Lian-Hua Huang

Selection of Appropriate Chinese Terms to Represent Intensity and Types of Physical Activity Terms for Use in the Taiwan Version of IPAQ

&NA; In order to analyze the health risks of insufficient activity by international comparisons, the first author obtained the permission to translate and develop a Taiwan version of the International Physical Activity Questionnaire (IPAQ). The objective was to determine culturally sensitive Chinese translations for the terms “moderate”, “vigorous” and “physical activity” as well as to identify representative types of physical activity for Taiwanese. This study used discussions by 12 expert focus groups, 6 expert audits, a scale survey, field study, Cognitive Aspect Survey Methodology (CASM), dual independent translation and back-translation to establish a consensus on physical activity-related concepts, terminologies and types that define the intensity of common activities of Taiwanese by integrating both local and foreign studies. The Chinese terms “fei li”, “zhong deng fei li” and “shen ti huo dong”, respectively, were identified as suitable and adequate translations for the English terms “vigorous”, “moderate” and “physical activity”. The common Taiwanese activities were accurately categorized and listed in questionnaires, forming culturally sensitive scales. Taiwan versions of IPAQs self-administered long version (SL), self-administered short version (SS), and telephone interview short version (TS) were developed. Their content validity indices were .992, .994, and .980, as well as .994, .992, and .994 for language equivalence and meaning similarity between the English and Chinese versions of the IPAQ-LS, IPAQ-SS, and IPAQ-TS, respectively. Consistency values for the English and Chinese versions in terms of intraclass correlation coefficients were .945, .704, and .894, respectively. The IPAQ-Taiwan is not only a sensitive and precise tool, but also shows the effectiveness of the methodology (CASM) used in tool development. Subjects who did not regularly exercise and had an education less than a junior high school level underestimated the moderate-intensity physical activity.

Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women.

BACKGROUND Depression during the perinatal period should be identified as early as possible to avoid negative effects on the new family. The purpose of this study was to examine the effectiveness of an exercise support program on reducing psychological morbidity after childbirth. METHODS A controlled trial was conducted in a regional hospital in Taipei, Taiwan. Eighty primiparas with an Edinburgh Postnatal Depression Scale (EPDS) score above 10 at 4 weeks postpartum agreed to participate. They were allocated alternately to an intervention (to receive exercise support) and control group (to receive standard care) at 6 weeks postpartum. The exercise support consisted of 1 hour per week at the hospital and two sessions at home for 3 months. Sixty-three primiparas finished the exercise support program. The main outcome measure was the EPDS score at 5 months postpartum. RESULTS Women who received the exercise support program were less likely to have high depression scores after childbirth when compared with the control group. CONCLUSIONS The exercise support program given to postpartum women appeared to benefit their psychological well-being. This promising finding should be tested in a well-designed randomized controlled trial.

Effectiveness of a discharge education program in reducing the severity of postpartum depression A randomized controlled evaluation study

OBJECTIVE The effectiveness of a hospital discharge education program including information on postnatal depression was evaluated to reduce psychological morbidity after childbirth. METHODS A randomized controlled trial (RCT) was conducted in a regional hospital in Taipei. Two hundred first-time mothers agreed to take part and were randomly allocated to an intervention group (n=100) or control group (n=100). The intervention group received discharge education on postnatal depression provided by postpartum ward nurses. The control group received general postpartum education. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) administered by postal questionnaire at six weeks and three months after delivery. RESULTS Women who received discharge education intervention on postnatal depression were less likely to have high depression scores when compared to the control group at three months postpartum. CONCLUSION A discharge educational intervention including postnatal depression information given to women during the postpartum stay benefits psychological well-being. PRACTICE IMPLICATIONS A postpartum discharge education program including information on postnatal depression should be integrated into postpartum discharge care in general practice.

Medication - Taking Behavior of the Elderly

The aim of this study was to examine the medication-taking behavior of older adults living in communities. Factors influencing their medication-taking behavior were also explored. Data were collected by way of a face-to-face interview survey through a random sample of 401 persons over 65 years of age, and were analyzed using SPSS computer software. The sample included two groups of people, one residing in an urban community and the other in a rural community. The results revealed information on the following kinds of medication behavior: self-medication, using non-prescription medications, sharing medication, forgetting to take medications, misusing medications, being non-compliant, using multi-medications, hoarding medications, and combining Western medications with traditional therapies. In comparing the differences between the urban and rural elderly, the urban elderly had more accurate medication knowledge and displayed better medication-taking behavior. An elderly persons age, gender, education level, marital status, living status and health belief were found to affect his/her medication knowledge and behavior. Education of both health care professionals and the general public is urgently needed to ensure the safety of taking medication by the elderly.

Knowledge about osteoporosis and its related factors among public health nurses in Taiwan

Although osteoporosis prevention has been identified as a critical issue for women and the elderly population, some health professionals still misunderstand osteoporosis. Public health nurses (PHNs) are responsible for health promotion and disease prevention in community populations. The objective of this study was to investigate PHNs’ knowledge of osteoporosis and its related factors. A cross-sectional research design was used: 678 subjects from 3,300 PHNs who worked at health centers in Taiwan during 2000 were selected by cluster random sampling to participate in this study; 539 of them returned the questionnaire. On average, the PHNs’ knowledge was found to be 0.68 (ranging from 0 to 1). The highest and lowest scores were found in the areas of disease prevention and the detection of the symptoms/signs of osteoporosis. By using one-way ANOVA, our study found that participants who had studied osteoporosis at school, had graduated from university, were RNs or LPNs and had studied osteoporosis as part of continuing education (CE) had higher knowledge scores. This study recommends that CE and nursing education about osteoporosis need to be highly valued. Nursing educators should reassess and reconstruct nursing curricula. Health administrators should evaluate learning needs and provide CE via multiple channels. Symptoms/signs, diagnosis/treatment and prevention issues are suggested as the core components of designing nursing curricula and CE.

A repeated measures study of changes in health‐related quality of life during pregnancy and the relationship with obstetric factors

AIMS To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy. BACKGROUND Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy. DESIGN A within-subject comparison was undertaken. METHODS In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures. RESULTS The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition. CONCLUSIONS The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.

The Relationships Among Sleep Quality and Chronotype, Emotional Disturbance, and Insomnia Vulnerability in Shift Nurses

Background:Shift work is a prominent feature of most nursing jobs. Although chronotype, emotional disturbance, and insomnia vulnerability are important factors for patients with insomnia in general, their effects on shift nurses are unknown. Purpose:This study explores the relationships between the sleep quality of shift nurses and the variables of chronotype, emotional disturbance, and insomnia vulnerability. Methods:A survey was conducted with 398 shift nurses in a medical center. Chronotype, emotional disturbance, insomnia vulnerability, and sleep quality were evaluated using the Smith Morningness–Eveningness Questionnaire, the Brief Symptom Rating Scale, the Ford Insomnia Response to Stress Test, and the Pittsburgh Sleep Quality Index, respectively. Results:On the Pittsburgh Sleep Quality Index, 70.1% of the participants scored higher than 5. Multiple regression analysis revealed that, together with night shift work (b [SE] = 1.05 [0.35], p = .003), higher levels of emotional disturbance (b [SE] = 0.30 [0.05], p < .001) and higher insomnia vulnerability (b [SE] = 0.18 [0.03], p < .001) were predictors of poor sleep quality and that chronotype was not a predictor of poor sleep quality. The multiple mediator model indicated that emotional disturbance significantly mediated an indirect effect of evening chronotype preference on poor subjective sleep quality (one subscale of the Pittsburgh Sleep Quality Index). Conclusions/Implications for Practice:In addition to shift patterns, emotional disturbance and high insomnia vulnerability are factors that may be used to identify shift nurses who face a higher risk of sleep disturbance. Because evening chronotype may indirectly influence subjective sleep quality through the pathway of emotional disturbance, further research into the mechanism that underlies this pathway is warranted.

Depressive Symptoms as a Predictor of Sexual Function during Pregnancy

INTRODUCTION Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. AIM To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). METHODS Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. MAIN OUTCOME MEASURES CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P=0.0004), arousal (P=0.0104), lubrication (P=0.0016), orgasm (P=0.0022), and pain (P<0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P=0.0005) and satisfaction (P<0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P<0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P<0.0005). Medical conditions were positive predictors of sexual desire (P=0.0023). CONCLUSIONS The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.

Leisure-time physical activities for community older people with chronic diseases

AIMS (1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people. BACKGROUND Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively. DESIGN A cross-sectional design was used for this study. METHODS Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting. RESULTS The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity. CONCLUSIONS The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA. RELEVANCE TO CLINICAL PRACTICE An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individuals needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas.

Attitudes toward maternal serum screening in Chinese women with positive results.

Maternal serum screening for fetal Down syndrome has been integrated into routine antenatal care in most clinics in Taiwan. We examined the attitudes toward serum screening and the possible implications in women with positive results. From January to July 1995, 276 women were referred to the Genetic Counseling Clinic, Mackay Memorial Hospital for amniocentesis because of positive screening results, and 214 participated in this study. All women opted for amniocentesis after genetic counseling. Over 40% stated that they made decisions independently after being informed of the serum screening. Need for certainty was the most frequently mentioned reason. Two-thirds believed that serum screening could provide a diagnosis. Almost all women would apply for maternal serum screening for future pregnancies. This study demonstrated that Chinese women need more counseling and autonomy regarding maternal serum screening.