Ruey-Hsia Wang

Risk and Protective Factors for Suicidal Ideation Among Taiwanese Adolescents.

Background:Suicide is the ninth leading cause of death in adolescents aged 15-19 years in Taiwan. Suicidal ideation is an important predictor of committing suicide among adolescents. Objectives:The aim of this study was to examine the important risk factors, the protective factors, and the role of protective factors on the relationship of risk factors to suicidal ideation among Taiwanese adolescents aged 15-19 years. Methods:By adopting a cross-sectional study, senior high school students (n = 577) aged 15-19 years in southern Taiwan were recruited for this study. An anonymous self-reported questionnaire was used to collect demographic characteristics, risk factors, protective factors, and suicidal ideation of the sample. Hierarchical logistic regression was used to identify the important risk and protective factors and the interaction between risk and protective factors on suicidal ideation. Results:Nearly 18% (n = 101) of the participants reported having suicidal ideation during the past 12 months. Gender (female; odds ratio [OR] = 4.23), life stress (OR = 1.03), depression (OR = 3.44), peer suicidal ideation (OR = 4.15), and bullying victimization (OR = 1.81) were important risk factors of suicidal ideation among the targeted sample. In addition, self-esteem (OR = 0.92) and emotional adaptation (OR = 0.88) were important protective factors of suicidal ideation. Self-esteem and emotional adaptation were not used to moderate the negative effects of life stress, depression, perceived peer suicidal ideation, and bullying victimization on suicidal ideation. The final model explained 40.6% of the total variance in suicidal ideation and correctly predicted 86.1% of participants with suicidal ideation. Discussion:Suicidal ideation prevention programs should be targeted to female adolescents. School-based efforts that provide adolescents with self-esteem enhancement, emotional regulation skills training, positive peer norms for life, coping skills for managing stress and depression, and antibullying programs might help reduce the suicidal ideation of adolescents.

A LONGITUDINAL STUDY OF NAUSEA AND VOMITING, FATIGUE AND PERCEIVED STRESS IN, AND SOCIAL SUPPORT FOR, PREGNANT WOMEN THROUGH THE THREE TRIMESTERS

Nausea and vomiting (NV), fatigue, stress and social support during pregnancy have been well documented using cross‐sectional research designs. However, few studies have addressed the patterns and relationships for these variables using a longitudinal research design. The purpose of this study was to examine the patterns of and relationships among NV, fatigue, perceived stress, and social support in pregnant women throughout the three trimesters. A prospective and longitudinal study was conducted from 2003 to 2005. Data were collected on four different measures: the Index of Nausea, Vomiting, and Retching (INVR), the Visual Analog Fatigue Scale (VAFS), the Perceived Stress Scale (PSS), and the Brief Social Support Questionnaire (BSSQ). A total of 91 pregnant women were recruited from prenatal clinics in southern Taiwan. One‐way ANOVA indicated that INVR scores and fatigue were significantly different among the three trimesters, but that perceived stress and social support were not. Post hoc analyses, using least significant difference testing, indicated that the first trimester was associated with significantly higher levels of NV than were the second and third trimesters. The first and third trimesters had significantly higher fatigue levels than did the second trimester. Mixed models indicated that the differences among INVR scores among the three trimesters were independent of gravidity, planned pregnancy and age. The difference in fatigue between the first and second trimesters was independent of gravidity, planned pregnancy and age, but fatigue was positively associated with NV. Perceived stress was positively correlated with NV. However, when further examining the relationships among the key variables by adding fatigue, perceived stress was found to positively correlate with fatigue and not NV, and negatively correlated with social support. The findings of this study provide a more comprehensive understanding and evidence‐based data of the patterns of and relationships among the above four key variables for pregnant women throughout the three trimesters. This will help health care professionals to provide more effective and appropriate care strategies based on the different stages of pregnancy.

A causal model of contraceptive intention and its gender comparison among Taiwanese sexually inexperienced adolescents

AIMS AND OBJECTIVES To test latent constructs of social influences, contraceptive attitude and self-efficacy for contraception as a causal model of contraceptive intention among adolescents and to search for possible gender differences in the causal model of contraceptive intention. BACKGROUND A greater understanding of the causal model of contraceptive intention among sexually inexperienced adolescents will help nurses design contraceptive programmes to improve adolescent contraceptive use when they have sex. Design. This was a cross-sectional study; 770 boys and 685 girls that self-reported not being sexually experienced were selected for this study. METHODS An anonymous questionnaire was used to collect data. By structural equation modelling using the eqs 6.1 software, a hypothesized structural model of contraceptive intention was tested. FINDINGS For both genders, social influences affected contraceptive intention indirectly through the contraceptive attitude and self-efficacy for contraception. Contraceptive attitude and self-efficacy for contraception affected contraceptive intention directly. Contraceptive attitude also affected contraceptive intention indirectly through the mediation of self-efficacy for contraception. There were gender differences in the variances of contraceptive intention explained by contraceptive attitude, self-efficacy for contraception and social influences. Nevertheless, the data explain only a low proportion of the variability in contraceptive intention. More causal constructs influencing contraceptive intention should be explored in future. CONCLUSIONS Personal factors and social influences operate interdependently to influence contraceptive intention among sexually inexperienced adolescents. Gender is a moderator that can modify the influential level of social influences, contraceptive attitude and self-efficacy for contraception on contraceptive intention. RELEVANCE TO CLINICAL PRACTICE Nurses should operate personal factors and social influences interdependently when they are designing intervention programmes for sexually inexperienced adolescents. To make intervention more effective, nurses also need to provide gender-specific intervention programmes for sexually inexperienced adolescents.

Relationships Between Leptin, hCG, Cortisol, and Psychosocial Stress and Nausea and Vomiting Throughout Pregnancy

The purposes of this prospective, longitudinal study were to examine the relationships between leptin, human chorionic gonadotropin (hCG), cortisol, and psychosocial stress and nausea and vomiting (NV) in women with mild-to-moderate NV throughout pregnancy. Participants comprised 91 pregnant women recruited from prenatal clinics in southern Taiwan. Data analysis using one-way analysis of variance (ANOVA) indicated that leptin, hCG, cortisol levels, and Index of Nausea, Vomiting, and Retching (INVR) scores, but not stress (measured with the Visual Analog Scale, VAS) scores, were significantly different among the three trimesters. The average INVR score and hCG level decreased from the first to third trimesters (p < .0001 for both). The average leptin and cortisol levels increased from the first to third trimesters (p = .001 and p < .0001, respectively). Analysis using mixed models indicated that the INVR scores decreased significantly in a progressive manner through the stages of pregnancy and were significantly lower in the second and third trimesters. Findings reveal that stress/VAS and hCG may both be significantly and independently associated with INVR scores. Future research should examine psychosocial reactions in addition to exploring other biochemical markers related to NV and stress.

The psychometric testing of the diabetes health promotion self-care scale.

Background: Health-promoting behavior is an important strategy to maintain and enhance health of patients with Type 2 diabetes. Few instruments have been developed to measure health promotion self-care behavior of patients with Type 2 diabetes. Purpose: Developing and psychometric testing of the Chinese version of the Diabetes Health Promotion Self-Care Scale (DHPSC) for patients with Type 2 diabetes. Methods: Four hundred and eighty-nine patients with Type 2 diabetes were recruited from endocrine clinics in four hospitals in Kaohsiung City in southern Taiwan. Exploratory and confirmatory factor analyses were used to assess the construct validity of the scale. Correlations between the DHPSC and the satisfaction subscale of Diabetes Quality of Life, Diabetes Empowerment Scale, and HbA1c were calculated to evaluate concurrent validity. Internal consistency and test–retest reliability were used to assess the reliability of the scale. The study was conducted in 2007 and 2008. Results: A proposed second-order factor model with seven subscales and 26 items fit the data well. The seven subscales were interpersonal relationships, diet, blood glucose self-monitoring, personal health responsibility, exercise, adherence to the recommended regimens, and foot care. The DHPSC statistically significantly correlated with the satisfaction subscale of Diabetes Quality of Life and the Diabetes Empowerment Scale. HbA1c only statistically significantly correlated with the subscale of health responsibility. Reliability was supported by acceptable Cronbach’s alpha (range, .78–.94) and test–retest reliability (range, .76–.95). Conclusions/Implications for Practice: The DHPSC has satisfactory reliability and validity. Healthcare providers can use the DHPSC to comprehensively assess the health promotion self-care behaviors of patients with Type 2 diabetes.

Self-Care and Well-Being Model for Elderly Women: A Comparison of Rural and Urban Areas

The purposes of this study were to examine the relationships among age, social class, perceived health, self‐care, and well‐being in urban and rural elderly women and to validate and compare two models using these two groups. A causal model of self‐care and well‐being was proposed for this study based on Orems self‐care model and empirical data. Data were collected using a survey‐interview method. Of the 351 elderly women recruited, 159 were in the urban group and 192 in the rural group. Two models of self‐care and well‐being were tested using path analysis with the LISREL 8 program. The resultant models yielded a Chi‐squared of 1.98 with two degrees of freedom (p = 0.37) in the urban group and a Chi‐squared of 4.20 with three degrees of freedom (p = 0.24) in the rural group, indicating good fit between the data and the two models. These two models provide guidelines for community nurses to design appropriate self‐care programs for elderly women.

Efficacy of five-element gymnastics in glucose and lipid control in taiwanese patients with type 2 diabetes

The purpose of this quasi-experimental study was to determine the efficacy of Five-Element Gymnastics (FEG) in controlling glycosylated hemoglobin (HbA1C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) at the 8th and the 16th weeks of intervention for patients with type 2 diabetes in Taiwan. FEG consolidates several traditional Chinese exercises including Qigong, Xiang Gong, and martial arts with gymnastics. The experimental group (n = 31) practiced FEG at home for 16 weeks. The control group (n = 35) maintained usual activities. FEG was associated with decrease of HbA1C, TG, and LDL-C levels at the 8th week and continuous decrease of HbA1C through the 16th week. FEG could be an exercise choice for patients with type 2 diabetes.

The Efficacy of a Family-Based Intervention Program on Childhood Obesity A Quasi-Experimental Design

The purpose of this quasi-experimental study was to assess the efficacy of a family-based (FB) weight-loss and behavior-modification intervention among overweight/obese children (age 9–11 years) and their parents in Taiwan. The intervention group (52 child–parent dyads) participated in an FB program for 7 weeks. The control group (55 child–parent dyads) received an educational pamphlet about obesity prevention. The children’s body mass index (BMI) z-scores were the primary outcome variable. The parents’ BMI, high-calorie (HC) food-intake behaviors, screen-related behaviors, and restrictions on children’s consumption of HC foods and screen-related behaviors and the availability of HC foods at home were the secondary outcome variables. Outcome variables were measured at baseline (T0), at the end of the intervention (T1), and 4 weeks after the end of the intervention (T2). A linear mixed model was used to assess the efficacy of the FB program. Results indicated that the children’s BMI z-scores decreased significantly more from T0 to T2 in the experimental group than in the control group. The decreases in parents’ HC food-intake behaviors and availability of HC foods at home and the increase in parental restrictions on children’s consumption of HC foods were significantly greater in the experimental than in the control group from T0 to T1 and T0 to T2. The FB program was effective in modifying parental behaviors and the weight of overweight/obese children in a Taiwanese population.

Development and Psychometric Testing of the Chinese Version of the Diabetes Empowerment Process Scale

Aim. This paper is a report of development and psychometric testing of the Chinese version of the Diabetes Empowerment Process Scale. Background. In people living with diabetes, empowering can improve metabolic and psychosocial outcomes. A scale for measuring empowerment processes can help healthcare professionals to optimize their empowering actions and would improve their interactions with people living with diabetes. Method. Based on literature reviews and interviews with people living with diabetes, a 27-item Chinese Diabetes Empowerment Process Scale was developed. Fifteen items were produced after item analysis and content validity testing. To test construct validity, concurrent validity, and internal consistency, 211 outpatients living with diabetes completed the Chinese Diabetes Empowerment Process Scale, a self-care behavior scale, and a Diabetes Empowerment Scale. Test- retest reliability was also analyzed in 30 patients. The study was conducted in 2008 and 2009 in Taiwan. Results. Confirmatory factor analysis indicated that a second-order factorial model with four subscales and 15 items best fit the data. The four subscales were mutual participation, raising awareness, providing necessary information, and open communication. Scores on the Chinese Diabetes Empowerment Process Scale significantly correlated with those on the Self-care Behavior Scale (r=0.21-0.40; P＜ 0.01) and Diabetes Empowerment Scale (r=0.35-0.65; P＜ 0.01). Reliability was supported by acceptable Cronbachs α (range, 0.73-0.91) and test-retest reliability scores (range, 0.75-0.83). Conclusions. The Chinese Diabetes Empowerment Process Scale has satisfactory reliability and validity for measuring the empowerment process of health professionals. Further studies are needed to test the applicability of the scale to other populations.