Longitudinal Effects of a Combined Program of Pelvic Floor Muscle Training and Yoga on Genitourinary Symptoms in Asian Women of Older Age: A Randomized Experimental Study.

This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.

The prevalence and risk factors of atopic dermatitis in 6-8 year-old first graders in Taipei.

BACKGROUND: Despite the advance in the understanding of etiology, pathophysiology and diagnosis of atopic dermatitis (AD), its prevalence has increased annually in Taiwan. PURPOSES: The purpose of this study is to explore the prevalence, and personal and environmental risk factors of AD. METHODS: A cross-sectional survey was conducted via health centers of elementary schools in Taipei city. We used the Chinese version of ISAAC questionnaire to examine possible personal and environmental risk factors of AD. Questionnaires were completed by parents or guardians of first graders (6-8 year-old) who agreed to participate in this study. Logistic regression was conducted to examine possible personal and environmental factors related to AD (in early life and currently). RESULTS: The 12-month prevalence of AD (in the past 12 months) was 10.7% (2683/24,999) among 6- to 8-year-old first graders in Taipei. Forty-five percent of first graders with AD had their first episode of AD symptoms before the age of two. Children with asthma history were 1.65 times (95% CI: 1.51-1.79, p < 0.001) and children with rhinitis were 2.57 times (95% CI: 2.34-2.84, p < 0.001) more likely to have AD than those without the conditions. Compare to their counterarts, children who used antibiotics during their first year of life (OR = 1.37, 95% CI: 1.22-1.53, p < 0.001) and who had bronchiolitis before the age of two (OR = 1.47, 95% CI: 1.33-1.63, p < 0.001) had a higher chance to have AD during the last 12 months of the study. However, receiving breastfeeding for less than 4 months (OR = 0.75, 95% CI: 0.67-0.83, p < 0.001) and having older siblings (OR = 0.83, 95% CI: 0.76-0.92, p < 0.001) had 25% and 17% reduced risks for AD in the 12 months before this study, respectively. CONCLUSION: Our study verified personal and environmental risk factors of AD in children in Taiwan. Based on the results, we propose that avoiding bronchiolitis before the age of two, using antibiotics properly in babies, and providing diet counseling for breastfeeding mothers may be good prevention strategies of AD.

[Pelvic Health: Healthcare Needs From Medical and Women Perspectives].

The pelvis, one of the most important cavities in the human body, is involved in human reproduction health. The pelvis changes in females with age and reproduction-related changes in hormones. Women generally lack sufficient knowledge regarding their pelvic-health needs and feel embarrassed to seek pelvic-health-related medical advice. Conversely, medical care related to women's health focuses mainly on maternal health and cancer prevention. When facing the challenges of pelvic floor dysfunction, surgical procedures are the most common treatment modality. The present article aims to define pelvic health and to compare the differences in perspective on this issue between the medical and women. Lastly, suggestions for pelvic healthcare that focus on women's needs are made.

A CMAC-based scheme for determining membership with classification of text strings.

Membership determination of text strings has been an important procedure for analyzing textual data of a tremendous amount, especially when time is a crucial factor. Bloom filter has been a well-known approach for dealing with such a problem because of its succinct structure and simple determination procedure. As determination of membership with classification is becoming increasingly desirable, parallel Bloom filters are often implemented for facilitating the additional classification requirement. The parallel Bloom filters, however, tend to produce additional false-positive errors since membership determination must be performed on each of the parallel layers. We propose a scheme based on CMAC, a neural network mapping, which only requires a single-layer calculation to simultaneously obtain information of both the membership and classification. A hash function specifically designed for text strings is also proposed. The proposed scheme could effectively reduce false-positive errors by converging the range of membership acceptance to the minimum for each class during the neural network mapping. Simulation results show that the proposed scheme committed significantly less errors than the benchmark, parallel Bloom filters, with limited and identical memory usage at different classification levels.

The mediating and moderating effects of sleep hygiene practice on anxiety and insomnia in hospital nurses.

This study aimed to test the mediating and moderating effects of sleep hygiene practice on the relationship between anxiety and insomnia severity in hospital nurses. A cross-sectional survey was employed, and a convenience sample was recruited from one regional hospital in Taiwan. Participants completed the following self-report questionnaires over a 3-month period in 2009: the Insomnia Severity Index, the Beck Anxiety Inventory, and Sleep Hygiene Awareness and Practice Scale. The results indicated that nurses with more anxiety tended to have higher insomnia severity. Further, nurses with poor sleep hygiene practice had more insomnia. Sleep hygiene practice partially mediated the effects of anxiety on insomnia severity. Also, sleep hygiene practice was a moderator in the relationship between anxiety and insomnia severity with age and work units as covariates. Sleep hygiene practice mediated and moderated the relationship between anxiety and insomnia severity after controlling the variables of age and work units. Continuing to learn and train sleep hygiene practice might promote nurses' sleep hygiene, and thereby ameliorate anxiety and reduce the risk of insomnia.

The relationship between light exposure and sleep, fatigue, and depression in cancer outpatients: test of the mediating effect.

BACKGROUND: Light is an important cue for the entrainment of circadian rhythms, which can be related to sleep quality, fatigue, and depression in cancer patients. OBJECTIVES: The purpose of this study was to determine the effects of light exposure on sleep quality, fatigue, and depression in cancer patients, to test whether the effect of light exposure on sleep quality, fatigue, and depression was mediated by the other 2 symptoms. METHODS: This was a cross-sectional study for which we recruited 163 cancer outpatients. For 3 consecutive days, they wore an Actiwatch to measure light exposure. Instruments included the Pittsburgh Sleep Quality Index-Taiwan form, the Brief Fatigue Inventory-Taiwan form, and the Beck Depression Inventory II-Taiwan version. RESULTS: The results indicated that the Pittsburgh Sleep Quality Index-Taiwan form score was significantly and negatively correlated with minutes of light exposure (MLE) of 1000 lux or greater (r = -0.61, P < .001) and the intensity of light exposure under activity (r = -0.59, P < .001). Fatigue was negatively correlated with MLE (r = -0.18, P = .03). Depression was also negatively correlated with MLE and intensity of light exposure (both r = -0.18, P = .02). Most important, the effect of light exposure on sleep quality, fatigue, and depression was mediated by the other 2 symptoms. CONCLUSION: Light exposure appeared to be a shared factor for the co-occurrence of fatigue, sleep disturbances, and depression. IMPLICATIONS FOR PRACTICE: Light exposure has great potential for improving sleep quality as well as ameliorating fatigue and depression in cancer outpatients.

High risk sexual behaviors for HIV among the in-school youth in Swaziland: a structural equation modeling approach.

BACKGROUND: Global efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. However, knowledge regarding intentions of young people to engage in protective sexual behaviors is still lacking in many countries around the world, especially in Sub-Saharan Africa where prevalence of human immunodeficiency virus is the highest. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland. METHODS: This cross-sectional survey was conducted using a anonymous questionnaire. A two-stage stratified and cluster random sampling method was used. Approximately one hundred pupils from each of four schools agreed to participate in the study, providing a total sample size of 403 pupils of which 369 were ultimately included for data analysis. The response rate was 98%. Structural equation modeling was used to analyse hypothesized paths. RESULTS: The TPB model used in this study was effective in predicting protective sexual behavior among Swazi in-school youths, as shown by model fit indices. All hypothesized constructs significantly predicted intentions for abstinence and condom use, except perceived abstinence controls. Subjective norms were the strongest predictors of intention for premarital sexual abstinence; however, perceived controls for condom use were the strongest predictors of intention for condom use. CONCLUSIONS: Our findings support application of the model in predicting determinants of condom use and abstinence intentions among Swazi in-school youths.

The relationships between postpartum adaptation and postpartum depression symptoms of first pregnancy mothers in Taiwan.

BACKGROUND: Motherhood is a critical situation characterized by role conflicts. These conflicts between the roles of mother, worker, and wife are the norm in the postpartum period and may jeopardize a mother's well-being. The purpose of this study was to explore the relationships between postpartum adaptation and depression among new mothers who live in northern Taiwan. MATERIAL AND METHODS: A total of 186 first pregnancy mothers were recruited via convenience sampling methods and they completed mailed questionnaires between 1 week and 2 months after giving birth. Structured questionnaires including Demographic Inventory Scale, Postpartum Self-Evaluation Questionnaire, and Edinburgh Postnatal Depression Scale were used. RESULTS: Ninety-four (50.5%) women exhibited depressive symptoms (EPDS > 10) and 73 (39.2%) women needed to consult the doctor (EPDS > 12). The risk factors for postpartum depression symptoms included unplanned birth, low socioeconomic status, and part-time employment. The correlation between women's different aspects of postpartum adaptation and depression ranged was from low to medium. The best predictors of postpartum depression were confidence in their own competence of motherhood tasks, satisfaction with life circumstances, and partner participating in child care. These three subsets explained 44.8% of the total variance. CONCLUSION: This study shows that healthcare providers who work with primiparas during the first 2 months after giving birth should pay more attention to postpartum depression, keeping in mind associated risk factors. A new mother's confidence in her own abilities as a new mother may be particularly important in determining the likelihood of postpartum depression.

Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: a cross-sectional observational study.

OBJECTIVE: The aim of the study was to investigate the association between dialysis shift and subjective sleep quality in chronic haemodialyzed patients. DESIGN: A cross-sectional observational study. PARTICIPANTS AND METHODS: A total of 206 haemodialyzed patients aged from 22 to 71 participated in this study. Participants were grouped into the morning-shift and other-shifts groups. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). All participants also completed the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS: Dialysis shift significantly predicted the PSQI score with patients receiving morning-shift haemodialysis having better sleep quality (ß=0.15, p=0.01). Other independent predictors of the PSQI score included depression (ß=0.42, p<0.001), anxiety (ß=0.38, p<0.001), and tea drinking (ß=0.20, p0.001). Together these factors explained 48.2% of the variance in the PSQI score. CONCLUSION: Morning dialysis shift was significantly associated with better subjective sleep quality in chronic haemodialyzed patients after adjusting for other confounders.

The development and psychometric testing of East Asian Acculturation Scale among Asian immigrant women in Taiwan.

OBJECTIVE: This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale. DESIGN: An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity. RESULTS: The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity. CONCLUSIONS: The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

Support groups for caregivers of intellectually disabled family members: effects on physical-psychological health and social support.

AIMS: This study aimed to examine the effectiveness of support groups for people caring for family members with intellectual disability with the goal of improving their physical-psychological health and social support. BACKGROUND: Little is known about how differences in the support group context influence either the nature of the social support available to caregivers of family member with intellectual disabilities or the effects on caregivers' physical-psychological health in eastern cultures. DESIGN: An experimental, preintervention postintervention control group design was used in this study. METHODS: The experimental group received intervention consisting of eight weekly support group meetings for caregivers of people with intellectual disabilities. A total of 72 participants were recruited by permuted block randomisation and evaluated before intervention, after intervention and at four-week follow-up. Participants were blinded to the arrangement. Longitudinal effects were analysed by means of generalised estimating equations. RESULTS: (1) Physical-psychological health (somatic, depressive and anxiety symptoms) of participants in the experimental group was significantly improved after the intervention and four-week follow-up. (2) After the support group, the experimental group scored better than the control group on measures of social support (positive social interaction, emotional, informational and material social support). At four-week follow-up, the differences between the two groups persisted except for positive social interaction support, suggesting a continued positive effect of the support group on caregivers of family members with intellectual disabilities. CONCLUSIONS: The results of this study confirm the experimental hypotheses that caregivers benefit from participating in support group interventions. RELEVANCE TO CLINICAL PRACTICE: The support group is an effective alternative intervention for promoting caregivers' physical-psychological health status as well as their social support. Therefore, the support group should become a routine component of the caregiver of people with intellectual disabilities.

Caregiver support groups in patients with dementia: a meta-analysis.

OBJECTIVES: Meta-analysis studies of specific types of support groups are limited. We conducted a review and assessment of the effectiveness of support groups for caregivers of demented patients, and examined the impact of support group characteristics. METHODS: A search of multiple, electronic databases including the Cochrane Library, Medline, PUBMED, and others was conducted; studies published between 1998 and 2009 were collected. Thirty quantitative journal articles that were true and quasi-experimental controlled trials on support groups for non-professional caregivers, including mutual support, psychoeducational, and educational groups were analyzed. Outcome indicators were psychological well-being, depression, burden, and social outcomes. RESULTS: Support groups showed a significant positive effect on caregivers' psychological well-being (Hedge's g = -0.44, 95% CI = -0.73, -0.15), depression (Hedge's g = -0.40, 95% CI = -0.72, -0.08), burden (Hedge's g = -0.23, 95% CI = -0.33, -0.13), and social outcomes (Hedge's g = 0.40, 95% CI = 0.09, 0.71). The use of theoretical models, and length and intensity of group sessions had a significant impact on the effect sizes for psychological well-being and depression. Ratio of female participation (for psychological well-being and depression) and average age (social outcomes) were significant predictor variables. CONCLUSIONS: Support groups benefit caregivers and findings of this meta-analysis serve as immediate guidance for group facilitators. Future research should include additional outcome variables with our defined factors on effectiveness collected as demographic characteristic data for comparison. A more comprehensive understanding of the effectiveness of support groups is indicated to enhance outcomes for caregivers and patients.

The effects of a support group on dementia caregivers' burden and depression.

OBJECTIVE: The aim of the study is to investigate the effects of a support group on depression levels and burden among dementia caregivers in Taiwan. METHOD: An experimental, pre-intervention postintervention control group design was used in this study. The experimental group received intervention consisting of a 12-week support group for dementia caregivers. A total of 85 subjects were evaluated before intervention, after intervention, and at 1-month follow-up. RESULTS: (a) The depression level of participants in the experimental group was significantly decreased after the intervention and at 1-month follow-up. (b) There was no significant difference in caregiver's burden after the support group intervention and 1-month follow-up. DISCUSSION: The improvement in dementia caregivers' depression levels shows that the support group was effective for reducing caregivers' depression although not effective for relieving their burden of care.

Perceptions of exercise in obese school-aged children.

BACKGROUND: Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited. PURPOSE: This study aimed to explore perceptions of exercise held by obese school-aged children. METHODS: This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1,714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes. RESULTS: Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: a questionnaire survey.

BACKGROUND: Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL). OBJECTIVES: To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS. DESIGN: This study was a cross-sectional, questionnaire survey. SETTINGS: Three medical centers and five regional hospitals in Taipei were selected randomly. PARTICIPANTS: In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean=31.02, SD=6.32), had normal body mass index, and had never given birth. Most nurses' bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate. METHODS: Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS. RESULTS: Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS. CONCLUSIONS: Although most of the nurses in this study were young (< or =35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses' possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses' physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.

Rapid recovery of dilute copper from a simulated Cu-SDS solution with low-cost steel wool cathode reactor.

Copper-surfactant wastewaters are often encountered in electroplating, printed circuit boards manufacturing, and metal finishing industries, as well as in retentates from micellar-enhanced ultrafiltration process. A low-cost three-dimensional steel wool cathode reactor was evaluated for electrolytic recovery of Cu ion from dilute copper solution (0.2mM) in the presence of sodium dodecyl sulfate (SDS), octylphenol poly (ethyleneglycol) 9.5 ether (TX), nonylphenol poly (oxyethylene) 9 ether (NP9) and polyoxyethylene (20) sorbitan monooleate (TW) and also mixed surfactants (anionic/nonionic). The reactor showed excellent copper recovery ability in comparison to a parallel-plate reactor. The reactor rapidly recovered copper with a reasonable current efficiency. 93% of copper was recovered at current density of 1 A m(-2) and pH 4 in the presence of 8.5mM SDS. Initial solution pH, cathodic current density, solution mixing condition, SDS concentration, and initial copper concentrations significantly influenced copper recovery. The copper recovery rate increased with an increase in aqueous SDS concentrations between 5 and 8.5mM. The influences of nonionic surfactants on Cu recovery from SDS-Cu solution depended not only on the type of surfactants used, but also on applied concentrations. From the copper recovery perspective, TX at 0.1mM or NP should be selected rather than TW, because they did not inhibit copper recovery from SDS-Cu solution.

Psychometric evaluation of the Taiwanese version of the Kiddo-kINDL generic children's health-related quality of life instrument.

BACKGROUND: Health-related quality of life measures are increasingly being used in evaluating health care outcome around the world. There is a demand for the development of quality of life measures to be used cross-culturally. The aim of this study is to evaluate the psychometric properties of the Taiwanese version of Kiddo-KINDL, a health-related quality of life questionnaire. METHODS: The original German-version of Kiddo-KINDL was translated into Chinese (Taiwanese) via the forward/backward translation process. Psychometric testing was performed with a national sample of 1,985 healthy students between the ages of 12 and 16. Data were analyzed based on 1,675 usable questionnaires. RESULTS: The reliability coefficients were alpha = 0.81 (overall) and -0.31 to 0.84 for six subscales. The subscales with low Cronbach's alpha were "school" and "friends." Test-retest reliability was 0.77. Convergent validity was examined with the broadly used Taiwanese version of the Adolescent Depressive Mood Self-Detecting Scale. The result was satisfactory. Construct validity was further examined with exploratory factor analysis. The six-factor solution explained 45.2% of the variance. The construct of Kiddo-KINDL (Taiwanese version) appeared to be appropriate for measuring health-related quality of life in healthy adolescents. CONCLUSIONS: Kiddo-KINDL (Taiwanese version) is a relatively reliable and valid questionnaire of adolescents' health-related quality of life. However, items in the "school" and "friends" subscales need to be further modified to be more culturally appropriate.

Family influence on self-care, quality of life, and metabolic control in school-age children and adolescents with type 1 diabetes.

This study explored the influence of family behaviors on self-care, quality of life (QoL), and metabolic control in school-age children and adolescents with type 1 diabetes. Ninety-nine participants were recruited in the midsouth from a health science center and an affiliated diabetes camp. Warm and caring family behaviors predicted self-care behaviors and aspects of QoL for the participants. African American school-age children and adolescents had more worries related to diabetes and had poorer metabolic control than Caucasians. Nursing implications included emphasizing open family communication and providing emotional support for diabetes management to promote developmentally appropriate levels of self-care and QoL.

Persistence of Campylobacter pyloridis despite healing of duodenal ulcer and improvement of accompanying duodenitis and gastritis.

Campylobacter pyloridis has been associated with antral gastritis and duodenal ulcer. To study the pathogenetic role of these organisms in duodenal ulcer, endoscopic biopsies, two from the first part of duodenum, four from antrum, and four from body and fundus, were taken before and after four weeks of cimetidine treatment (1.2 g/day) from 67 patients with active duodenal ulcer. The biopsies were examined for the presence and severity of any inflammation by two independent pathologists in the absence of any clinical information and for the occurrence and density of Campylobacter pyloridis by culture and Warthin-Starry stain. Before treatment, inflammation was present in 71.1, 100, and 25.8%, while the organisms were present in 34.3, 91.0, and 79.1% of the duodenal, antral, and fundal biopsies, respectively. With complete healing of duodenal ulcer, inflammation was present in 48.9, 98.2, and 30.2%, while the organisms were present in 25, 76.7, and 63.3% of the respective mucosae. With ulcer healing, duodenitis became significantly milder (P less than 0.05). With improvement of gastritis and duodenitis, there was no significant change in the occurrence and density of Campylobacter pyloridis. These findings indicate that healing of duodenal ulcer is not influenced by the presence of Campylobacter pyloridis, which is frequently found in the gastroduodenal mucosa of patients with duodenal ulcer, but does not appear to be associated with mucosal inflammation except in the antrum.