Yu Yun Hsu

A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety

AIMS To determine the effect of music therapy and verbal relaxation on state anxiety and anxiety-induced physiological manifestations among patients with cancer before and after chemotherapy. BACKGROUND Cancer and its treatment provoke a series of changes in the emotional sphere of the patients anxiety. Music therapy and verbal relaxation had reported the anxiety reduction effect on patients with cancer receiving chemotherapy. Few studies have been undertaken comparing music therapy and verbal relaxation in differentiating high-normal state anxiety subsample. DESIGN A randomised controlled trial and permuted block design were used. Outpatient chemotherapy clinic operated by a University medical centre in southern Taiwan. METHODS Ninety-eight patients were randomised into three groups: the music therapy group received one-hour single music session; the verbal relaxation group received 30 minutes of guided relaxation; the control group received usual care. Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, three biobehavioural indicators: skin temperature, heart rate and consciousness level were measured during and after chemotherapy. RESULT Music therapy had a greater positive effect on postchemotherapy anxiety than verbal relaxation and control groups and a significantly increase in skin temperature. Patients with high state anxiety receiving music therapy had a greater drop in postchemotherapy anxiety than did the normal state anxiety subsample. CONCLUSIONS Both music and verbal relaxation therapy are effective in reducing chemotherapy-induced anxiety. Thirty minutes of intervention initiates anxiety reduction. Patients with high state anxiety receiving chemotherapy obtain the most benefit from music or verbal relaxation. RELEVANCE TO CLINICAL PRACTICE Prior to chemotherapy, patients with high state anxiety must be sorted from all patients as they are more responsive to interventions. Oncology nurses can offer music and verbal relaxation as adjuvant interventions to reduce chemotherapy-induced anxiety and enhance the quality of care.

Intention to obtain human papillomavirus vaccination among taiwanese undergraduate women

Background: The human papillomavirus (HPV) vaccine provides an effective strategy against HPV infection, genital warts, and cervical cancer. While the HPV vaccine is available worldwide, acceptance outside of Western countries is unknown. The purpose of the study was to examine health beliefs and intention to obtain the HPV vaccination among undergraduate women in Taiwan. A predictive model of HPV vaccination intention was investigated. Methods: A convenience sample of 845 female undergraduate students (mean age = 20 years, aged: 17–36 years) recruited from 5 universities located in South Taiwan, provided data. A self-administered questionnaire requested demographic information, gynecologic history, awareness of HPV and the vaccine, health beliefs, and intention to obtain the HPV vaccine. Results: Over 50% of the undergraduate women were aware of HPV and the HPV vaccine. Sixty-three percent of the students reported a high intention to obtain the HPV vaccine. Demographic factors predicting HPV vaccination included: age, family history of gynecologic cancer, personal history of gynecological visit, sexual experience, and awareness of HPV and the HPV vaccine. Health belief factors predicting HPV vaccination included: personal susceptibility of disease, perception of disease severity, attributes of HPV, cost and availability of vaccine, attributes of HPV, and recommendations from others. Conclusions: Improving undergraduate women’s HPV vaccination rate will require educational campaigns, specifically focused on the efficacy, safety, and benefits of the HPV vaccine and the attributes of HPV infection. Targeting incoming students who are not yet sexually active could achieve successful outcomes.

Knowledge and beliefs about cervical cancer and human papillomavirus among Taiwanese undergraduate women.

PURPOSE/OBJECTIVES To assess knowledge and attitudes regarding cervical cancer and human papillomavirus (HPV) among undergraduate women in Taiwan. DESIGN A descriptive cross-sectional design. SETTING Five universities in southern Taiwan. SAMPLE 953 undergraduate women aged 17-36 years. METHODS The self-administered HPV Belief questionnaire was used to collect data on knowledge and beliefs regarding cervical cancer, Pap testing, and HPV. MAIN RESEARCH VARIABLES Knowledge, beliefs, cervical cancer, Pap testing, HPV, likelihood of cervical cancer, and HPV infection. FINDINGS Seventy percent of participants agreed that cervical cancer could be prevented and was a severe disease, and 80% knew the purpose of Pap testing. Forty-nine percent were aware of HPV. Undergraduate women with an awareness of HPV were more likely to be older, studying a health-related major, have a higher class standing, have a personal history of gynecologic visits, and have had a Pap test. Neither family history of gynecologic cancer nor sexual experience predicted HPV awareness, although sexual experience had a significant association with the knowledge and beliefs of cervical cancer. Most of the undergraduate women believed themselves unlikely to acquire cervical cancer or HPV infection. CONCLUSIONS Undergraduate women in Taiwan have limited knowledge of cervical cancer and HPV. Awareness of the likelihood of HPV infection is low among undergraduate women, even those who are sexually active. IMPLICATIONS FOR NURSING Educational campaigns focusing on cervical cancer screening and HPV infection are needed, particularly for sexually active undergraduate women.

Health beliefs of Taiwanese women seeking HPV vaccination

In Taiwan, human papillomavirus (HPV) vaccine is recommended for women aged 9-26 years. The purpose of this study was to examine health beliefs and reasons for HPV vaccination among young adult women (aged 18-26 years), and adult women (aged over 26 years). Women who initiated HPV vaccination were recruited from three hospitals in southern Taiwan. One hundred and eighty-nine subjects completed a questionnaire on health beliefs and reasons for HPV vaccinations. 38% (n=72) of the women who initiated vaccination were over the age of 26. Health beliefs regarding HPV vaccination differ between young adult women and adult women. Recommendations from others (family, health care providers, etc.) are among the main reasons for young adult women to initiate HPV vaccination; while self-awareness of the risk for HPV infection and personal gynecologic diseases are main reasons for adult women to initiate HPV vaccination. Furthermore, women aged 18-26 are more likely than women aged over 26 to consider the cost and availability of vaccination. Media also plays an important role in a womans decision to seek HPV vaccination.

Early oral intake and gastrointestinal function after cesarean delivery: A Systematic Review and Meta-Analysis

OBJECTIVE: To evaluate whether early oral intake after cesarean delivery has an effect on gastrointestinal outcomes during postpartum recovery. DATA SOURCES: Electronic searches of published studies between 1980 and 2011 were conducted using PubMed, Medline, CINAHL, ClinicalTrials.gov, and Airiti databases. METHODS OF STUDY SELECTION: Randomized controlled trials (RCTs) and nonrandomized trials were included. Data were extracted in a systematic manner and the quality of each study was appraised independently by two reviewers. Meta-analyses were conducted only for RCTs using the RevMan5. TABULATION, INTEGRATION, AND RESULTS: Seventeen studies met eligible criteria and were retrieved, including 14 RCTs and three non-RCTs. The majority of early oral intake was provided within 6–8 hours after cesarean delivery. Early oral intake was significantly related to the return of gastrointestinal functions compared with delayed oral intake (bowel sounds –9.2 hours; passage of flatus –10 hours; bowel evacuation –14.6 hours). Early oral intake did not significantly increase the occurrence of gastrointestinal complications compared with delayed oral intake after cesarean delivery (ileus symptoms 18.7% compared with 18%, odds ratio [OR] 0.98; vomiting 5% compared with 5.5%, OR 0.9; nausea 10.3% compared with 10.3%, OR 1.03; abdominal distention 9.3% compared with 11.6%, OR 0.82; diarrhea 3.4% compared with 5%, OR 0.62). CONCLUSION: Early oral intake after cesarean delivery improves the return of gastrointestinal function and does not increase the occurrence of gastrointestinal complications. A clinical implication based on the findings of the current evidence is proposed.

Electronic personal maternity records

This study develops an antenatal care information system to assist women during pregnancy. We designed and implemented the system as both a web-based service and a multi-platform application for smartphones and tablets. The proposed system has three novel features: (1) web-based maternity records, which contains concise explanations of various antenatal screening and diagnostic tests; (2) self-care journals, which allow pregnant women to keep track of their gestational weight gains, blood pressure, fetal movements, and contractions; and (3) health education, which automatically presents detailed information on antenatal care and other pregnancy-related knowledge according to the womens gestational age. A survey was conducted among pregnant women to evaluate the usability and acceptance of the proposed system. In order to prove that the antenatal care was effective, clinical outcomes should be provided and the results are focused on a usability evaluation.

Estimation of Potential Gain in Quality of Life from Early Detection of Cervical Cancer

OBJECTIVE To estimate the lifetime gain in the health-related quality of life (HRQOL) from early detection of cervical cancer. METHODS A consecutive, cross-sectional sample of 421 patients with cervical cancer was administered the World Health Organization Quality of Life-brief version questionnaires. A nationwide sample of 22,543 patients with invasive cervical cancer (ICC) was collected from the national cancer registry for estimation of lifetime survival function from 1998 to 2007, which was further multiplied by the ratio of HRQOL score functions for patients with ICC and patients with carcinoma in situ (CIS), and summed up over lifetime to obtain expected relative-quality-adjusted survival. The difference between lifetime survival and the expected relative-quality-adjusted survival gives the expected total dissatisfied time during the life course. RESULTS In comparison with patients with CIS postconization, patients with ICC showed consistently lower scores in the physical and psychological domains and that of sexual life after adjustment for other risk factors. The expected years of life lost for an invasive cancer was 6.48 years using the general population as the reference cohort, while the durations of equivalent to living with a very dissatisfied HRQOL were 1.71 and 0.25 for the physical and psychological domains, respectively, and 1.47 years for sexual life. Validation of the extrapolation method based on a subcohort followed from the 6th to the 13th year shows a relative bias of 0.4%. Sensitivity analysis with 37,000 CIS cases as the reference cohort yields a similar result. CONCLUSIONS Early detection of cervical cancer not only avoids premature mortality but also prevents long-term living under lower HRQOL scores, including sexual life.

Enhanced myometrial autophagy in postpartum uterine involution.

OBJECTIVE To understand the mechanisms of postpartum uterine involution, we investigated the uterine myometrial changes during pregnancy and the postpartum period. MATERIALS AND METHODS Nine groups of uterine myometrial samples from mice (n = 4) were collected on gestational Day 0 (nonpregnant), Day 1, Day 2, Day 7, Day 14, and Day 21 and on postpartum Day 1, Day 2, and Day 7. Human samples of uterine myometrium on term (n = 1) and postpartum Day 1 (n = 2) were also collected. Ki-67 immunostaining was used to determine myometrial proliferation. For cell hypertrophy analysis, organelle proteins, β-actin, prohibin, calnexin, and golgin-97 were analyzed by Western blotting. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) and evaluation of activated caspase-3 expression by Western blot analysis assay were used to detect apoptosis. Autophagy was assayed via the evaluation of LC3 expression by Western blotting, immunohistochemistry, and autophagosomes by electron microscopy. RESULTS Uterine myocytes proliferated during the early stage of gestation with a peak at Day 2, whereas myocyte hypertrophy with increased cellular organelle production occurred gradually in later stages of pregnancy. Postpartum autophagy developed abruptly in uterine myocytes without obvious apoptosis. CONCLUSION Autophagy of myocytes may play an important role in uterine involution. These results have implications for our understanding of myometrial functional adaptations during pregnancy and the physiological role of autophagy in the uterine remodeling events in the postpartum period.

Chemotherapy-Induced Peripheral Neuropathy Assessment Tools: A Systematic Review

PROBLEM IDENTIFICATION Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting chemotherapy toxicity, which has a long-lasting effect and decreases quality of life. Although several tools have been developed to detect CIPN, the study quality, psychometric properties, and practicality of CIPN assessment tools have not been systematically reviewed.
. LITERATURE SEARCH Electronic searches using keywords were conducted in Medline, PubMed, CINAHL®, and Cochrane Library for articles published from 1980-2015. Eligible studies were included if they involved patients with cancer receiving chemotherapy, provided CIPN assessment tools with psychometric properties, and were published in English.
. DATA EVALUATION Data were extracted, and study quality was assessed. CIPN tools were evaluated in terms of psychometric properties and practicality.
. SYNTHESIS A total of 19 studies describing 20 tools were reviewed. The quality of studies varied from strong to weak. The validity ranged from low to high, and the reliability with internal consistency ranged from 0.56-0.96. Poor inter-rater agreement was found. Not all of the tools were deemed practical.
. CONCLUSIONS Considering the psychometric properties and practicality, two tools (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity [FACT/GOG-Ntx] and Total Neuropathy Score [TNS]) are recommended for assessing CIPN.
. IMPLICATIONS FOR NURSING Routine assessment of CIPN and choosing appropriate assessment tools are imperative. The FACT/GOG-Ntx and TNS are recommended for clinical use.

The depressive symptoms, resourcefulness, and self-harm behaviors of adolescents

Background: A report published by the World Health Organization indicates that depression typically first manifests during youth. However, adolescents usually lack the capacity for self-help or to seek help proactively from health professionals or other related resources to relieve their emotional distress. Failing to manage depression appropriately places adolescents at risk for self-harm and suicide. Purpose: This study explored the correlations among the depressivesymptoms, resourcefulness, and self-harm behaviors of adolescents. In addition, the impact of depressive symptoms and resourcefulness on the self-harm behaviors of adolescents was examined. Methods: A cross-sectional and correlational design was used. One hundred forty secondary school (junior and senior high school) students in southern Taiwan were recruited for data collection using three questionnaires that measured, respectively, their depressivesymptoms, resourcefulness, and self-harm behaviors. Results: Depressive symptoms and self-harm behaviors correlated significantly and positively (r = .79, p < .001). Resourcefulness correlated significantly and negatively with both depressive symptoms (r = −.35, p < .001) and self-harm behaviors (r = −.29, p < .001). Finally, depressive symptoms significantly predicted self-harm behaviors. Conclusions/Implications for Practice: This study provides new findings regarding the significant relationship between resourcefulness and self-harm behaviors in adolescents. Future research is suggested to explore the effect of interventions about resourcefulness training on the mental health of adolescents.