A Comparison of Two Cross-Sectional Studies on Successful Model of Introducing Nursing Information System in a Regional Teaching Hospital in Taiwan.

Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.

Lifestyle changes for treating psoriasis.

BACKGROUND: Psoriasis is an inflammatory skin disease that presents with itching, red, scaling plaques; its worsening has been associated with obesity, drinking, smoking, lack of sleep, and a sedentary lifestyle. Lifestyle changes may improve psoriasis. OBJECTIVES: To assess the effects of lifestyle changes for psoriasis, including weight reduction, alcohol abstinence, smoking cessation, dietary modification, exercise, and other lifestyle change interventions. SEARCH METHODS: We searched the following databases up to July 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched the China National Knowledge Infrastructure, the Airiti Library, and five trials registers up to July 2018. We checked the references of included trials for further relevant trials, and we asked the authors of the included trials if they were aware of any relevant unpublished data. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of lifestyle changes (either alone or in combination) for treating psoriasis in people diagnosed by a healthcare professional. Treatment had to be given for at least 12 weeks. Eligible comparisons were no lifestyle changes or another active intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Severity of psoriasis' and 'Adherence to the intervention'. Secondary outcomes were 'Quality of life', 'Time to relapse', and 'Reduction in comorbidities'. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS: We included 10 RCTs with 1163 participants (mean age: 43 to 61 years; 656 men and 478 women were reported). Six trials examined the effects of dietary intervention (low-calorie diet) in 499 obese participants (mean age: 44.3 to 61 years; where reported, 395 had moderate-to-severe psoriasis). One trial assessed a combined dietary intervention and exercise programme in 303 obese participants with moderate-to-severe psoriasis who had started a systemic therapy for psoriasis and had not achieved clearance after four weeks of continuous treatment (median age: 53 years). Another trial assessed a walking exercise and continuous health education in 200 participants (mean age: 43.1 years, severity not reported). Finally, two trials included education programmes promoting a healthy lifestyle in 161 participants (aged 18 to 78 years), with one trial on mild psoriasis and the other trial not reporting severity.Comparisons included information only; no intervention; medical therapy alone; and usual care (such as continuing healthy eating).All trials were conducted in hospitals and treated participants for between 12 weeks and three years. One trial did not report the treatment period. Seven trials measured the outcomes at the end of treatment and there was no additional follow-up. In two trials, there was follow-up after the treatment ended. Five trials had a high risk of performance bias, and four trials had a high risk of attrition bias.We found no trials assessing interventions for alcohol abstinence or smoking cessation. No trials assessed time to relapse. Only two trials assessed adverse events; in one trial these were caused by the add-on therapy ciclosporin (given in both groups). The trial comparing two dietary interventions to a no-treatment group observed no adverse events.The results presented in this abstract are based on trials of obese participants.Outcomes for dietary interventions versus usual care were measured 24 weeks to six months from baseline. Compared to usual care, dietary intervention (strict caloric restriction) may lead to 75% or greater improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.07 to 2.58; 2 trials, 323 participants; low-quality evidence). Adherence to the intervention may be greater with the dietary intervention than usual care, but the 95% CI indicates that the dietary intervention might also make little or no difference (RR 1.26, 95% CI 0.76 to 2.09; 2 trials, 105 participants; low-quality evidence). Dietary intervention probably achieves a greater improvement in dermatology quality-of-life index (DLQI) score compared to usual care (MD -12.20, 95% CI -13.92 to -10.48; 1 trial, 36 participants; moderate-quality evidence), and probably reduces the BMI compared to usual care (MD -4.65, 95% CI -5.93 to -3.36; 2 trials, 78 participants; moderate-quality evidence).Outcomes for dietary interventions plus exercise programme were measured 16 weeks from baseline and are based on one trial (303 participants). Compared to information only (on reducing weight to improve psoriasis), combined dietary intervention and exercise programme (dietetic plan and physical activities) probably improves psoriasis severity, but the 95% CI indicates that the intervention might make little or no difference (PASI 75: RR 1.28, 95% CI 0.83 to 1.98). This combined intervention probably results in a greater reduction in BMI (median change -1.10 kg/m², P = 0.002), but there is probably no difference in adherence (RR 0.95, 95% CI 0.89 to 1.01; 137/151 and 145/152 participants adhered in the treatment and control group, respectively). There were no data on quality of life. These outcomes are based on moderate-quality evidence. AUTHORS' CONCLUSIONS: Dietary intervention may reduce the severity of psoriasis (low-quality evidence) and probably improves quality of life and reduces BMI (moderate-quality evidence) in obese people when compared with usual care, while combined dietary intervention and exercise programme probably improves psoriasis severity and BMI when compared with information only (moderate-quality evidence). None of the trials measured quality of life.We did not detect a clear difference in treatment adherence between those in the combined dietary intervention and exercise programme group and those given information only (moderate-quality evidence). Adherence may be improved through dietary intervention compared with usual care (low-quality evidence). Participants generally adhered well to the lifestyle interventions assessed in the review.No trials assessed the time to relapse. Trial limitations included unblinded participants and high dropout rate.Future trials should reduce dropouts and include comprehensive outcome measures; they should examine whether dietary intervention with or without an exercise programme is effective in non-obese people with psoriasis, whether an additional exercise programme is more effective than dietary intervention alone, whether the time to relapse prolongs in people who receive dietary intervention with or without exercise programme, and whether smoking cessation and alcohol abstinence are effective in treating psoriasis.

Associations Between Unhealthy Lifestyle Behaviors and Metabolic Syndrome by Gender in Young Adults.

OBJECTIVE: Unhealthy lifestyle behaviors, such as smoking, drinking, betel-quid chewing, insufficient exercise, and inadequate sleep are significantly correlated with metabolic syndrome (MetS). To further understand this relationship, this study examined the main effect of unhealthy lifestyle behaviors and their interaction on MetS by gender in young adults. METHOD: A cross-sectional study involving 694 young adults from a national survey was performed in which demographic characteristics, unhealthy lifestyle behaviors, anthropometric measurements, and blood chemistry panels were collected during face-to-face interviews. RESULTS: The prevalence of MetS among young adults was 17.4% and was greater in males than females (19.0% vs. 7.8%). The unhealthy lifestyle-behavior risk factors associated with MetS included smoking (odds ratio [ OR] = 4.53) and physical activity ( OR = 0.51) among males and betel-quid chewing ( OR = 8.90) and less sleep ( OR = 0.08) among females. Significant interaction effects were observed between the abovementioned behaviors and gender for the risk of developing MetS. CONCLUSION: These results can guide health-care providers in reducing MetS risk by encouraging young adult males to reduce or quit cigarette smoking and maintain optimum levels of physical activity and young adult females to quit chewing betel quid and obtain appropriate amounts of sleep.

Acupuncture-Related Techniques for Psoriasis: A Systematic Review with Pairwise and Network Meta-Analyses of Randomized Controlled Trials.

OBJECTIVE: There has be a large body of evidence on the pharmacological treatments for psoriasis, but whether nonpharmacological interventions are effective in managing psoriasis remains largely unclear. This systematic review conducted pairwise and network meta-analyses to determine the effects of acupuncture-related techniques on acupoint stimulation for the treatment of psoriasis and to determine the order of effectiveness of these remedies. METHODS: This study searched the following databases from inception to March 15, 2016: Medline, PubMed, Cochrane Central Register of Controlled Trials, EBSCO (including Academic Search Premier, American Doctoral Dissertations, and CINAHL), Airiti Library, and China National Knowledge Infrastructure. Randomized controlled trials (RCTs) on the effects of acupuncture-related techniques on acupoint stimulation as intervention for psoriasis were independently reviewed by two researchers. RESULTS: A total of 13 RCTs with 1,060 participants were included. The methodological quality of included studies was not rigorous. Acupoint stimulation, compared with nonacupoint stimulation, had a significant treatment for psoriasis. However, the most common adverse events were thirst and dry mouth. Subgroup analysis was further done to confirm that the short-term treatment effect was superior to that of the long-term effect in treating psoriasis. Network meta-analysis identified acupressure or acupoint catgut embedding, compared with medication, and had a significant effect for improving psoriasis. It was noted that acupressure was the most effective treatment. CONCLUSIONS: Acupuncture-related techniques could be considered as an alternative or adjuvant therapy for psoriasis in short term, especially of acupressure and acupoint catgut embedding. This study recommends further well-designed, methodologically rigorous, and more head-to-head randomized trials to explore the effects of acupuncture-related techniques for treating psoriasis.

Modifiable Lifestyle Behaviors Are Associated With Metabolic Syndrome in a Taiwanese Population.

PURPOSE: To explore associations between metabolic syndrome and modifiable lifestyle behaviors among the adult population in Taiwan. DESIGN: This cross-sectional study analyzed data from a nationally representative sample that participated in the 2005-2008 Nutrition and Health Survey in Taiwan. The sample (2,337 participants older than 19 years) provided data on demographic characteristics, modifiable lifestyle behaviors, anthropometric measurements, and blood chemistry panel. METHODS: These data were analyzed by descriptive statistics, univariate logistic regression, and multivariate logistic regression to determine factors associated with metabolic syndrome. FINDINGS: Metabolic syndrome had a prevalence of 25.2%, and this prevalence increased with age. In univariate regression analysis, metabolic syndrome was associated with age, living with family members, educational level, and modifiable lifestyle behaviors (smoking, drinking, betel quid chewing, and physical activity). Individuals with a smoking history and currently chewing betel quid had the highest risk for metabolic syndrome. CONCLUSIONS: The risk for metabolic syndrome might be reduced by public health campaigns to encourage people to quit smoking cigarettes and chewing betel quid. Implementing more modifiable lifestyle behaviors in daily life will decrease metabolic syndrome in Taiwan. CLINICAL RELEVANCE: Considering that betel quid chewing and tobacco smoking interact to adversely affect metabolic syndrome risk, public health campaigns against both behaviors seem to be a cost-effective and efficient health promotion strategy to reduce the prevalence rate of metabolic syndrome.

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.

Postpartum women's sleep quality and its predictors in Taiwan.

PURPOSE: The purpose of this study was to explore postpartum women's sleep quality and its predictors in Taiwan. DESIGN: Cross-sectional design. METHODS: Postpartum women (N = 327) were recruited during their postnatal check-ups in Taiwan. Data were collected from October 2008 to July 2009 using a demographic form, the Pittsburgh Sleep Quality Index (PSQI), Physical Symptoms Checklist, Perceived Stress Scale, and Postpartum Social Support Scale. Descriptive statistics, Pearson's correlation, and stepwise multiple regression analysis were used to analyze data. RESULTS: Most participants (87.5%) reported poor sleep quality (PSQI > 5). Postpartum sleep quality was predicted by postpartum physical symptoms, frequency of nighttime awakening, co-sleeper disturbance, marital satisfaction, perceived stress, and baby sleep status, which explained 29.9% of the total variance. CONCLUSIONS: Most postpartum women did not sleep well due to physical discomfort, perceived stress, co-sleeper disturbance, and marital dissatisfaction. CLINICAL RELEVANCE: Evaluation of sleep quality should be a routine part of postnatal check-ups. Information on women's sleep problems, marital satisfaction, stress, co-sleepers, and baby sleep status can be used to individualize intervention protocols for sleep-disturbed women.

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.

Comparison of health-promoting lifestyles between postnatal han taiwanese and indigenous women.

BACKGROUND: The health-promoting lifestyle of postpartum women is an important issue, but few studies have been undertaken to examine the role of cultural difference. PURPOSE: The purpose of this study was to better understand the health-promoting lifestyles of postnatal mothers in Taiwan in terms of differences between ethnic Han Taiwanese and indigenous women and of factors predicting health-promoting lifestyles in the two groups. METHODS: For this cross-sectional comparative study, data on postnatal health-promoting behaviors, as measured using the Health-Promoting Lifestyle Profile (HPLP), were collected from 314 mothers during their sixth postpartum week. HPLP scores of ethnic Han Taiwanese mothers living in Kaohsiung City, and indigenous women living in Pingtung County were then compared. RESULTS: : Han Taiwanese and indigenous mothers differed significantly in terms of age, education, employment status, socioeconomic status, type of family, and primary postnatal helper. Han Taiwanese had better original scores in overall health-promoting lifestyle, self-actualization, stress management, nutrition, and interpersonal support. However, these differences did not achieve statistical significance when subjected to analysis of covariance. Indigenous participants had significantly higher scores in terms of health responsibility and exercise than Han Taiwanese women. Significant predictors of higher HPLP score in the Han Taiwanese group included employment status and breast-feeding, which together accounted for 8.2% of total variance. In the indigenous group, significant predictors of higher HPLP score included more years of education and middle socioeconomic status, which together accounted for 22.0% of total variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Results showed significant differences in the health responsibility and exercise subscales and significant differences in key predictors between the Han Taiwanese and the indigenous groups. Findings support the role of culture as a significant factor affecting the health-promoting lifestyle of postnatal women in Taiwan. Nurses should be aware of cultural mores and influences when delivering healthcare to postpartum mothers of different ethnic groups to maximize postnatal care efficacy.

A comparative study of sleep quality between pregnant and nonpregnant Taiwanese women.

PURPOSE: This study explored (a) differences in sleep quality, depression, and stress among second- and third-trimester pregnant and nonpregnant women, and (b) relationships among depression, stress, and sleep quality of pregnant women in Taiwan. DESIGN: Cross-sectional. METHODS: A convenience sample of 150 second-trimester and 150 third-trimester pregnant women was recruited from two medical centers in Taiwan. A comparison group of 300 nonpregnant women was recruited by the acquaintance technique. Data were collected from October 2006 to September 2007 using a demographic form, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale, and Perceived Stress Scale. FINDINGS: The prevalence of poor sleepers (PSQI score>5) was 60.0% for second- and third-trimester pregnant women and 48.0% for nonpregnant women. After controlling for significant covariates, pregnant women reported worse global sleep quality, habitual sleep efficiency, and sleep disturbances than nonpregnant women, and poorer sleep quality and sleep latency were most prevalent during their third trimester. A high prevalence of antenatal depression (27.3% to 36.0%) was found in pregnant women, depressed women had worse sleep quality than nondepressed women in all groups, and stress affected sleep quality in pregnant women but not in nonpregnant women. CONCLUSIONS: This cross-sectional study provides preliminary evidence that pregnant women suffer significantly more poor sleep quality than nonpregnant women, and that sleep quality of pregnant women was related to stress and depression. CLINICAL RELEVANCE: Evaluation for sleep quality and depression should be part of routine prenatal check-ups. Information on women's sleep quality, stress, and depressive status can be used to individualize interventions for pregnancy-associated sleep disorder.