Factors Associated With Unhealthy Weight Control Behaviors Among a Representative Sample of U.S. High School Students.

Adolescents often practice unhealthy behaviors to lose weight or keep from gaining weight. Centers for Disease Control and Prevention has conducted biennial Youth Risk Behavior Survey (YRBS) of various health risk behaviors since 1991 using U.S. representative samples of high school students and is therefore best for us to identify risk/preventive factors associated with unhealthy weight control behaviors (UWCB). We quantitatively assessed the association between various health risk behaviors with UWCB by gender using YRBS data. Due to the absence of UWCB items since 2015, we analyzed the latest (2013) data using binary multiple logistic regression. Among the 13,583 participants, 22.7% of girls and 10.1% of boys engaged in UWCB. Among girls and boys separately, the common significant factors included suicidal behaviors, alcohol drinking, misused prescription drug, feeling depressed, skipping breakfast, and attending physical education class. School nurses are suggested to have knowledge about the aforementioned risk factors and provide assessment, consultation, and education to help reduce UWCB.

Interobserver Variation in Evaluating Perineural Invasion for Oral Squamous Cell Carcinoma: Phase 2 Survey Study.

In a previous study, we found interobserver agreement among 88 board-certified pathologists evaluating perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) was fair, and participants most often used the following criteria: (1) tumor invading the perineurium, (2) tumor surrounding a nerve. In this study, we aimed to determine whether application of these most commonly used criteria may improve interobserver agreement. 512 pathologists were invited to participate in a web-based survey. Participants were asked to assess the presence/absence of PNI in a set of OSCC photomicrographs by applying each of the two criteria above. The survey was completed by 84 board-certified pathologists [mean age: 52 years (range 31-81), mean years in practice: 19 (range 1-56)]. Interobserver agreement was moderate (k = 0.46, 95% CI 0.45-0.46) when using definition #1 (tumor invading the perineurium) and fair (k = 0.24, 95% CI 0.23-0.25) when using definition #2 (tumor surrounding a nerve). By comparison, interobserver agreement was fair (k = 0.36, 95% CI 0.35-0.37) among phase 1 participants asked to evaluate these photomicrographs as they would in their pathology practice. Differences in kappa between definition #1 and phase 1, definition #2 and phase 2, and definition #1 and #2 were statistically significant (p < 0.001). Compared to our prior study based on pathologists' personal views, the current study shows improved interobserver agreement with application of the criterion, "tumor invading the perineurium." However, further work is needed to delineate concise, objective, and more reproducible criteria for histopathologic assessment of PNI.

Impact of nurse champion on quality of care and outcomes in type 2 diabetes patients.

Over 29 million people in the United States have diabetes, with an additional 86 million living with prediabetes. On inpatient hospital units it is estimated that 50% of admitted patients have diabetes as a primary or secondary diagnosis. Nurse champions have improved outcomes and quality of life for patients across different clinical settings. The purposes of this evidence literature review are to evaluate and synthesize evidence regarding the impact of a nurse champion model on nurses' performances and diabetic patient health outcomes. Nurse champions in this review also refer to clinical nurse specialists, certified diabetes educators, and clinical mentors. Search of evidence-based literature was conducted using PubMed, CINAHL, Ovid, Cochrane Library, and Google Scholar databases. Keywords included Nurse Champion and Diabetes, Clinical Mentor and Diabetes, and Diabetes Educator. Search limits included date of publication within last 15 years, English language, and peer-reviewed journals. A total of 14 articles were included in the synthesis of literature with level of evidence ranging from I to V. The study designs of selected evidence fluctuate from randomized controlled trials (3), case studies (6), qualitative studies (2), systematic review (1), and quasi-experimental study (1). The synthesis of evidence indicated that implementation of a nurse champion model did not only significantly improve nurses' diabetic knowledge and skills, but also improved the health outcomes of diabetic patients including reduction in hemoglobin A1c levels, reduction in perceived Diabetes Distress Scale, quality of life improvement, reduction of number of near misses, decreased readmission rates, improved hypoglycemic outcomes, and greater weight loss in patients with type 2 diabetes. Improving diabetic patient outcomes could save the hospital a significant amount of money and create a higher standard of care across the healthcare field. Bettering patient outcomes are good not only for the patient but also the hospital and nurses. Implementation of nurse champion models into nursing practice could significantly improve patient outcomes and quality of life as well as nursing performance. Nurse champion models also can create new leadership roles in nursing.

Predictors of Nurses' Intentions to Administer As-Needed Opioid Analgesics for Pain Relief to Postoperative Orthopaedic Patients in the Acute Care Setting.

BACKGROUND: Patients undergoing orthopaedic surgery experience severe postoperative pain that is frequently undertreated. No study was found that examined the predictors of nurses' intentions to administer as needed (PRN) opioid analgesics for postoperative pain relief. PURPOSE: The purpose of this study was to determine what constructs from the Integrated Behavioral Model (IBM) can predict nurses' intentions to administer PRN opioid analgesics for pain relief to hospitalized postoperative orthopaedic patients. METHODS: A nonexperimental, cross-sectional quantitative format was used. The sample consisted of 800 nurses. Data collection was done by survey. RESULTS: Path analysis revealed the significant predictors of nurses' intention to administer opioid analgesics to be self-efficacy (ß= 0.15), normative beliefs (ß= 0.21), and salience (importance) of the behavior (ß= 0.25). CONCLUSION: The study showed that the IBM constructs are useful for predicting intentions toward performance of a professional behavior. The inclusion of self-efficacy, underlying beliefs, and salience of the behavior was new and unique contributions to the existing body of knowledge.

Interobserver Variation Among Pathologists in Evaluating Perineural Invasion for Oral Squamous Cell Carcinoma.

The aims of this study are as follows: (1) to assess variations among pathologists in evaluating perineural invasion (PNI) in oral squamous cell carcinoma (OSCC), (2) to survey PNI criteria used by pathologists and how they came to adopt those criteria. An electronic survey was sent to 363 oral and/or surgical pathologists. Eligibility criteria included pathology board certification. The survey participants were asked to rate whether PNI was present, absent, or uncertain for 15 provided photomicrographs, which depicted various types of tumor-nerve relationships without excessive desmoplasia or lymphocytic host response. The survey obtained information regarding demographics, whether PNI criteria were taught during residency, criteria used by participants to evaluate PNI, how the participants developed their criteria, and agreement with six proposed PNI definitions. 88 pathologists completed the survey. The participants included 47 males and 41 females, with average age = 49 years and average practice experience = 17 years. Practice settings included dental school (40 %), medical school (36 %), private pathology lab (13 %), and other (11 %). Agreement between participants in rating PNI status for the provided images was fair (κ = .38, 95 % CI .37-.39). 56 % of respondents indicated that they were taught PNI criteria during residency training. The basis for criteria currently used by participants included residency training (n = 42), published literature (n = 29), and own experience/views (n = 32). Agreement regarding six proposed PNI definitions was slight (κ = .10, 95 % CI .08-.11). In conclusion, interobserver agreement in assessing PNI status was fair. Our results suggest that more widely accepted, objective, and reproducible criteria are needed for evaluating PNI in OSCC.

Levels of potential oral cancer salivary mRNA biomarkers in oral cancer patients in remission and oral lichen planus patients.

OBJECTIVES: To gather preliminary data concerning the feasibility of using seven salivary mRNAs-IL-8; IL-1ß; dual specificity phosphatase 1 (DUSP1); H3 histone family 3A (H3F3A); ornithin decarboxylase antizyme 1 (OAZ1); S100 calcium-binding protein P (S100P); and spermidine/spermine N1-acetyltransferase 1 (SAT1)-for detecting development of oral squamous cell carcinoma (OSCC) in oral lichen planus (OLP) patients and OSCC patients whose disease was in remission. MATERIALS AND METHODS: Saliva samples were collected from five study groups (25 subjects/group): newly diagnosed OSCC, OSCC-in-remission, disease-active OLP, disease-inactive OLP, and normal controls. The salivary mRNA levels were determined by a pre-amplification RT-qPCR approach with nested gene-specific primers. Mean fold changes between each pair of study groups were analyzed by the Mann-Whitney U test. RESULTS: Salivary levels of OAZ1, S100P, and DUSP1 mRNAs were significantly higher in newly diagnosed OSCC patients, compared to: (1) normal controls (p = 0.003; p = 0.003; and p < 0.001, respectively); (2) OSCC-in-remission (p < 0.001; p = 0.001; and p < 0.001, respectively); (3) disease-active OLP (p < 0.001; p = 0.016; and p < 0.001, respectively); and (4) disease-inactive OLP (p = 0.043; p < 0.001; and p < 0.001, respectively). No significant differences were found in the levels of salivary IL-8, IL-1ß, H3F3A, and SAT1 mRNAs between newly diagnosed OSCC patients and the normal controls (p = 0.093, 0.327, 0.764, and 0.560, respectively). CONCLUSION: Salivary OAZ1, S100P, and DUSP1 mRNAs are candidate biomarkers for detecting OSCC development in OSCC patients in remission and in OLP patients. CLINICAL RELEVANCE: The results of this study serve as the basis for a further large-scale study which may lead to a non-invasive screening method for early detection of OSCC.

Salivary interleukin-6 and -8 in patients with oral cancer and patients with chronic oral inflammatory diseases.

BACKGROUND: Previous research has indicated that salivary interleukin (IL)-6 and IL-8 are potential biomarkers for oral squamous cell carcinoma (OSCC). However, their levels have been found to be significantly elevated in patients with chronic periodontitis (CP) or oral lichen planus (OLP). The data also showed wide variations in levels among the different studies, and no standardization procedure was ever performed. Therefore, the objective of this study is to determine whether CP or OLP confounds the use of IL-6 or IL-8 for OSCC detection. METHODS: Saliva samples were collected from five groups: OSCC before treatment (n = 18); CP (n = 21); disease-active OLP (n = 21); disease-inactive OLP (n = 20); and healthy controls (n = 21). IL-6 and IL-8 concentrations (determined by enzyme-linked immunosorbent assays) were compared, using total salivary protein-standardized levels to validate the data. The Kruskal-Wallis test (α = 0.05) followed by pairwise Mann-Whitney U (post hoc) tests with Bonferroni adjustments (α = 0.00625) were used for statistical analysis. RESULTS: Salivary IL-6 levels were significantly higher in patients with OSCC than in patients with CP (P <0.001), disease-active OLP (P = 0.001), disease-inactive OLP (P <0.001), and healthy controls (P <0.001). Salivary IL-8 levels were significantly higher in patients with OSCC than in patients with CP (P <0.001), but only marginally significantly higher than in healthy controls (P = 0.014). Statistical results of standardized IL-6 and IL-8 levels were consistent with the non-standardized levels in all pairs except one. CONCLUSION: Salivary IL-6 may be a useful biomarker in the detection of OSCC, unconfounded by CP or OLP.

Population-based study of birth prevalence and factors associated with cleft lip and/or palate in Taiwan 2002-2009.

BACKGROUND: Facial cleft deformities, including cleft lip with or without cleft palate (CL/P) and cleft palate (CP), are common congenital birth anomalies, especially in Asia. This study aimed to analyze the prevalence of CL/P and CP and to identify associated factors in Taiwan. METHODS: This population-based epidemiological study retrospectively analyzed birth data obtained from the Department of Health in Taiwan for years 2002-2009. Frequency distribution, percentages and related predictors were investigated, and findings were presented by types of cleft deformities. Logistic regression analysis was performed to identify factors associated with cleft deformities. RESULTS: Overall prevalence of cleft deformities among 1,705,192 births was 0.1% for CL/P and 0.04% for CP over the 8-year study period. Higher prevalence of CL/P or CP was observed with multiple pregnancies, being male for CL/P, being female for CP, gestational age ≤37 weeks and lower birth weight (<1.5 kg). Both CL/P and CP were significantly associated with gestational age <37 weeks and birth weight<1.5 kg (all P <0.0001). CL/P was significantly associated with multiple parities (P = 0.0004-0.002). Male newborns and female newborns were significantly associated with CL/P and CP, respectively (both P<0.0001). CONCLUSIONS: Overall prevalence for congenital cleft deformities in study subjects was 0.1%, in keeping with high rates in Asia. Results suggest the need for awareness and early identification of those at high risk for cleft deformities, including newborns with gestational age <37 weeks, weighing <1.5 kg at birth and women with multiple parities, as a potential strategy to counter long-term adverse effects on speech and language in this population.

Salivary basic fibroblast growth factor in patients with oral squamous cell carcinoma or oral lichen planus.

OBJECTIVE: The objective of this study was to gather preliminary data concerning the feasibility of using salivary basic fibroblast growth factor (bFGF) for detecting development of oral squamous cell carcinoma (OSCC) in patients with oral lichen planus (OLP), and in patients with OSCC whose disease was in remission. STUDY DESIGN: Saliva samples were collected from 5 patient groups: patients with newly diagnosed OSCC, patients with OSCC whose disease was in remission, patients with OLP in disease-active state, patients with OLP in disease-inactive state, and healthy controls. Salivary bFGF levels were determined by enzyme-linked immunosorbent assay, and data were analyzed using the Mann-Whitney U test. RESULTS: Salivary bFGF levels were significantly elevated in patients with newly diagnosed OSCC compared with patients with OSCC in remission, patients with disease-active OLP, and healthy controls. No significant difference was found between patients with newly diagnosed OSCC and patients with disease-inactive OLP. CONCLUSIONS: Our results suggested that salivary bFGF might be a potential biomarker for detecting OSCC development in patients with OSCC in remission, but not in patients with OLP.

Salivary endothelin-1 potential for detecting oral cancer in patients with oral lichen planus or oral cancer in remission.

Endothelin-1 (ET-1) is a potent vasoconstrictor involved not only in vascular biology but also in carcinogenesis. Results of a study in 2007 suggested salivary ET-1 as a potential biomarker for oral squamous cell carcinoma (OSCC), but a later study showed conflicting results. The purpose of our pilot study was to investigate feasibility of using salivary ET-1 as a biomarker for OSCC in two groups: oral lichen planus (OLP) patients and patients with OSCC in remission. Saliva samples were collected from five groups of subjects: patients with newly diagnosed, active OSCC (Group A); patients with OSCC in remission (Group B); patients with active OLP lesions (Group C); patients with OLP in remission (Group D); and normal controls (Group E). Salivary ET-1 levels were determined by enzyme-linked immunosorbent assay, and the results were analyzed by the Mann-Whitney U test. The mean salivary ET-1 level in Group A was significantly higher than that found in Group C (p=0.001), Group D (p=0.015) or Group E (p=0.004). There were no significant differences (p>0.05) in the mean salivary ET-1 levels between Groups A and B; Groups B and C; Groups B and D; Groups B and E; Groups C and D; Groups C and E; or Groups D and E. Salivary ET-1 could be a good biomarker for OSCC development in OLP patients regardless of the degree of OLP disease activity. However, it appeared not to be a good biomarker for detecting recurrence of OSCC in patients in remission.

Psychometric characteristics of the parsimonious Chinese version of the Smoking Self-Efficacy Survey (CSSES-20).

BACKGROUND: Cigarette smoking is a health-risk behavior of global proportions. Self-efficacy plays an important role in both smoking acquisition and smoking resistance. Reliability and validity of an instrument is fundamental to research results, particularly in its simplified form on a different population. The purpose of this study was to conduct psychometric testing on the parsimonious Chinese version of the Smoking Self-efficacy Survey (CSSES-20). METHODS: The randomized cluster sample was drawn from 61 middle schools in Taipei City, Taiwan. Following a pilot test of the CSSES-20, the CSSES was administered to 571 adolescents. Construct validity was tested by the exploratory factor procedures and the contrasted group approach. Pearson correlation coefficients were used to examine the criterion validity and test-retest reliability for the stability of the scale. Cronbach's alpha coefficients were used to determine the internal consistency of the scale. RESULTS: The exploratory factor analysis yields three components, "opportunity to smoke,""emotional stress," and "influence of friends," accounting for 80.4% of the total variances. The criterion validity was also supported by the study results. The contrasted group approaches affirmed the construct validity of the CSSES-20. Stability of scales was supported by test-retest reliability. Cronbach's alphas for 3 subscales ranged from .90 to .93. CONCLUSIONS: A concise instrument can alleviate response burden for adolescent study participants and increase their recruitment and retention rates. The CSSES-20 demonstrated satisfactory construct validity, criterion validity, stability, and internal consistency reliability. These findings can be used to provide school teachers and nurses with information about the relationship between self-efficacy to resist smoking and adolescent smoking behavior.

Stages of smoking acquisition of young Taiwanese adolescents: self-efficacy and decisional balance.

The objective of this study was to assess relationships of the stages of smoking acquisition with self-efficacy and decisional balance in young Taiwanese adolescents. A random sample of 401 students was recruited. Students who were at the precontemplation stage had higher self-efficacy to resist smoking initiation than those who were at the decision-making or maintenance stages. Ratings of benefits of smoking were significantly higher for those in the maintenance stage than in the precontemplation or decision-making stages. In a discriminant function analysis, self-efficacy and decisional balance correctly predicted 77.4% of membership in the three stages. Health educators could use stage-specific skills and strategies based on self-efficacy and decision balance constructs to develop smoking prevention programs.

Morbidity at elementary school entry differs by sex and level of residence urbanization: a comparative cross-sectional study.

BACKGROUND: Health is vital to a child's learning in school and success in life. Therefore, early physical examination, and follow-up if necessary, would bring parents' attention to their child's health and would likely improve outcomes. The purposes of this study are twofold: to assess the health status of first-graders and to examine the health status differences between sexes, levels of residence urbanization, and quantity of available medical resources. METHODS: This is a comparative descriptive study. Data from the 2002 Student Entry Physical Examination (SEPE) and Student Medical History Inventory (SMHI) were obtained from 203 public and private elementary schools in northern Taiwan where a population of 53,053 students was included. Frequencies, independent sample t test, one-way ANOVA along with Scheff's post hoc test, and Pearson's correlation were conducted using SPSS. RESULTS: This study showed that 13.7% of students had at least one diagnosed disease from the SMHI reported by parents. Moreover, the SEPE indicated that 79.5% students had at least one health concern. Dental caries, myopia, and obesity were the most prevalent health problems among the first-graders (69.6%, 27.1%, and 9.5%, respectively). Research results show that there were significant differences in the prevalence of dental caries, myopia, and obesity between different sexes and among levels of urbanization. However, the quantity of available medical resources made no significant difference. CONCLUSION: Elementary school entry physical examination is an important way to detect students' health problems. It is suggested that school health interventions consider students' health profiles along with their sex and level of urbanization in planning. More research is needed to find the risk factors of the health problems. Additionally, the creation of a school health committee is suggested to implement and evaluate the entry health examination program.

The chinese version of the decisional balance scale: further validation.

BACKGROUND: Although the Decisional Balance Scale (DBS) has been established to have sound psychometric properties, the reliability and validity of this instrument have not been evaluated in different populations. OBJECTIVES: The aim of this study was to conduct psychometric validations for the Chinese version of the DBS (CDBS). METHODS: This research project was designed as a descriptive cross-sectional study. The CDBS was administered to children in Grades 5-9 (ages 11-17 years, n = 952) recruited from elementary and junior high schools in northern Taiwan. A random cluster sampling method was used. RESULTS: The pros and cons subscales were supported by Cronbach's alpha coefficients of .88 and .85, respectively. Item-to-subtotal correlation coefficients for the subscales were above .48. The results from confirmatory factor analysis, used to assess the construct validity of the CDBS, indicated that the two-factor structure was the best fit for the CDBS when it was used with Taiwanese adolescents (comparative fit index = .96). The contrasted group approach affirmed the construct validity of the pros and the cons of the CDBS. The validity and reliability of the CDBS were supported by the psychometric test results of this study. DISCUSSION: The CDBS is congruent with the culture of Taiwanese adolescents. However, to expand the usefulness of this tool across cultures, the CDBS should continue to be tested with other Chinese-speaking populations and settings.

Psychometric testing of the Chinese version of the Decisional Balance Scale (CDBS).

The purpose of this study was to conduct psychometric testing on the Chinese version of the decisional balance scale (CDBS) with Taiwanese seventh, eighth,and ninth graders who were recruited from the Taipei metropolitan area. A random cluster sampling method was used with 554 adolescents between the ages of 13 and 17 years. Factor analysis procedures showed two components, Pros and Cons, accounting for 74.32% of the total variances and contrasted group comparisons affirmed the construct validity of the Pros, the Cons, and the CDBS. Item-to-subtotal correlation coefficients for the two subscales, the Pros and Cons, were greater than .50 and their reliability was supported by Cronbach's alpha coefficients, .87 and .91, respectively. The validity and reliability of the CDBS suggested that the CDBS was applicable to and congruent with the culture of the Taiwanese adolescent's smoking behavior. Further validation of the CDBS scale with different populations and larger sample size is suggested.

Cross-cultural validation of the stages of the tobacco acquisition questionnaire and the decisional balance scale.

The first phase in a study of smoking behaviors of 11- to 14-year-old Taiwanese children was designed to ensure the reliability and validity of newly translated instruments. The stages of the tobacco acquisition questionnaire (STAQ) and the decisional balance scale (DBS) were translated into Chinese, then back-translated into English. The DBS was adapted based on input from a focus group with young adolescents, reviewed by a panel of experts and laypersons, and pilot-tested. The next step consisted of administering the instruments to 401 children (ages 11-14 years) for psychometric testing. Factor analysis yielded three components for the STAQ accounting for 57.8% of the total variance, with alphas of the subscales ranging from.85 to.92. The DBS had two components accounting for 59.3% of the total variance, with alphas of.87 and.90 for the subscales. Accuracy of the translated instruments was supported by the psychometric test results.

Validation of the smoking self-efficacy survey for Taiwanese children.

PURPOSE: To determine the psychometric properties of the Chinese version of the smoking self-efficacy (SSE) survey. DESIGN AND METHODS: The SSE survey was translated into Chinese then was back-translated into English, reviewed for content validity, pilot tested, and administered to 401 children between December 1998 and August 1999. A random cluster sampling method was used in this study. FINDINGS: Reliability was indicated by Cronbach's alpha coefficient, .98. The validity of the SSE scale was determined by face validity, item-total correlation coefficient, content validity index, and concurrent validity. Principal component analysis was done to determine the construct validity of the SSE scale. The revised SSE scale had three components accounting for 74.3% of the total variance with alpha of .96. The correlation coefficient between the SSE and revised SSE scale was .99. CONCLUSIONS: Findings show that the revised SSE scale is not only parsimonious but also it is as reliable and valid as is the original SSE scale. This translated instrument is appropriate for use in studies of smoking behavior in Taiwanese children aged 11 to 14 years. Further research will be needed to validate the SSE scale with different populations and settings in Taiwan.