaire before, during, and after chemotherapy from July 2016 to March 2018. Fertility intention was assessed using the Fertility Intention Scale. The M.D. Anderson Symptom Inventory-Taiwanese version was used to measure the symptom burden. The generalized linear mixed model was used for multivariate analysis. RESULTS: Patients had significantly lower scores for fertility intention after treatment than before treatment. The study patients had substantially worse symptom burden during treatment than before or after treatment. Symptom burden scores, especially for symptom interference, correlated significantly with fertility intention. A higher Fertility Intention Scale score was significantly associated with younger age. LINKING EVIDENCE TO ACTION: Fertility intention decreased over time in women with breast cancer. Understanding fertility intention and controlling symptom burden throughout the course of treatment and beyond might help nurses provide better care for preserving fertility and maintaining fertility options for these women with breast cancer.

Gender Gap and Risk Factors for Poor Stroke Outcomes: A Single Hospital-Based Prospective Cohort Study.

BACKGROUND: This study intended to investigate whether etiological stroke subtypes and their corresponding major risk factors have differential effects on outcomes between genders. PATIENTS AND METHODS: We enrolled 403 consecutive patients with first-ever acute ischemic stroke (170 women, 233 men), from a referral hospital in Taiwan over a 2-year period. Gender differences in demographics, vascular risk factors, access to health care, etiological stroke subtypes, stroke severity, and outcomes were examined. The primary outcome variable of the study was any unfavorable outcome due to acute ischemic stroke, defined as a modified Rankin Scale score of 3 or higher at 90 days after stroke. Multivariable logistic regression models were used to identify predictors of poor outcomes. RESULTS: There were no gender disparities in baseline severity, stroke subtypes, access to health care, and medical comorbidities. Although women had poorer outcomes, female gender was not a predictor of unfavorable outcomes. Important predictors included age of 75years or older (odds ratio [OR] = 2.67; 95% confidence interval [CI], 1.46-4.90), National Institutes of Health Stroke Scale greater than or equal to 8 (OR = 8.38; 95% CI, 4.61-15.2), lack of cohabitation (OR = 2.13; 95% CI, 1.26-3.61), subtypes of cardioembolism (OR = 2.76; 95% CI, 1.29-5.93), and large-artery atherosclerosis (OR = 2.93; 95% CI, 1.47-5.85). In subgroup analyses, the gender-specific independent predictors were cardioembolism (OR = 7.42; 95% CI, 2.21-24.9) or atrial fibrillation (OR = 3.57; 95% CI, 1.31-9.74) in women, and large-artery atherosclerosis (OR = 3.35; 95% CI, 1.30-8.64) or symptomatic large-artery stenosis (OR = 3.42; 95% CI, 1.69-6.96) in men. The differential effects of these predictors according to gender were revealed by interaction tests. CONCLUSION: Atrial fibrillation and symptomatic large-artery stenosis are predictors of poor stroke outcomes in women and men, respectively.

Differential Pharmacological Activities of Oxygen Numbers on the Sulfoxide Moiety of Wasabi Compound 6-(Methylsulfinyl) Hexyl Isothiocyanate in Human Oral Cancer Cells.

6-(methylsulfinyl) hexyl isothiocyanate (6-MITC) is a naturally occurring compound isolated from Wasabia japonica (wasabi). The synthetic derivatives, 6-(methylsulfenyl) hexyl isothiocyanate (I7447) and 6-(methylsulfonyl) hexyl isothiocyanate (I7557), were derived from 6-MITC with the deletion and addition of oxygen, respectively. We aimed to evaluate the effect of these synthetic compounds on human oral cancer cells, SAS and OECM-1. All three compounds (I7447, 6-MITC, and I7557) inhibited the viability of SAS and OECM-1 cells using MTT assay. Morphological observations showed various proportions of mitotic arrest and apoptosis in cells treated with these compounds. Cell cycle analysis revealed relatively abundant G2/M arrest in 6-MITC and I7557-treated cells, whereas sub-G1 accumulation was found in I7447-treated cells. In using phosphorylated histone H3 as a marker for mitosis, the addition of 6-MITC and I7557 (excluding I7447) could be shown to arrest cells during mitosis. In contrast, I7447 induced more prominent apoptosis than the 6-MITC or I7557 compounds. The down-regulated expression of the phosphorylated form of CHK1 and Cdc25c was noted in 6-MITC and I7557-treated cells. I7557 could sensitize SAS cells to death by radiation. The wasabi compound, 6-MITC, and its chemical derivatives with different numbers of oxygen may have differential pharmacological effects on human oral cancer cells.

Understanding the relationship between cesarean birth and stress, anxiety, and depression after childbirth: A nationwide cohort study.

BACKGROUND: Women who undergo cesarean birth might have an increased risk for poor mental health after childbirth, possibly because of maternal and neonatal physical problems, low parental confidence, and decreased levels of oxytocin. However, this relationship remains controversial and requires further examination. The study aimed to examine the effect of cesarean birth on postpartum stress, anxiety, and depression. METHODS: This nationwide population-based cohort study was conducted using the Taiwan National Health Insurance Database. A total of 12 619 women who underwent cesarean birth and 12 619 control women who underwent vaginal birth were matched by propensity score based on age, socioeconomic status, residential urbanicity, antepartum comorbidity, and index year of delivery. We compared the incidence of stress, anxiety, and depression during the first postpartum year between cesarean and comparison groups by calculating incidence rate ratios (IRRs). RESULTS: The cesarean group showed a significantly higher risk for stress symptoms (IRR 1.4 [95% confidence interval {CI} 1.02-1.92]), but not anxiety (IRR 1.14 [95% CI 0.95-1.38]) or depression (IRR 1.32 [95% CI 0.94-1.87]), although the IRRs were also greater than one. The cesarean group had a significantly higher risk of any of the above-listed three disorders than the comparison group (incidence 27.6 vs 23.4 per 1000 person-years; IRR 1.18 [95% CI 1.01-1.38]). CONCLUSIONS: Cesarean birth was associated with an increased risk of postpartum stress symptoms. Health professionals should avoid unnecessary cesarean birth, pay attention to women who deliver by cesarean, and intervene appropriately in an attempt to improve mental health among postpartum women.

Cimetidine Attenuates Therapeutic Effect of Anti-PD-1 and Anti-PD-L1 and Modulates Tumor Microenvironment in Colon Cancer.

Histamine modulates immunity by binding to histamine receptor 2 (H2R). Cimetidine, an H2R antagonist that inhibits gastric acid secretion and treats gastrointestinal ulcers, interferes with histamine-mediated immunomodulation and may have anticancer activity. This study examined cimetidine's effect on the anticancer effect of anti-PD-L1 in colon cancer. The MTT assay, colony formation assay, and DNA histograms assessed cell viability, clonogenicity, and cell cycle distribution, respectively. Flow cytometry measured H2R and PD-L1 expression and estimated specific immune cell lineages. For the in vivo study, tumor cells were subcutaneously implanted into the right flank of BALB/c mice. Cimetidine had no significant effect on CT26 cell viability, clonogenicity, or cell cycle distribution. It also did not affect H2R and PD-L1 expression levels in CT26 cells. In vivo, anti-PD-1 and anti-PD-L1 suppressed CT26 tumor growth, whereas cimetidine showed mild antitumor activity. In the combined experiment, cimetidine significantly attenuated anti-PD-1 and anti-PD-L1' antitumor effects without major toxicity. In the tumor microenvironment, anti-PD-L1 increased CD3+ T, CD4+ T, and CD8+ T cells and M1 macrophages. Combined treatment with cimetidine reversed this. Cimetidine also reversed anti-PD-1 and anti-PD-L1's decrease in circulating and tumor-associated neutrophils. Cimetidine attenuated anti-PD-L1's antitumor effect and modulated the tumor microenvironment in colon cancer.

A structural model of the influence of immigrant mothers' depressive symptoms and home environment on their children's early developmental outcomes in Taiwan.

In this cross-sectional study of 61 immigrant mothers and their 6- to 24-month-old children in Taiwan, we examined the structure of relationships among maternal depressive symptoms, quality of the child-rearing home environment, and child development using a partial least squares approach. Maternal depressive symptoms as measured by the Edinburgh Postnatal Depression Scale had a direct and negative effect on the quality of the home environment as measured by the IT-HOME, which in turn had a direct and positive effect on child development as measured by the Comprehensive Developmental Inventory for Infants and Toddlers. Maternal depressive symptoms did not directly affect child development, suggesting that the quality of the home environment mediated the relationship between maternal depressive symptoms and child development.

Influence of Sex Differences on Serum Lipid Profiles among Habitual Coffee Drinkers: Evidence from 23,072 Taiwan Biobank Participants.

The bioactive compounds of coffee are involved in lipid metabolism, and sex differences may play an important role. This study aimed to evaluate the influence of sex differences on serum lipid profiles among habitual coffee drinkers. We conducted a nationwide cross-sectional study of 23,628 adults using data obtained from the Taiwan Biobank database. Adults who drank more than one cup of coffee per day and those who drank less than one cup per day were compared with non-drinkers. After adjusting for baseline demographics and lifestyle, a generalized linear model was used to estimate the change in serum lipid profiles in men and women and in postmenopausal and premenopausal women among different coffee-drinking behaviors. We found that habitual coffee consumption changed the serum lipid profiles of men and women. Further, coffee drinkers had higher serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and lower serum triglyceride levels than non-drinkers. Compared with premenopausal women, both men and postmenopausal women had increased serum total cholesterol and low-density lipoprotein cholesterol levels. Menopausal status may play an important role in modulating the effect of habitual coffee intake on dyslipidemia. Moreover, premenopausal women potentially benefit more from habitual coffee drinking than men and postmenopausal women.

The effect of hospital-based health promotion on the health practices of full-time hospital nurses: a cross-sectional study.

Many studies have reported positive contributions of health promotion on the health behavior of nursing staff working in hospitals, including the maintenance of a regular healthy diet, engagement in physical activity, performance of routine screening practices, and participation in a health examination. Despite being considered a role model for healthy lifestyles, little is known about the effect of health-promoting hospital settings on nursing staff. The aim of this study was to perform a nationwide, hospital-based, cross-sectional, survey comparing health practices between full-time nurses of health-promoting hospitals and those of non-health-promoting hospitals in Taiwan. We conducted a nationwide, hospital-based, cross-sectional, survey in 100 hospitals from May to July 2011 using a questionnaire as the measurement tool. Nurses aged between 18 and 65 years from certified health-promoting hospitals (n = 14,769) were compared with nurses in non-health-promoting hospitals (n = 11,242). A multiple logistic regression model was conducted to estimate the effect of certified HPH status on the likelihood of performing health behavior, receiving general physical examination, undergoing cancer screening, and participating in hospital-based health-promoting activities. All nurses of HPH hospitals were more likely to perform physical activity, practice cancer screening, receive at least one general physical examination in the past 3 years, and had a higher chance of participating in at least one hospital-based health-promoting activity in the past year (particularly weight-control groups and sports-related clubs) than those of non-HPH hospitals. This study suggests the effectiveness of implementing health promotion on the health behavior of full-time nursing staff in hospitals.

Sex and age disparities in the influence of tobacco smoking on depression: Evidence from the Taiwan Biobank.

INTRODUCTION: The global tobacco epidemic poses a notable challenge to global health due to its association with various tobacco-related diseases. Although tobacco smoking is associated with depression, the exact mechanism by which tobacco smoking increases the risk of depression is unclear. This study explored the potential effects of tobacco smoking on depression. METHODS: We used data in the analysis from the Taiwan Biobank of 27916 individuals recruited from 2015 to 2020. To investigate the associations between tobacco use and depression, the results of the depression-measuring subscale of the Patient Health Questionnaire-4 as well as data on participants' tobacco consumption and other relevant covariates, were analyzed. RESULTS: Participants who smoked were more likely to report depression than those who did not smoke (AOR=1.50; 95% CI: 1.21-1.86). Furthermore, depression was significantly higher in women who smoked than in their male counterparts (females: AOR=1.68; 95% CI: 1.27-2.23, and males: AOR=1.32; 95% CI: 0.96-1.80). Women aged <55 years and who smoked were more likely to report depression, whereas this trend was not observed in those aged ≥55 years (<55 years: AOR=1.75; 95% CI: 1.23-2.48), and ≥55 years: AOR=1.58; 95% CI: 0.97-2.56). CONCLUSIONS: Tobacco smoking is a significant factor associated with depression, particularly in younger women. The increasing prevalence of tobacco use for years among younger women in Taiwan might contribute to shifts in the associations between depression and tobacco use in women.

The Relationship between Habitual Coffee Drinking and the Prevalence of Metabolic Syndrome in Taiwanese Adults: Evidence from the Taiwan Biobank Database.

Previous studies revealed inconsistent results between coffee drinking and metabolic syndrome (MetS). The aim of the study was to evaluate the relationship between habitual coffee drinking and the prevalence of MetS among men and women. We conducted a nationwide, cross-sectional study using 23,073 adults obtained from the Taiwan Biobank database (mean ± SD (range) age, 54.57 ± 0.07 (30-79) years; 8341 men and 14,731 (63.8%) women). Adults who drank more than one cup of coffee per day (n = 5118) and those who drank less than one cup per day (n = 4515) were compared with nondrinkers (n = 13,439). Multivariate logistic regression models were used to evaluate the risk of MetS between the two groups. Separate models were also estimated for sex-stratified and habitual coffee-type-stratified (black coffee (BC), coffee with creamer (CC), and coffee with milk (CM)) subgroup analyses. The MetS diagnosis was based on at least three of the five metabolic abnormalities. Coffee drinkers (≥1 cup/day) had a significantly lower prevalence of MetS than nondrinkers (AOR (95% CI): 0.80 (0.73-0.87)). Women who drank any amount of coffee and any type of coffee were more likely to have a significantly lower prevalence of MetS than nondrinkers. Only men who drank more than one cup of coffee per day or black coffee drinkers were more likely to have a lower prevalence of MetS. Our study results indicate that adults with habitual coffee drinking behaviors of more than one cup per day were associated with a lower prevalence of MetS. Moreover, women could benefit from habitual coffee drinking of all three coffee types, whereas men could only benefit from drinking BC.

Determinants of health-seeking behavior toward Chinese or Western medicine in Taiwan: An analysis of biobank research database.

BACKGROUND AND PURPOSE: Health-seeking behavior has a direct impact on individual's health. A proper understanding of patients' demographics and health factors is essential in constructing high-quality health care services toward Chinese or Western medicine. The objective of this study was to understand the tendency among Taiwanese to opt for either Chinese or Western medicine when both services are available. MATERIALS AND METHODS: This study was based on the analysis of secondary data. A total of 13,151 individuals with an age of 30 years or more were selected from the Taiwan Biobank Research Database in Taiwan. Multiple logistic regression analysis was used to identify factors associated with health-seeking behaviors toward Chinese or Western medicine. RESULTS: Among all the participants, 50.8% showed a greater tendency to seek Western medicine treatment, while 10.4% showed a preference for Chinese medicine treatment. Main drivers for a Chinese medicine health-seeking behavior were women, hypotension, low income, normal HbA1c, normal total cholesterol, and yang deficiency. The preference for Western medicine treatment was associated mainly with men, an older age, a married status, lower income, a lower education, an abnormal cholesterol level, and the absence of stasis. CONCLUSION: Healthcare providers should understand the factors associated with health-seeking behavior and refer patients to their desired treatment.

Development and Validity Testing of an Assessment Tool for Oncofertility Barriers in Multidisciplinary Healthcare Providers on the Breast Cancer Team.

BACKGROUND: Multidisciplinary healthcare providers, especially clinical nurses, lack a valid tool to assess the comprehensive barriers affecting oncofertility care in breast cancer treatment. PURPOSE: The aims of the research were to develop a self-assessment scale on oncofertility barriers and test its validity and reliability. METHODS: This was a methodological study. The initial 36 items of the developed Oncofertility Barrier Scale (OBS) were generated through qualitative study and a review of the literature. This scale was further refined using expert validity (n = 10), face validity (n = 10), and item analysis (n = 184). Exploratory factor analysis with principal axis factoring and direct oblimin rotation was used to determine the construct validity. The reliability of the OBS was evaluated using internal consistency and test-retest analyses. RESULTS: The mean item-level and scale-level content validity indices of the initial OBS were higher than .96. The data were shown to be feasible for the factor analysis, and a six-factor solution was chosen that accounted for approximately 57.6% of the total variance. These factors included (a) lack of information and education, (b) rigid thinking toward oncofertility care, (c) cancer patient stereotypes, (d) fertility risk, (e) insufficient support, and (f) interrupted oncofertility care. The Cronbach's alpha of the 27-item OBS was .91, and the test-retest reliability coefficient was .55. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The final version of the developed OBS has acceptable reliability, content validity, and construct validity. This scale is appropriate for use in research and clinical practice settings to identify the barriers to fertility cancer care that should be resolved by the breast cancer care team.

The psychometric properties of the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women in Taiwan.

INTRODUCTION: Marriage-based immigrant women are increasing around the world. Although bi-dimensional acculturation is important for immigrant women's health, the existing scales have mainly been developed for immigrant women in Western countries and hence some items may not be suitable for Asian contexts. Thus, we developed and evaluated the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women (BAS-MBIW) in Taiwan. METHODS: The BAS-MBIW was developed based on a literature review and clinical observations. Bi-dimensional acculturation involves "adaptation to host culture (acculturation)" and "maintenance of heritage culture (enculturation)." The initial scale included two 24-item subscales. The validation samples were 310 marriage-based immigrant women who were pregnant for at least twelve weeks in Taiwan. The BAS-MBIW was assessed and modified by experts. Data analyses included factor analysis, Pearson's correlation, and Cronbach's alpha coefficient. RESULTS: Expert reviews and factor analysis indicated that the scale had acceptable content and construct validity. The validated scale includes two 19-item subscales, encompassing six domains: language, media, food preference, cultural heritage, social interaction, and shopping and merchandise preference, with good internal consistencies (Cronbach's alpha coefficient is 0.88 for acculturation and 0.83 for enculturation). Acculturation was positively related to local language ability and duration of immigration but negatively related to age at immigration, stress, and depression; whereas enculturation was positively related to age at immigration, stress, and depression but negatively related to duration of immigration, indicating convergent validity. CONCLUSIONS: The BAS-MBIW offers reliable and valid assessments of pregnant immigrant women's level of acculturation and enculturation in Taiwan. The BAS-MBIW could be used to assess bi-dimensional acculturation among marriage-based immigrant women.