Exploration of Inflammatory Biomarkers and Psychological Cardiovascular Disease Risk Factors Among Community Dwelling Adults: A Gender Comparison Study.

Patients with rheumatic disease (RD) are at high risk for cardiovascular disease (CVD), which is the leading non-communicable chronic disease cause of death worldwide. Inflammatory biomarkers and psychological health status are reliable predictors of CVD in patients with RD. The primary aim of this study was to compare the inflammatory biomarkers and psychological CVD risk factors (CRFs) between a group of community-dwelling adults with RD and CRFs and a group of their peers with CRFs only. The secondary aim of this study was to analyze and compare the collected data by gender in the RD group. Data were collected and analyzed from 355 participants, with the 135 participants with physician-diagnosed RD assigned to the RD group and the remainder (n = 220) assigned to the comparison group. The measures used included a demographic datasheet, medical information, serum homocysteine (Hcy) levels, high sensitive C-reactive protein (hs-CRP) levels, and depression and global sleep-quality scale scores. The RD group had higher ratios of hypertension and depression diagnoses than the comparison group. The gender analysis of the RD group found significantly more-severe sleep disturbances in women than men and a significantly higher mean value of Hcy in men than women. The women in the RD group were significantly older, less educated, and less employed than their male counterparts and thus may be presumed to at higher risk of health illiteracy. Gender-tailored interventions to modify the risk factors of CVD identified in this study for patients with RD are recommended.

Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial.

We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.

[Community Innovation and Regional Sustainability: The Practice of Time Banking at Fooyin University].

The need for health literacy in the context of older adult healthcare has increased significantly with population aging. Employing innovative models of social service delivery will be necessary to effectively integrate academic, medical, and community resources to address diverse healthcare needs. The project of university social responsibility supported by Fooyin University is a comprehensive program that employs a time bank model and cultivates community. The Fooyin Time Bank leverages reciprocity to cultivate sustainable manpower to satisfy community needs. The five strategies of the Fooyin Time Bank include: 1) strengthen the awareness of the time bank in community volunteers, 2) cultivate seed members to initiate the time bank, 3) adapt the mutual help model to meet local individual needs, 4) promote the online platform system of the time banking infrastructure and diversities of resource exchange, and 5) emphasize the key role of community and supplementary role of university to enhance sustainability. The Fooyin Time Bank coordinates with government agencies, private companies, and academic institutions to bolster the sustainability of its networks. In addition, faculties and students participate in the community to create a social climate of mutual help, inter-generational aged care, and social welfare.

The Impact of Gender on the Effectiveness of an Auricular Acupressure Intervention Administered to Community-Dwelling Poor Sleepers: A Cluster Randomized Controlled Trial.

BACKGROUND: Women report a higher incidence of sleep problems than men. Few studies addressing the effect of gender on the efficacy of administering auricular acupressure (AA) at shenmen points (heart meridian 7 [HT7]) on sleep quality have been published. PURPOSE: The primary aim of this study was to investigate the effects of a 4-week AA intervention applied at the HT7 points on sleep quality, perceived physical health, and perceived mental health in community-dwelling individuals with poor self-reported sleep quality. Additional analyses were used to evaluate the gender-specific effects of this intervention. METHODS: A cluster randomized controlled trial with repeated-measures design was used. One hundred seventy-nine eligible participants were randomly assigned to either the AA group (n = 88; 47 women, 41 men) or the sleep hygiene instruction (SHI) group (n = 91; 52 women, 39 men). The AA group self-administered acupressure at HT7 on both ears for a 4-week period, whereas the SHI group received an SHI information sheet. Outcome measures included the Pittsburgh Sleep Quality Index (PSQI) and the Short-Form Health Survey-12 Version 2, with data collected at baseline and at 2, 4, and 8 weeks posttest. RESULTS: Linear mixed-model analysis revealed that the participants in the AA group experienced significantly greater reductions in mean PSQI global score and the three indices of sleep latency, subjective sleep quality, and daytime dysfunction than the SHI group at 2 and 4 weeks posttest. The improvements in subjective sleep quality and daytime dysfunction remained at 4 weeks posttest in the AA group, but not in the SHI group. The PSQI global score decreased significantly more in men than women in the AA group between baseline and 4 weeks posttest. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Four weeks of self-administered acupressure at HT7 on both ears is an effective intervention for community-dwelling poor sleepers who are over 45 years old. Moreover, the improvements in subjective sleep quality and daytime dysfunction persist for up to 4 weeks after the end of the intervention. This self-administered acupressure intervention is more effective in men than in women in terms of improving sleep quality. Gender bias is known to influence research results and may lead to inappropriate generalizations. Thus, future studies that are performed to build basic scientific evidence should include considerations of the effects of gender in the study design.

Outcomes of a walking exercise intervention in postpartum women with disordered sleep.

AIM: Good sleep quality is essential to physical and mental-health-related quality of life. The purpose of this study was to evaluate the effects of a walking exercise in relieving sleep quality, fatigue, and depression in new mothers during the postpartum period. METHODS: This quasi-experimental study was conducted at a teaching hospital in southern Taiwan. One hundred and four eligible postpartum women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score ≧16) were assigned to either the experimental group (n = 50) or the control group (n = 54) according to their individual preferences. The participants in the experimental group participated in a 12-week stride walking exercise intervention. The control group did not receive any exercise intervention. The PSQS, Postpartum Fatigue Scale, and Edinburgh Postnatal Depression Scale were used to assess outcomes. RESULTS: Repeated measures ANOVA demonstrated that the experimental group participants perceived milder physical symptoms associated with sleep inefficiency at 4-week posttest (F = 7.25, p < 0.01) than their control group peers. However, no significant differences were found between two groups in terms of either fatigue or depression at 4-week and 12-week posttest. CONCLUSION: Significant improvement in the physical symptoms associated with sleep inefficiency was observed. The findings may be used to encourage postpartum women with disordered sleep to incorporate 20-30 min of stride walking into their regular routine to improve sleep quality.

The clinically crucial predictors of depression in women with systemic autoimmune diseases.

The researchers' aim of this study was to identify and quantify the useful, clinically crucial predictors of depression in Taiwanese women with systemic autoimmune diseases (SADs). We used a cross-sectional method. A total of 241 Taiwanese women with SADs between 21 and 85 years of age participated in the study. Analysis revealed that the strongest predictors of depression in participants were: perceived stress, fatigue, mental health, physical health, chronic-disease-related comorbidities, self-perceived SAD severity, and social support. The model used in the present study explained 70.9% of the variance in the depression.

Impacts of Fatigue, Stress, and Perceived Health Status on Women With Rheumatic Diseases: A Comparison Study.

BACKGROUND: Rheumatic conditions, which increase in prevalence as populations age, are a growing public health problem that disproportionately affects women. Understanding the influences of rheumatic diseases (RDs) on fatigue, stress, and perceived health status is deemed important to the improvement of physical and mental health for women with RDs. PURPOSE: This study was designed to compare the fatigue, stress, and perceived physical and mental health status of women with RDs (RD group) with those of peers who did not have chronic illnesses (comparison group). METHODS: A cross-sectional, purposive sample and comparative design was used. Four hundred forty-three women with a mean age of 46.2 years participated in this study. Those with physician-diagnosed RDs (n = 212) were enrolled in the RD group, and those without chronic disease were enrolled in the comparison group (n = 231). Measures used included a demographic datasheet, Fatigue Severity Scale, Perceived Stress Scale, and Short Form-12 Items Health Survey. Analysis of covariance was used to examine the intergroup differences for major variables based on demographic covariates. RESULTS: The RD group reported significantly more fatigue and stress than the comparison group. Moreover, the RD group reported significantly poorer perceived physical health status, significantly poorer physical functioning and general health, and greater bodily pain compared with the comparison group. Conversely, the RD group reported significantly better perceived mental health status, significantly lower vitality, and better role emotional status than the comparison group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings support the theory that RDs have a negative impact on perceived stress and fatigue in women. Physical function, bodily pain, and general health may be the most significantly affected domains of perceived physical health in women with RDs. Of note, with the exception of the vitality subscale, RDs did not adversely affect the perceived mental health of participants with RD in this study. Healthcare professionals should cooperate with clinical rheumatologists, psychologists, and physiotherapists to provide comprehensive care that includes long-term education to help patients with RD self-manage stress, restore vitality, relieve pain, and increase physical function.

[Non-Pharmacological Interventions for Pregnancy-Related Sleep Disturbances].

Most women experience the worse sleep quality of their life during pregnancy and the early postpartum period. Although pregnancy typically accounts for a relatively short part of a woman's life, the related sleep disturbances may have a significant and negative impact on her long-term health. Approximately 78-80% of pregnant women experience sleep disturbances, including interruptions in deep sleep, decreased total sleep time, poor subjective sleep quality, frequent night waking, and reduced sleep efficacy. Sleep disturbances during pregnancy start during the first trimester and become prevalent during the third trimester. Related factors include physiological and psychosocial changes and an unhealthy lifestyle. As non-pharmacological interventions have the potential to improve sleep quality in 70% to 80% of patients with insomnia, this is the main approached that is currently used to treat pregnancy-related sleep disturbances. Examples of these non-pharmacological interventions include music therapy, aerobic exercise, massage, progressive muscle relaxation, multi-modal interventions, and the use of a maternity support belt. The efficacy and safety of other related non-pharmacological interventions such as auricular acupressure, cognitive therapy, tai chi, and aromatherapy remain uncertain, with more empirical research required. Additionally, non-pharmacological interventions do not effectively treat sleep disturbances in all pregnant women.

Effects of Qigong Exercise on Biomarkers and Mental and Physical Health in Adults With at Least One Risk Factor for Coronary Artery Disease.

Current medical technology permits the early detection of risk factors for coronary artery disease (CAD) in adults, and interventions are available to prevent CAD-related morbidity and mortality. The goal of this study was to determine the effectiveness of a Qigong exercise intervention in improving biomarker levels and mental and physical health outcomes in community-dwelling adults diagnosed with CAD risk factors, in a southern Taiwanese city. Participants were randomly assigned to an experimental (n= 84) group that participated in a 60-min Qigong group session 3 times per week for 3 months or a control (n= 61) group that did not receive the intervention. Self-perceived mental and physical health assessed with the Chinese Health Questionnaire-12, and body fat percentage were measured at baseline and 6, 12, and 16 weeks. Blood samples were collected at baseline and 12 weeks for analysis of lipid profiles, high-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin (HbA1c), and fasting plasma sugar. Linear mixed model analyses revealed that experimental participants had significantly improved perceived mental and physical health and body fat percentage compared to the control group at 6 and 12 weeks but not 16 weeks. The lipid profiles were significantly more improved in the Qigong group than in the control group at 12 weeks. Qigong exercise, however, had no significant effects on hs-CRP, HbA1c, or fasting plasma sugar. Findings suggest that Qigong exercise improves a limited number of CAD risk factors in community-dwelling adults aged 40 years and over.

The association between prenatal sleep quality and obstetric outcome.

BACKGROUND: Pregnancy-associated sleep disorder is a new category on the latest version of the International Classification of Sleep Disorders. It is a significant problem for pregnant women. PURPOSE: The present follow-up study assesses the association between sleep quality during the second and third trimesters of pregnancy and obstetric-neonatal outcomes. METHODS: A prospective follow-up study design was used. Follow-up examination of the obstetric birth records in the immediate postpartum period were carried out on 128 second-trimester and 120 third-trimester women and their newborns in two hospitals in Taiwan. Poor sleep quality was identified using the Pittsburgh Sleep Quality Index. Data were collected from October 2007 to June 2008. RESULTS: The prevalence of poor sleepers (Pittsburgh Sleep Quality Index score > 5) was 58% for second-trimester participants and 66% for third-trimester participants; participants who were unemployed reported a significantly higher prevalence of poor sleep quality than those who were employed. Subsequent review of the participant's obstetric birth records revealed that third-trimester poor sleepers were more likely to have had a vacuum-assisted delivery. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study identified poor sleep quality during the third trimester as a novel risk factor for vacuum-assisted delivery. We suggest that prenatal healthcare providers focus greater attention to the sleep disturbance condition of pregnant women and provide proactive sleep counseling to facilitate pregnant women's adjustment to the new psychosocial and physiological demands of motherhood.

Sleep quality in postpartum women: exploring correlation with childbirth experience and household work.

BACKGROUND: New mothers commonly report sleep deprivation and sleep disturbances during the first 3 postpartum months. A better understanding of factors related to postpartum sleep quality is necessary to develop interventions to improve sleep quality in postpartum women. PURPOSE: This study explored the impact of specific demographic and obstetric factors on the subjective sleep quality of postpartum women. METHODS: We used a cross-sectional, correlational study design. A convenience sample of 202 women in their fourth to sixth postpartum week was recruited from two hospitals in southern Taiwan. A demographic data form and the Postpartum Sleep Quality Scale were used to collect data. RESULTS: The mean Postpartum Sleep Quality Scale score of participants was 22.82 (SD = 8.16), indicating a mild level of sleep disturbance. We found that better sleep quality correlated positively with a satisfactory childbirth experience and correlated negatively with daily time spent on household work. Pain, discomfort, and fear were the main dimensions associated with unsatisfactory childbirth experiences. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Study results recommend that health professionals should improve current protocols to help women better confront and manage childbirth-related pain, discomfort, and fear. Evidence-based postnatal education for parents should highlight the positive relationship between reduced daily household workloads and sleep quality for new mothers.

Patterns and predictors of sleep quality in Taiwanese pregnant women.

PURPOSE: This study examined the patterns and psychosocial predictors of sleep quality in Taiwanese pregnant women. STUDY DESIGN AND METHODS: A cross-sectional, correlational study design was used. A convenience sample of 400 pregnant women from two urban hospitals in Taiwan participated in this study. Data were collected using six self-report measures: Pittsburgh Sleep Quality Index (PSQI), Edinburgh Prenatal Depression Scale, Perceived Stress Scale, State-Trait Anxiety Inventory, Attitude to Body Image Scale, and Interpersonal Support Evaluation List. RESULTS: Our findings revealed that the prevalence of pregnancy-associated sleep disturbance (PSQI score >5) was 65.5%. The mean score of the global PSQI was 7.25 ± 3.43, indicating that participant pregnant women in general reported mild sleep disturbance. Trend analyses of PSQI score indicated a linear trend, with a gradual decline in the sleep quality as the pregnancy progressed. Sleep latency, habitual sleep efficiency, and subjective sleep quality scores differed significantly by trimesters. Stepwise multiple regression analyses revealed that the best subsets to predict sleep quality were prenatal depression, prepregnancy sleep quality, current body image, and week of gestation for Taiwanese pregnant women. CLINICAL IMPLICATIONS: These findings offer evidence that healthcare professionals should provide sleep counseling to pregnant women, and incorporate depression and body image into a supportive model of sleep-related prenatal care.

Unique symptoms at midlife of women with osteoporosis and cardiovascular disease in Taiwan.

OBJECTIVE: This study compared symptoms at midlife, menopause attitudes, and depression among three groups of late peri- or postmenopausal women, namely, women with cardiovascular disease (CVD group), women with osteoporosis (Os group), and women in generally good health (Co group). METHODS: We used a cross-sectional method. Participants were purposively sampled from a medical center and a residential community in southern Taiwan. A total of 500 women between 45 and 60 years of age participated in the study. Four measures were used: a demographics and health habits questionnaire, the Women's Health Initiative Symptom Scale, the Attitudes Towards Menopause Scale, and the Center for Epidemiological Studies-Depression Scale. RESULTS: Significant demographic differences among the groups were found in age, number of children, educational level, family income, employment status, exercise duration per session, smoking status, daily cigarette consumption, and number of years smoking. After significant covariates had been controlled for, the CVD group reported significantly more severe symptoms at midlife than did the Co group; significantly more severe "psychosomatic symptoms" than did the Co group; and significantly more severe "gastrointestinal symptoms and swelling" and "vasomotor symptoms" than did either the Os group or the Co group. The CVD group also reported significantly greater depressive symptoms than did the Os group. CONCLUSIONS: This study identified a number of differences in symptoms at midlife and depressive symptoms among the three groups. Results support the importance of providing unique care for peri- and postmenopausal women in different health categories. Findings may help healthcare professionals better appreciate the diversity of menopausal experiences and support the development of appropriate care strategies.

Development of the model of health for older adults.

AIMS: This study aimed to explore the pertinent health indicators and to form a model of health for older adults. BACKGROUND: Health assessment and early detection are foundations for health promotion. Finding essential health indicators for older adults can better reflect the health status of this population and efficiently detect their health problems in a timely and economical manner. METHODS: This study had two phases. Data were collected from July 2008 to January 2009. Phase I began with sending evaluation surveys to a panel of ten professional experts to generate health indicators for older adults. Phase II was a preliminary determination of the extent of health predictions using these indicators by conducting a descriptive survey involving a stratified random sample of 55 community-dwelling older adults. RESULTS: The ten experts had fairly high agreement on the representativeness and importance of the proposed health model for older adults. The predictability of the health of older adults in the three domains (physical health, psychological health and social-economic health), four constructs (activities of daily living, physical status, emotional health and social engagement), and 47 indicators in this model was 84·50%. CONCLUSION: Results of this study could be used for making health policy and/or to set the goals for intervention. In addition, nurses who care for the older adults may use the health indicators to plan and control the given quality of care. The researchers may further examine the effects of study programmes for health promotion.

[Using alternative therapies in treating sleep disturbance].

Sleep disturbance is a common health problem among adults, and enhancing sleep quality is an issue of significant importance to healthcare providers. As sleep quality worsens into insomnia, individuals may seek assistance from medication. However, sedative hypnotic drugs pose potentially adverse effects. Also, most medical treatments (e.g., positive pressure assistant ventilators) represent invasive interventions that must be prescribed by physicians. Non-pharmacological alternative therapies are commonly recommended and adopted by community nurses. Alternative therapies for sleep disturbance included exercise, cognitive behavior therapy, multiple strategies, music, and acupressure. In general, moderately intensive walking exercise is the intervention most recommended by professionals to help patients deal with sleep disturbance. Therefore, it is suggested that future researchers devise sleep quality promotion strategies that are suitable for home practice in order to apply the findings and spirit of research already done in this area.

[Nursing knowledge: the evolution of scientific philosophies and paradigm trends].

Different aspects of philosophy are derived from different paradigms that contain various main points, some of which are repeated or overlap. Belief and practice are two components of a paradigm that provide perspective and framework and lead to nursing research. Changes in healthcare have popularized empirical and evidence-based research in the field of nursing research. However, the evidence-base study approach has given rise to a certain level of debate. Until now, no standard paradigm has been established for the nursing field, as different professionals use different paradigms in their studies. Such provides certain limitations as well as advantages. The quantitative aspects of a nursing paradigm were developed by Peplau and Henderson (1950) and Orem (1980). Such remained the standard until 1990, when Guba and Parse proposed qualitative viewpoints in contextual features. Therefore, the nursing paradigm has made great contributions to the development of knowledge in nursing care, although debate continues due to incomplete knowledge attributable to the presentation of knowledge and insight within individually developed paradigms. It is better to apply multiple paradigms to different research questions. It is suggested that better communication amongst experts regarding their individual points of view would help nursing members to integrate findings within the global pool of knowledge and allow replication over multiple studies.

[Scientific and holistic therapy perspectives on Qigong practice for elders with cardiovascular disease risk factors].

The ratio of older adults with chronic illnesses has increased due to increased average life spans. The incidence of cardiovascular diseases among older adults has reached 33.26%, becoming the leading chronic disease and second most significant cause of mortality among older adults. Statistics show that the largest proportion of expenditures on prescription pharmaceuticals in the National Health Insurance goes toward the treatment of cardiovascular diseases. In addition, complications resulting from cardiovascular diseases result in burdens of care that impact seriously on the individual, their family, and society. Studies have supported physical activity as the most important behavior in reducing cardiovascular disease risk factors. Qigong, a traditional Chinese therapeutic activity, uses gentle movements of extremities and control of breathing to improve health, enhance vitality and enable bodies, emotion, and spirit to reach optimal performance. Evidence-based research supports the argument that Qigong improves cardiovascular-respiratory function and lipid profile, decreases blood sugar, and relieves anxiety and depression. We suggest developing a safe, convenient, and simple Qigong exercise regimen for older adults at higher risk of cardiovascular diseases to extend their life expectancy and quality of life.

Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial.

BACKGROUND: Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind-body interaction should be tested to enhance the mental health of older adults. OBJECTIVE: To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status. DESIGN: Cluster randomized trial. SETTINGS: Eight senior activity centers, southern Taiwan. PARTICIPANTS: A sample of 139 participants was recruited, and 128 of them completed the study. INCLUSION CRITERIA: (1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 +/- 6.23 years, and the average number of chronic illness was 0.83 +/- 0.90. The average BI score of the participants was 99.92 +/- 0.62, and the mean SPMSQ score was 9.90 +/- 0.30. METHODS: Participants were randomly assigned into either the experimental (n=62) or the control (n=66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group. RESULTS: Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p<.05). CONCLUSIONS: After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.