Does a one-session sexual health education program improve sexual confidence in patients with cervical cancer? A transtheoretical model-based clinical study.

PURPOSE: This study aimed to evaluate the effects of a one-session sexual health education program using a transtheoretical model to enhance sexual self-efficacy in patients with cervical cancer. METHODS: This study recruited patients with cervical cancer from the gynecological wards of a medical center in northern Taiwan. A total of 63 participants were divided into 2 groups: the control group (n = 30) received traditional sexual health education. The intervention group (n = 33) participated in a transtheoretical model (TTM)-based sexual health education program. Scores from self-report questionnaires for variables of knowledge, attitudes, and self-efficacy regarding sexual health collected 1 and 6 weeks after the intervention were compared with baseline scores. RESULTS: Patients who received transtheoretical model (TTM)-based sexual health education had significantly greater sexual knowledge (ß = 3.794, p < 0.01), sexual attitudes (ß = 9.226, p < 0.01), and sexual self-efficacy (ß = 17.053, p < 0.01) than those who received traditional sexual health education at 1 and 6 weeks. CONCLUSION: Our findings suggest that a one-session sexual health education using a TTM-based model can enhance sexual knowledge, attitudes, and sexual self-efficacy among patients with cervical cancer. This educational program can be translated into routine clinical practice to help patients with cervical cancer enhance their sexual health and improve confidence in their sexual well-being.

The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis.

Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI). Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity. Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = - 1.538 to - 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = - 1.749 to - 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = - 0.0025, SE = 0.0129, p = 0.849, R 2 analog = 0.37). Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.

Social media (Facebook) improper use and the influence of sleeping quality in Taiwan's university students.

This study examines the relationship between Facebook (FB) usage and addiction level, and sleep quality of university students. A Google Forms questionnaire was prepared and disseminated via the authors' FB profile for university students to fill out. A total of 277, including two studying overseas, took part in this research. Among the survey respondents, over 60% (n = 144) were medical students (p = 0.000); over 30% (n = 84) were always logged into FB; the average and daily usage time of most was 5 to 60 min at a time (p = 0.009), and 3 to 5 h a day (p = 0.040), respectively. The respondents' average sleep time was 7.11 h, but over 61% categorized their sleep quality as poor. It was also found that students from financial and management school were 4.23 times more at risk of FB addiction than the medical counterparts and were likely to be already addicted to FB as well as have a sleep disorder. Based on these results, it is suggested that university students, who fall in the high-risk category, be screened early to prevent them from developing social media addiction and sleep disorders. For improving youths' health and sleep quality, future research should attach the importance to early screening for sleep disturbances caused by the internet and social media addiction.

Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis.

BACKGROUND: To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6-minute walk test, 10-meter walk test). RESULTS: A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non-RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non-RCTs (AS: 95%CI = -0.202 to -0.068, p ≤ 0.001; MAS: 95%CI = -2.886 to -1.412, p ≤ 0.001). The results on pain did not show significant change after RAGT in either RCTs or non-RCTs. LEMS and walking ability significantly increased in favor of RAGT. CONCLUSIONS: RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.

Photon recycling characteristics of InGaAs/GaAsP multiple quantum well solar cells incorporating a spectrally selective filter and distributed Bragg reflector.

Photon management plays a vital role in the power conversion efficiency of III-V semiconductor solar cells. However, the photon recycling characteristics of GaAs-based multi-quantum-well (MQW) solar cells employed different optical designs had yet been fully explored. In this work, we investigate the impact of the spectrally selective filter (SSF) and distributed Bragg reflector (DBR) on the photovoltaic characteristics of single-junction, strain-balanced In0.1Ga0.9As/ GaAs0.85P0.15 MQW solar cells. Specifically, the SSFs with cutoff wavelengths of 880, 910, and 940 nm are designed and implemented on MQW solar cells with and without the incorporation of a rear DBR. Photon confinement in the vertical direction is verified based on the characterizations of reflectance, electroluminescence, and external quantum efficiency. We show that the photon confinement reduces the saturation current density, up to 26 times and 3 times for the 880 nm SSF-MQW and SSF-MQW-DBR devices, respectively, compared to that of the 940 nm devices. Furthermore, by comparing the SSF-MQW-DBR solar cells under simulated one-sun and concentrated illumination conditions, the open-circuit voltage exhibits a maximal net increase for the 910 nm SSF due to tradeoff between the short-circuit and saturation current density. The proposed SSF design may offer a viable approach to boost the performance of GaAs-based MQW solar cells.

A Systematic Review and Meta-Analysis of the Effect of Lifestyle Modification on Metabolic Control in Overweight Children.

Childhood obesity is associated with type 2 diabetes mellitus. We aimed to determine the effects of lifestyle modification programs on fasting plasma glucose (FPG) levels in overweight children. We queried six relevant electronic databases and manually searched for studies published before December 2016. Overweight/obese children who underwent a lifestyle modification for more than 6 months were included. A total of 3923 children from eight randomized controlled trials (RCTs) were included. Compared with the control group, the lifestyle modification group had significantly lower FPG levels by 1.3 mg/dL. The mean differences were significantly decreased for both secondary outcomes; BMI z-score decreased by 0.16 units and insulin levels decreased by 2.4 mU/L. The metaregression showed that the follow-up duration was associated with FPG levels and BMI and insulin levels and half year is a suitable follow-up duration for this population. This study showed that lifestyle modification programs may be effective in reducing the FPG levels of overweight/obese children. Further high-quality RCTs with longer follow-up periods are needed to evaluate the long-term effect of this complementary approach for diabetes mellitus prevention on overweight/obese children.

Hypoxia-inhibited DUSP2 expression promotes IL-6/STAT3 signaling in endometriosis.

PROBLEM: How does hypoxia-mediated downregulation of dual-specificity phosphatase-2 (DUSP2) promote the development of endometriotic lesions? METHOD OF STUDY: The levels of IL-6 and DUSP2 were assessed in eutopic stromal cells with DUSP2 knockdown or hypoxia treatment. Bromodeoxyuridine (BrdU) incorporation was applied for evaluating cell proliferation. The protein levels of DUSP2, cleaved caspase-3, phosphorylated STAT3, and STAT3 were analyzed using immunoblot. RESULTS: The genomewide analysis of cells with DUSP2 overexpression indicated IL-6 regulates multiple pathways related to inflammation, proliferation, and apoptosis. DUSP2 overexpression significantly suppressed IL-6 expression, while DUSP2 knockdown promoted IL-6 expression. The hypoxia-treated eutopic stromal cells expressed higher levels of IL-6, recapitulating the elevated levels of IL-6 in ectopic stromal cells. The treatment with IL-6 elicited the phosphorylation of STAT3, mimicking the elevated levels of phosphorylated STAT3 in the ectopic stromal cells. The IL-6-treated eutopic stromal cells showed more BrdU incorporation and less cleaved caspase-3, which can be reversed by STAT3 inhibitor. CONCLUSION: Hypoxia-induced IL-6 production in endometriotic lesions is mediated via downregulation of DUSP2, which causes aberrant activation of STAT3 signaling pathway and helps the endometriotic cells survive under the ectopic environment.

Transformation of Sexual Expression in Taiwanese Women After Treatment for Gynecological Cancer.

BACKGROUND: Understanding the sexual experience of women after gynecological cancer is important for nurses caring for this population. Sexual experience should be studied within women's sociocultural context because it influences the construction of sex. However, the sexual experience of Chinese women after gynecological cancer has not been examined qualitatively. OBJECTIVE: The aim of this study is to explore the sexual experience of Taiwanese women after treatment for gynecological cancer. METHODS: Data for this phenomenological study were collected during in-depth, semistructured interviews with 11 women purposively recruited from outpatients of the gynecological clinic of a medical center in northern Taiwan. Interview data were analyzed using the Colaizzi method. RESULTS: Data analysis yielded 4 themes: (1) suffering from sexual changes and difficulties, (2) judgments and uncertainty about the appropriateness of sexual behavior, (3) maintenance and transformation of sexual expression, and (4) reinterpretation and reaffirmation of feminine value. CONCLUSIONS: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate Chinese and Asian clients about women's sexual expression during and after cancer treatment. IMPLICATIONS FOR PRACTICE: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate women about possible alternative ways of sexual expression during and after cancer treatment.

[Effectiveness evaluation of healthy lifestyle interventions in childhood obesity prevention: a systematic review].

BACKGROUND: There is significant reporting on evidence-based research in the literature regarding lifestyle modification programs. There is a need to review and synthesize results in order to develop childhood obesity prevention and intervention strategy recommendations. PURPOSE: Main purposes of the present review were to update the systematic review and critical appraisal of recent evidence in this area and assess the efficacy and quality of published research studies. METHODS: Studies included in this review incorporated the following inclusion criteria: obese children participants 5 to 14 years of age; a face-to-face randomized-controlled study with a 4-week intervention period; and anthropometry, physical activity, sedentary behavior evaluated as primary outcomes after > 6 months. Eleven studies met the 3 inclusion criteria. All were found using the following key word string: RCT or CCT interventional study researches, childhood obesity, overweight, preventive intervention, healthy lifestyle". RESULTS: Evidence from these studies showed that all interventions varied in terms of approach and settings. Most provided a healthy lifestyle program duration of more than 15 minutes per week. Those that included culturally sensitive diet education and 30-60 minutes of moderate-intensity exercise everyday significantly enhanced childhood obesity prevention in terms of both anthropometry and dietary habits and decreased sedentary behavior. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Results suggest that effective healthy lifestyle programs for childhood obesity prevention in Taiwan should provide dietary guidance sensitive to Taiwanese dietary habits, encourage daily physical activities, and decrease sedentary behavior.

[Comfort: a concept analysis].

Comfort is an important concept and core value of nursing. The defining attributes, antecedents and consequences of comfort need further analysis and exploration, even though the concept of comfort has been addressed previously in nursing literature. We employed the strategies of concept analysis as described by Walker&Avant (2005) to analyze the concept of comfort. The defining attributes of comfort include: 1) effective communication; 2) family and meaningful relationships; 3) maintaining functionality; 4) self-characteristics; 5) physical symptom relief, states, and interventions; 6) psychological, spiritual activities and states; and 7) a sense of safety and security. Antecedents consist of discomfort, distress and suffering. Consequences consist of (1) met/satisfied needs; (2) increased sense of control; (3) sense of inner peace; (4) a pleasant experience; (5) feeling cared for; (6) relief of symptoms; (7) reduced suffering; (8) decreased disequilibrium; and (9) absence of discomfort. We also outline the construction of cases, empirical references and comfort measurement tools. Analysis found comfort to have multiple dimensions and confirmed it as a clinical issue that should receive greater emphasis and valuation. Findings are hoped to increase nurse understanding of the concept of comfort and enable nurses to evaluate level of comfort and follow up on variations in such using empirical tools. Concept analysis can guide further comfort related interventions and research to benefit patients.

Transtheoretical model-based postpartum sexual health education program improves women's sexual behaviors and sexual health.

INTRODUCTION: Postpartum sexual health education was once routinely administered to postpartum women, but few interventions were specifically described or clearly based on theory, and few sexual interventions affected women's sexual behaviors. AIM: To evaluate the effectiveness of a refined theory-based interactive postpartum sexual health education program (IPSHEP) in enhancing postpartum women's sexual behavior and health. METHODS: For this prospective, randomized controlled trial, 250 participants were randomized to three groups. Experimental group A received our refined theory-based IPSHEP. Experimental group B received only an interactive, self-help pamphlet. The control group received routine education (a 10- to 15-minute educational talk and a sexual health pamphlet without an interactive design). Data were collected at baseline, 3 days, 2 months, and 3 months postpartum. MAIN OUTCOME MEASURE: Postpartum women's sexual self-efficacy (SSE), diversity of sexual activity (DSA), return to sexual activity, and sexual satisfaction (SS). RESULTS: Women who received our theory-based postpartum sexual health education program had significantly greater SSE (P < 0.05) and greater DSA (P < 0.05), and tended to resume their sexual life earlier than women in the routine teaching and interactive pamphlet-only groups (P < 0.05). However, the SS levels of postpartum women who received our program did not differ significantly from those of women who received routine teaching or the interactive pamphlet only. CONCLUSIONS: Our findings suggest that a theory-based postpartum sexual health education program improved women's sexual health and sexual behavior and that the transtheoretical model can be translated into practice, supporting its use to enhance the sexual health of postpartum women. Despite the lack of a significant effect on SS, women who received our theory-based postpartum sexual health education program tended to maintain their prepregnancy level of SS in early postpartum.

Effectiveness of a theory-based postpartum sexual health education program on women's contraceptive use: a randomized controlled trial.

BACKGROUND: The aim of this study was to evaluate the effectiveness of a refined theory-based Interactive Postpartum Sexual Health Education Program to enhance postpartum women's effective contraceptive behavior. STUDY DESIGN: Participants (N=250) were randomized to three groups. Experimental Group A received our intervention program via strategies that matched participants' learning preparedness, as determined by the transtheoretical model. Experimental Group B received only a pamphlet. The control group received routine education. Only Group A received health education. Data were collected at baseline, 3 days, 2 months and 3 months postpartum. RESULTS: Women who received theory-based postpartum sexual health education program had significantly greater contraceptive self-efficacy and were more likely to choose more effective contraceptive methods at 2 months postpartum than women in the routine teaching and interactive pamphlet-only groups. CONCLUSION: Our theory-based Interactive Postpartum Sexual Health Education Program enhanced postpartum women's contraceptive self-efficacy and effective contraceptive behavior.

Explaining and selecting treatments for autism: parental explanatory models in Taiwan.

Parental explanatory models about autism influence the type of therapy a child receives, the child's well-being, and the parents' own psychological adaptation. This qualitative study explored explanatory models used by parents of children with autism. In-depth interviews were conducted with 13 parents of children with autism from a medical center in Taiwan. Despite high educational background, most of these parents attributed their child's autism to both biomedical and supernatural etiologies without apparent conflicts. These parents chose a wide variety of treatment strategies, including biomedical and alternative treatments, which often created time/energy pressures and financial burden, and were influenced by parents' cause attribution. Parents' illness explanations influence their treatment selections and need to be understood and accepted by health care providers.

Integrating the nurturer-trainer roles: Parental and behavior/symptom management processes for mothers of children with autism.

When a child is ill, it is commonplace for his/her mother to become the major caretaker. However, little information could be found on the process by which mothers of children with intellectual disability care for their children in the context of a specific disorder. To explore this phenomenon in mothers of children with autism, this study used a grounded theory approach to develop a substantive theory for explaining the parenting and behavior/symptom management processes for such mothers in Taiwan. Data were collected by in-depth, tape-recorded interviews with 12 mothers of a child with autism, ages 3-7 years. Analysis of interview transcripts revealed that the process used by these mothers to deal with the complex needs of their children was "integrating nurturer-trainer roles." This process had four components: searching effective treatments, developing training and nurturing competencies, negotiating roles, and adjusting expectations. Different types of "integrating nurturer-trainer" processes were found: trying it all, going along, insisting on training, and facilitating the child's strengths. The "strength-facilitating" type of mothers seemed to be better at integrating the nurturer-trainer roles and had better role preparedness, less role strain, and positive emotional reactions. These results can sensitize health care providers to the conditions of these mothers, thus helping them to develop appropriate interventions to facilitate the process of integrating the nurturer-trainer roles.

[A study of the process by which a school-age child adapted to body image changes following open-heart surgery].

This case report attempts to explore the adaptive process of body image changes in school-age children suffering from congenital ventricular septal defect (VSD) following open-heart surgery. After establishing trust relationship, we applied atraumatic care, projective communication techniques, interviews, behavioral observation, storytelling and play in our interaction with that child. We found the child experienced "body image disturbance" after open-heart surgery and underwent a four stage adaptive process as follows: (1) Impact (questioning, perception of punishment for wrongdoing, loss, anger); (2) Retreat (denial, anxiety, withdrawal, escaping social contact, inferiority); (3) Acknowledgment (cognitive change, active participation, future-oriented concerns); and (4) Reconstruction (positive self-image, reconstructing body image). Nursing intervention provided the case with more opportunities for sensory feedback and positive reinforcement and also assisted the patient to adopt a positive view of the situation and then to reconstruct and realize the meaning of such surgery. We reinforced the social supporting system to promote self-confidence, self-esteem, and self-value. The child finally accepted the wounds resulting from the operation as a symbol of "bravery"; a breakthrough likely to help in the child's re-entrance to school and normalization of life. Study findings both enhanced pediatric nurse understanding of the adaptive process involved in body image change and provided knowledge essential to designing flexible-option nursing interventions tailored to meet the demands of different adaptation stages. Obviously, such a caring model designed to meet the differing needs of different body image changes has the potential to benefit of body image integration greatly and can provide the pediatric nursing framework in the future.