The role of alexithymia in suicide ideation among Taiwanese army military personnel: A serial mediation model investigating the effects of perceived stress and depression.

Maintaining the good mental health of Taiwanese military personnel is crucial, especially in light of incidents such as the Taiwan Strait crisis. Suicide is a leading cause of death among military personnel and alexithymia is a significant risk factor for suicidal ideation. However, the mechanisms linking alexithymia and suicidal ideation in this psychologically burdened population remain poorly understood. In total, 863 voluntary army military personnel from Taiwanese reserve brigades and combined-arms brigades were enroled between May 2020 and February 2021. Structured questionnaires about alexithymia, perceived stress, depression, suicidal ideation, and background characteristics were used. Mediation analyses were conducted to examine the serial mediation roles of perceived stress and depression in the relationship between alexithymia and suicidal ideation. Significant positive correlations were observed between alexithymia, perceived stress, depression, and suicidal ideation in bivariate analyses. Serial mediation analyses revealed that alexithymia significantly predicted higher levels of perceived stress, subsequently leading to depressive symptoms, which were associated with suicidal ideation. Depression served as a significant mediator between alexithymia and suicidal ideation. The strongest mediating effect (71.4%) was observed in the pathway from alexithymia through perceived stress and depression to suicidal ideation. Limitations included the utilization of cross-sectional data and a reliance on retrospective self-report measures. Perceived stress and depression were identified as serial mediators in the association between alexithymia and suicidal ideation. Clinically, it is crucial to prioritise interventions that target emotional regulation skills and assess the presence of alexithymia to effectively reduce suicidal ideation in military personnel.

Sense of Coherence as a Mediator Between Functional Status and Health-Related Quality of Life in Patients With Heart Failure.

BACKGROUND: Poor functional status relating to heart failure (HF) negatively affects health-related quality of life (HRQOL). Patients with HF, especially those with New York Heart Association (NYHA) Class III or IV HF, often exhibit poor HRQOL because of physical limitations and HF-related symptoms. Although sense of coherence (SOC) has been reported to be a determinant of HRQOL, its role as a mediator between functional status and HRQOL remains unclear, and few studies have explored the prevalence of HF in patients in NYHA Classes I and II. PURPOSE: This study was designed to investigate SOC as a mediator between different functional status classes and HRQOL in patients with HF. METHODS: A cross-sectional study was conducted on patients with HF recruited from a hospital in northern Taiwan from April 2020 to September 2020. The Minnesota Living with Heart Failure Questionnaire and a questionnaire on sociodemographic characteristics; functional classification in terms of NYHA Classes I, II, and III; and SOC were administered. The PROCESS v3.5 (by Andrew F. Hayes) macro was applied to analyze the effects, and Model 4 was used to examine the mediating role of SOC on the relationship between NYHA functional class and HRQOL. RESULTS: Of the 295 participants, SOC was found to mediate the effects of functional status on HRQOL more significantly in patients in Class II than those in Class III but not more significantly in patients in Class I than those in Class III. A weaker mediating effect of SOC was noted on the relationship between functional status and HRQOL in patients with HF in NYHA Class II than those in Class III. CONCLUSIONS: In patients with HF, poor functional status often reduces HRQOL significantly. SOC mediates the relationship between functional status and HRQOL more significantly in those in NYHA Class II than those in Class III. Nursing staff should work to increase patients' SOC by strengthening their coping capacity and improving their functional status to improve their HRQOL.

Relations between concussion symptoms and depression among patients with mild traumatic brain injury: A moderated mediation model.

INTRODUCTION: Concussion symptoms following a traumatic accident are both common and known to adversely affect mental health and recovery in patients with traumatic brain injury. Depression, highly prevalent among patients with traumatic brain injury, is also associated with the important factors of sleep quality and resilience. However, the mediator and moderator roles of depression following concussion in patients with traumatic brain injury have been underexplored. The aims of this study were to investigate the mediating role of sleep quality in the relation between concussion symptoms and depression and to examine the moderating effect of resilience on this mediated model. DESIGN: Cross-sectional pretest data analysis of a randomized controlled trial. METHODS: A total of 249 adult patients with mild traumatic brain injury (Glasgow Coma Scale 13-15) at admission following brain injury were surveyed at a medical center in Taipei, Taiwan. The outcome variables were concussion symptoms (Rivermead Post-Concussion Symptom Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), resilience (Resilience Scale for Adults), and depression (Beck Depression Inventory II). These data were analyzed using moderated mediation regressions with the SPSS PROCESS macro. RESULTS: In patients with mild traumatic brain injury, there was a significant positive relation between concussion symptoms and depression, of which sleep quality was a significant mediator. Additionally, resilience had a negative moderating effect on the relations between sleep quality and depression. Patients with less resilience showed a stronger negative effect of sleep quality on depression. CONCLUSION: Our findings suggest that ameliorating both concussion symptoms and sleep disturbance is important for reducing the risk of depression in patients with mild traumatic brain injury, especially in those patients with less resilience. CLINICAL RELEVANCE: It is essential for clinical nurses to develop interventions for patients with mild traumatic brain injury that will improve their sleep quality, while strengthening their resilience, to alleviate depression.

Influence of resilience on perceived stress and depression among Taiwanese army military personnel.

Resilience has been reported to attenuate psychological burden and promote mental health. Military personnel constitute a population with a high psychological burden and poor sleep quality and are thus at a high risk of depression. This study is aim to examine the mechanism underlying the effects of resilience on perceived stress, sleep quality, and depression among Taiwanese army military personnel. A cross-sectional survey was conducted between May 2020 and February 2021. Participants comprised 1505 voluntary army military service personnel aged 20 years or older; they completed self-reported questionnaires measuring their perceived stress, resilience, sleep quality, and depression. Data were analysed using structural equation modelling. The results indicated that the association between resilience and depression was partially mediated by perceived stress and sleep quality. Perceived stress is a significant mediator on the association between resilience and depression. A high level of sleep disturbance was observed in this population and results found that sleep quality showed a slight partial mediation effect on the association between resilience and depression. Resilience can alleviate the effects of stress, which in turn alleviates depression among military personnel. Promoting resilience-enhancing education and mitigating environmental barriers to sleep is essential for reducing depressive symptoms among military personnel.

Determinants of quality of life in frontline healthcare providers caring for COVID-19 patients.

AIMS AND OBJECTIVES: To investigate the factors affecting quality of life in healthcare providers who care for patients with COVID-19. BACKGROUND: Healthcare providers caring for COVID-19 patients during the pandemic suffered a deterioration in their quality of life. Several studies have explored their psychological impact of working with COVID patients, but none have examined the causes of this deterioration. DESIGN: A cross-sectional study. METHODS: In the current study, the authors investigated the factors affecting quality of life in 293 healthcare providers recruited from a medical centre in northern Taiwan who had recently cared for patients with suspected or confirmed COVID-19 by analysing their responses to an online self-report questionnaire, using bivariate correlations and structural equation modelling. Reporting of this research adheres to the STROBE guideline. RESULTS: The study identified an important sequence of factors that mediated the effects of perceived success of epidemic prevention policies, family relations problems and education level on quality of life in a sample of healthcare workers caring for COVID-19 patients. The mediators were use of approach-oriented coping strategies and current mental health status. Specifically, use of approach-oriented coping strategies was found to directly cause improved quality of life and indirectly cause improved mental health, whereas use of avoidant coping strategies was found to directly cause worsening of mental health. Poor mental health predicted poor quality of life. CONCLUSIONS: Results suggest that implementation of sound epidemic prevention policies that promote adoption of approach-oriented coping behaviour should lead to a better quality of life in the future for healthcare providers working in challenging circumstances. RELEVANCE TO CLINICAL PRACTICE: Assessment of these policies as well as the providers' family relations are necessary first steps to improving the success of approach-oriented coping behaviour in this population, which in turn can improve their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor members of the public were involved in the design or execution of the study.

Effectiveness of exercise in improving quality of life in patients with traumatic brain injury: A systematic review and meta-analysis.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide. People with TBI exhibit poor quality of life (QOL). Exercise is considered a possible intervention for improving cognitive function and mood, helping improve QOL in patients with TBI. According to our review of the relevant literature, meta-analyses have yet to explore the effect of exercise on QOL in patients with TBI. OBJECTIVES: To determine by meta-analysis of relevant studies whether physical exercise could promote QOL in patients with TBI. METHODS: A systematic review and meta-analysis of intervention studies involving physical exercise for improving QOL outcomes in TBI populations were conducted according to the PRISMA guideline. Our inclusion criteria were as follows: being randomized or nonrandomized controlled trials with quantitative designs that included patients diagnosed with TBI. RESULTS: Thus, six studies met the inclusion criteria. The interventions in four of the six studies had statistically significant effects on QOL improvement. Our meta-analysis revealed a moderate effect size of physical exercise on QOL promotion in patients with TBI. CONCLUSION: For TBI, exercise seems to improve QOL. More research with long-term follow-up should be conducted to assess the effect of exercise on patients with TBI.

Intestinal Mucosal Barrier Improvement with Prebiotics: Histological Evaluation of Longish Glucomannan Hydrolysates-Induced Innate T Lymphocyte Activities in Mice.

Use of prebiotics is a growing topic in healthcare. A lightweight molecule and water-soluble fiber ingredient, longish glucomannan hydrolysates (LGH), has been developed to improve the intestinal mucosal barrier and confer gut health benefits. This study aims to investigate the implications of continuous LGH intervening in intestinal epithelium integrity and protective immunity against chemical dextran sodium sulfate (DSS)-induced colitis. Twelve male BALB/c mice were randomly arranged into four groups. The LGH/DSS group had results in bodyweight variance, epithelial cell density, and aberrancy score as good as the LGH group, and both were equivalent to the control group. LGH consumption effectively protects the distal intestinal epithelium by activating innate T lymphocytes. Meanwhile, T-cell subsets in subepithelial interspersion take a bystander role in these microenvironmental alterations. Under this stress, the cluster of differentiation 3 (CD3)+ T cells infiltrate the epithelium, while CD4+ T cells inversely appear in submucosal large lymphoid aggregates/isolated lymphoid follicles (ILFs) in which significant CD3+, CD4+, and CD8+ T-cell populations agglomerate. Moreover, forkhead box P3 (Foxp3) and interleukin 17 (IL-17) are observed in these ILFs. Agglomerated CD4+ T-cell lineages may have roles with proinflammatory T helper 17 cells and anti-inflammatory regulatory T cells in balancing responses to intraluminal antigens. Collectively, LGH administration may function in immune modulation to protect against DSS-induced inflammation.

Development and Validation of an Artificial Intelligence Electrocardiogram Recommendation System in the Emergency Department.

The machine learning-assisted electrocardiogram (ECG) is increasingly recognized for its unprecedented capabilities in diagnosing and predicting cardiovascular diseases. Identifying the need for ECG examination early in emergency department (ED) triage is key to timely artificial intelligence-assisted analysis. We used machine learning to develop and validate a clinical decision support tool to predict ED triage patients' need for ECG. Data from 301,658 ED visits from August 2017 to November 2020 in a tertiary hospital were divided into a development cohort, validation cohort, and two test cohorts that included admissions before and during the COVID-19 pandemic. Models were developed using logistic regression, decision tree, random forest, and XGBoost methods. Their areas under the receiver operating characteristic curves (AUCs), positive predictive values (PPVs), and negative predictive values (NPVs) were compared and validated. In the validation cohort, the AUCs were 0.887 for the XGBoost model, 0.885 for the logistic regression model, 0.878 for the random forest model, and 0.845 for the decision tree model. The XGBoost model was selected for subsequent application. In test cohort 1, the AUC was 0.891, with sensitivity of 0.812, specificity of 0.814, PPV of 0.708 and NPV of 0.886. In test cohort 2, the AUC was 0.885, with sensitivity of 0.816, specificity of 0.812, PPV of 0.659, and NPV of 0.908. In the cumulative incidence analysis, patients not receiving an ECG yet positively predicted by the model had significantly higher probability of receiving the examination within 48 h compared with those negatively predicted by the model. A machine learning model based on triage datasets was developed to predict ECG acquisition with high accuracy. The ECG recommendation can effectively predict whether patients presenting at ED triage will require an ECG, prompting subsequent analysis and decision-making in the ED.

A Novel Intensity-Based Approach to Increasing Prefrontal Cerebral Oxygenation by Walking Exercise.

Regional cerebral blood flow (rCBF) increases after moderately intense exercise and is significantly correlated with cognitive function. However, no intensity-based physiological indicator for enhancing rCBF during low- to-moderate-intensity exercise has been proposed. The purpose of this study was to develop a physiological indicator housed in a wearable device to determine whether low-to-moderate intensity walking can increase rCBF. A cross-sectional study with four parallel arms was performed. Each of 114 participants was randomly assigned to either the moderate, low-to-moderate, low, or very low walking intensity groups. A novel dynamic cardiac force meter (CFM) was used to quantify walking intensity. Heart rate and hemoencephalography (HEG) were measured during each phase of the session. Compared to baseline, HEG significantly increased in both the submaximal exercise and recovery phases in members of the low-to-moderate intensity group but not the very low intensity group. Low-to-moderate intensity walking improves prefrontal cerebral blood oxygenation. The present results demonstrate the usefulness of a dynamic CFM housed in a wearable device for quantifying the intensity of walking exercise aimed at increasing prefrontal blood oxygenation. The results of the study may help guide further development of exercise strategies for brain disease patients and the ageing population.

Machine Learning Algorithms to Predict In-Hospital Mortality in Patients with Traumatic Brain Injury.

Traumatic brain injury (TBI) can lead to severe adverse clinical outcomes, including death and disability. Early detection of in-hospital mortality in high-risk populations may enable early treatment and potentially reduce mortality using machine learning. However, there is limited information on in-hospital mortality prediction models for TBI patients admitted to emergency departments. The aim of this study was to create a model that successfully predicts, from clinical measures and demographics, in-hospital mortality in a sample of TBI patients admitted to the emergency department. Of the 4881 TBI patients who were screened at the emergency department at a high-level first aid duty hospital in northern Taiwan, 3331 were assigned in triage to Level I or Level II using the Taiwan Triage and Acuity Scale from January 2008 to June 2018. The most significant predictors of in-hospital mortality in TBI patients were the scores on the Glasgow coma scale, the injury severity scale, and systolic blood pressure in the emergency department admission. This study demonstrated the effective cutoff values for clinical measures when using machine learning to predict in-hospital mortality of patients with TBI. The prediction model has the potential to further accelerate the development of innovative care-delivery protocols for high-risk patients.

Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters.

Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers' work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74-0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.

Calling nurses to care for burn victims after color-dust explosion.

BACKGROUND: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse-patient relationships. AIM: This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. RESEARCH DESIGN: A qualitative descriptive study using a phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi's method. ETHICAL CONSIDERATIONS: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. FINDINGS: Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. CONCLUSIONS: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient-nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Effectiveness of Theory-Based Health Information Technology Interventions on Coronary Artery Disease Self-Management Behavior: A Clinical Randomized Waitlist-Controlled Trial.

PURPOSE: Secondary prevention of coronary artery disease, self-management behavior, and blood pressure control are important to cardiovascular event prevention and promotion of quality of life (QOL), but they are underutilized. The purpose of this study was to investigate the effects of a self-efficacy theory-based health information technology intervention implemented through blood control and patient self-management. DESIGN: A clinical randomized waitlist-controlled trial. METHODS: The study was conducted at a medical center in Taipei, Taiwan. A total of 60 subjects were randomly assigned to either the immediate intervention (experimental) group or the waitlist control group. The primary endpoint was systolic blood pressure at 3 months; secondary end points included self-management behavior and QOL. Treatment for the immediate intervention group lasted 3 months, while the waitlist control group received routine care for the first 3 months, at which point they crossed over to the intervention arm and received the same intervention as the experimental group for another 3 months. Both groups were evaluated by questionnaires and physiological measurements at both 3 and 6 months postadmission. The results were analyzed using generalized estimating equations. RESULTS: Systolic blood pressure significantly improved for the intervention group participants at 3 months, when there was also significant improvement in self-management behavior and QOL. There was no significant or appreciable effect of time spent in the waitlist condition, with treatments in the two conditions being similarly effective. CONCLUSION: The use of a theory-based health information technology treatment compared with usual care resulted in a significant improvement in systolic blood pressure, self-management behavior, and QOL in patients with coronary artery disease. CLINICAL RELEVANCE: This treatment would be a useful strategy for clinical care of cardiovascular disease patients, improving their disease self-management. It also may help guide further digital health care strategies during the COVID-19 pandemic.

Meaning of critical traumatic injury for a patient's body and self.

BACKGROUND: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient's body and self. AIM: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. RESEARCH DESIGN: A qualitative descriptive study using Giorgi's phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30-60 min. Audiotaped interviews were transcribed and analyzed. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board of the medical center. FINDINGS: The impact of the experience of traumatic injury on participants' body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. DISCUSSION AND CONCLUSION: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient's body and self that facilitates ethical care and recovery from injury.

Using tabletop exercises to evaluate nurses' clinical performance of hazardous materials disaster management: A cross-sectional study.

BACKGROUND: Hazardous materials (Hazmat) disaster is a specific event with low probability but may be a heavy burden on public health. Competence in Hazmat disaster emergency management is necessary for nurses who care about mass casualties in the first line, especially for nurses in military hospitals. However, less attention has been paid to evaluation of competence of Hazmat disaster emergency responses using tabletop exercises. OBJECTIVE: To identify competence in Hazmat disaster emergency response and factors influencing performance on tabletop exercises. METHODS: A cross-sectional design was employed in this study. Competence of nurses responding to a hazardous materials invasion was evaluated by a tabletop exercise. In each case the "Task Based Checklist" was used for evaluation. Multivariate analysis of covariance was conducted to detect the effects of traditional training on performance in Hazmat disaster tabletop exercises. RESULTS: A total of 161 nurses were recruited for this study. A checklist with 12 items comprised of two dimensions of disaster management was created and validated (CVI = 0.90). Inter-rater reliability for the evaluators ranged from 0.88 to 1. Performance on Hazmat site control, debris management and individual skills in decontamination were found to be suboptimal. Traditional disaster nursing training had no significant influence either on performance on Hazmat site control or patient care after controlling for differences in education level, age and gender. CONCLUSIONS: The tabletop exercise is an innovative method for disaster nursing educators seeking to evaluate response competence in Hazmat disaster simulation exercises. It is necessary to consider the characteristics of the participants when designing the training program and educational strategies. Participants from the military hospital were shown to have limited competence in Hazmat disaster emergency management.

Controlled randomized trial of walking exercise with positive education on cardiovascular fitness and happiness in retired older adults.

AIM: Regular walking exercise (RWE) is associated with increased cardiovascular fitness and might elevate subjective psychological well-being. Positive education links positive psychology concepts with self-efficacy through the curriculum, which helps foster well-being. This study examines if regular walking exercise with positive education has better effects on cardiovascular fitness and happiness than RWE alone in retired older adults. METHODS: Three arms of experimental design were used: pedometer walking exercise training (PWET); positive education and pedometer walking exercise training (PEPWET); and pedometer walking exercise (PWE). Trained walking exercise was provided to the PWET and PEPWET groups by a walking exercise coach three times per week, for 45 min per session for 12 weeks. Positive education was designed and led by a licensed PhD psychologist every other week. Of 150 participants, 60, 60 and 30 were randomly assigned to PWET, PEPWET and PWE, respectively. Demographic information, Chinese Happiness Inventory, RWE, and 6-min walking distance were assessed before and after the intervention. RESULTS: The percentage of participants who practiced RWE after 12 weeks was significantly higher in the PEPWET group (96.7%), followed by the PWET (75%) and PWE groups (40%). Cardiovascular fitness in the PWET and PEPWET groups was significantly better than in the PWE group. Chinese Happiness Inventory scores in the PWET and PEPWET groups were significantly higher than in the PWE group, and the PEPWET group also showed significantly higher Chinese Happiness Inventory scores than the PWET group. CONCLUSIONS: In addition to RWE, the study findings show that positive education can be beneficial to promote older adults' RWE, cardiovascular fitness and happiness. Geriatr Gerontol Int 2019; 19: 879-884.

Impact of Coping Strategies on Nurses' Well-Being and Practice.

OBJECTIVES: To examine the mechanisms of coping strategies on nurses' psychological well-being, practice environments and safety attitudes. METHODS: A cross-sectional study design was used. Structural equation modeling was performed to analyze the results. Five hundred clinical nurses were randomly selected from a large group of 1,500 from a medical center with 1,350 beds in Taipei, Taiwan, from July to October 2015. Self-report questionnaires were administered to measure coping strategies (Brief COPE), psychological well-being (Ryff's Psychological Well-being Scale), nurses' practice environments (Practice Environment Scale of the Nursing Work Index), and safety attitudes (Safety Attitudes Questionnaire). RESULTS: Of the 500 participants who gave written consent, 474 (94.8%) filled out the questionnaire. Results showed that using more approach-oriented coping strategies and fewer avoidant coping strategies was associated with greater psychological well-being. Psychological well-being was directly associated with quality of nurses' practice environments and safety attitudes. The impact of psychological well-being on safety attitudes was mediated significantly by the quality of the practice environment. The use of approach-oriented coping strategies was significantly predictive of positive psychological well-being, a good practice environment, and good safety attitudes. CONCLUSIONS AND CLINICAL RELEVANCE: This study found a distinct pathway for the relationships between clinical nurses' psychological well-being, practice environment, and safety attitudes. Psychological well-being in clinical nurses was higher for those with more approach-oriented coping strategies. Psychological well-being directly impacted safety attitudes, which mediated nurses' practice environments. The practical implications of the results suggest that interventions designed to promote positive psychological well-being may help improve nurses' practice environments, which, in turn, may result in better safety attitudes and nursing care outcomes.

Family relations, sense of coherence, happiness and perceived health in retired Taiwanese: Analysis of a conceptual model.

AIM: A growing awareness of the rapidly increasing aged population in the world has led to growing attention to mental health in late life. Happiness has been emphasized as an important indicator of physical health and is predicted by a sense of coherence. However, the mechanism of influence of family relations on sense of coherence, happiness and perceived health is unknown. The present study aimed to analyze a conceptual model of the relationships among family relations, sense of coherence, happiness and perceived health in retired persons. METHODS: A total of 142 retired participants were recruited from social service centers in Taipei, Taiwan. A structured questionnaire measuring the relationships among family relations, sense of coherence, happiness and perceived health was filled in by each respondent. Data were analyzed using structural equation modeling. RESULTS: The results showed that family relations is positively correlated with happiness, sense of coherence and perceived health. The results also showed that good family relations and a sense of coherence predict greater happiness. The results from structure equation modeling showed that the relationship between family relations and perceived health is completely mediated by happiness and a sense of coherence, but only the indirect effect of happiness is significant. The results also showed that family relations is partially mediated by the sense of coherence to happiness. CONCLUSIONS: In caring for retired older people, medical professionals need to increase their family relations and sense of coherence simultaneously, and then promote happiness in their interventions. Geriatr Gerontol Int 2018; 18: 154-160.

Psychometric integrity of the Chinese Happiness Inventory among retired older people in Taiwan.

AIM: Happiness is an important indicator of mental and physical health. It has been emphasized as one kind of well-being, and its definition varies from culture to culture. The main objective of the present study was to examine the psychometric integrity and dimensions of the Chinese Happiness Inventory (CHI) in relation to scores on Ryff's Psychological Well-Being Scale among retired older people in Taiwan. METHODS: A cross-sectional study was carried out at social service centers in Taipei, Taiwan. Retired adults gave informed consent from September to November 2010, and completed a package of structured questionnaires measuring happiness and psychological well-being. Internal consistency, the factor structure of the CHI and criterion validity were assessed. RESULTS: Results from an exploratory factor analysis showed a three-factor solution for the CHI. These factors were named Positive Affect, Life Satisfaction and Interpersonal Relationships. Internal consistency coefficients were 0.95 (Positive Affect), 0.91 (Life Satisfaction), 0.85 (Interpersonal Relationships) and 0.97 (total scale). The results of a canonical correlation analysis showed the presence of a strong relationship between CHI and Ryff's Psychological Well-Being Scale (r = 0.69), and that two canonical variates could be derived from the relationship between them. CONCLUSIONS: The results show that the CHI is a three-dimensional scale with high reliability and validity. The construct of happiness emphasizes relationships in relation to others and environment rather than autonomy in this sample. Although the components of happiness might be similar for Positive Affect and Life Satisfaction, their weights for Interpersonal Relationships should be considered when measuring happiness in different cultures. Geriatr Gerontol Int 2016; 16: 865-872.

Uncertainty, mood states, and symptom distress in patients with primary brain tumors: analysis of a conceptual model using structural equation modeling.

BACKGROUND: Patients with primary brain tumors (PBTs) face uncertainty related to prognosis, symptoms, treatment response, and toxicity. The authors of this report examined the direct/indirect relations among patients' uncertainty, mood states, and symptoms. METHODS: In total, 186 patients with PBTs were accrued at various points in the illness trajectory. Data-collection tools included an investigator-completed clinician checklist, a patient-completed demographic data sheet, the Mishel Uncertainty in Illness Scale-Brain Tumor Form (MUIS-BT), the MD Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT), and the Profile of Mood States-Short Form (POMS-SF). Structural equation modeling was used to explore correlations among variables. RESULTS: Participants were primarily white (80%) men (53%) with a variety of brain tumors. They ranged in age from 19 to 80 years (mean ± standard deviation, 44.2 ± 12.6 years). Lower functional status and earlier point in the illness trajectory were associated with greater uncertainty (P < .01 for both). Uncertainty (P < .05), except in the model of "confusion," and the 5 negative mood states measured by the POMS-SF were directly associated with symptom severity perceived by patients (P < .01 for all). The impact of uncertainty on perceived symptom severity also was mediated significantly by mood states. CONCLUSIONS: The results from the study clearly demonstrated distinct pathways for the relations between uncertainty-mood states-symptom severity for patients with PBTs. Uncertainty in patients with PBTs is higher for those who have a poor performance status and directly impacts negative mood states, which mediate patient-perceived symptom severity. This conceptual model suggests that interventions designed to reduce uncertainty or that target mood states may help lessen patients' perception of symptom severity, which, in turn, may result in better treatment outcomes and quality of life.