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[[alternative]]Developing a Deep Learning-Based De-identification System for Facial Features in Medical Images Integrated with a Dynamic Patient Consent Mechanism
No full text[[abstract]]隨者醫學影像在臨床診斷、學術研究、教育和醫療保健資訊平台中的二次使用顯著增加了腦科學中包含臉部影像的資料集的可用性。在這些情況下保護病患隱私至關重要，需要強大的去識別方法。本研究提出了一種基於深度學習的新穎方法，該方法整合了用於醫學影像去識別的動態授權機制，其中包含去臉部識別(de-face)。3D U-Net 模型可在 3D 重建大腦影像中準確偵測和分割臉部特徵，包括眼睛、鼻子、耳朵和嘴巴。然後，生成對抗網路（3D GAN）合成並替換原始大腦影像中的這些特徵，確保核心大腦結構保持不變。此方法重點在於顯示 3D 大腦影像表面部分的區域。方法包括收集 490 張頭部 CT 影像，分為訓練集和測試集（80:20 比例），以及來自台北榮總醫院的 70 張頭部 MR 影像作為驗證集。訓練資料集的鼻子、嘴巴和眼睛偵測準確率達 100%，耳朵偵測準確率達 85.03%。在測試集中，耳朵檢測準確率為 65.98%，而驗證資料集的耳朵檢測準確率為 100%。結構相似性指數（SSIM）分析顯示原始特徵和生成特徵在像素值上的相似性有顯著差異。為了驗證去識別化後不影響圖片的研究價值，我們將產生的 3D 影像轉換為 2D，並與腦組織區域中的原始 2D影像進行比較，顯示相同的相似度值。這說明本實驗在去辨識過程中保護了腦影像組織，也達到了去辨識的目的。該系統與醫院的影像存檔和通訊系統（PACS）安全地整合，遵守數位醫學影像（DICOM）標準，並包含動態同意機制以維護病患自主權。此方法非常適合現實世界的成像場景，在未來的臨床應用中具有巨大的潛力，促進去識別技術的進步，增強隱私保護。[[abstract]]The secondary use of medical images for clinical diagnosis, academic research, education, and healthcare information platforms has significantly increased the availability of datasets containing facial images in brain science. Protecting patient privacy in these contexts is crucial, necessitating robust de-identification methods. This thesis proposes a novel deep learning-based approach that integrates a dynamic authorization mechanism for medical image de-identification including de-face. A 3D U-Net model accurately detects and segments facial features, including eyes, nose, ears, and mouth, in 3D reconstructed brain images. A generative adversarial network (3D GAN) then synthesizes and replaces these features in the original brain image, ensuring core brain structures remain unchanged. The approach focuses on regions showing parts of the surface of 3D brain images. The methodology involved collecting 490 head CT images, split into training and test sets (80:20 ratio), and 70 head MR images from Taipei Veteran General Hospital as a validation set. The training dataset achieved 100% accuracy for detecting the nose, mouth, and eyes detection, and 85.03% for ear detection. In the test set, ear detection accuracy was 65.98%, while the validation set achieved 100% accuracy for ear detection. Structural Similarity Index (SSIM) analysis shows significant differences in the similarity between the original and generated features in pixel value. To verify the proposed de-facing method does not affect the research value of the images, we converted the generated 3D images to 2D and compared them with the original 2D images in the brain tissue regions, showing the same similarity values. This demonstrates that this experiment protects the brain image tissue in the process of de-identification and also achieves the intention of de-identification. The system integrates securely with the Picture Archiving and Communication System (PACS) in the hospital, adheres to Digital Imaging and Communication in Medicine (DICOM) standards, and includes a dynamic consent mechanism to maintain patient autonomy. This method is well-suited for real-world imaging scenarios and has significant potential for future clinical applications, promoting advancements in de-identification technology and enhancing privacy protection
[[alternative]]Acoustic-phonetic Enhancement of Vowels and Tones in Taiwan Mandarin Clear Speech Productions
No full text[[abstract]]為了有效的傳遞訊息，說話者會試圖增強聲學線索以克服環境中的挑戰，此說 話方式為清晰言語。雖然英語清晰言語或其他中文的誇張式言語(如嬰兒導向語言)受到關注，但在臺灣中文的清晰言語研究相對較少。而此研究可以提升 我們對語音處理和音調編碼的認識，並為語音識別和合成技術提供見解。 本研究旨在探究元音和聲調線索在清晰言語中的增強方式，並探討元音類別是 否影響聲調增強的效果。我們招募 30 位臺灣中文母語女性，並請她們分別使 用自然言語和清晰言語說出指定句子(例如「我這樣說搭機這個詞」)。 首先，元音分析顯示清晰言語中的元音空間擴展和分散，且此變化主要由 /a/ F1 值增加和/u/ F2 值降低所致。其次，聲調分析顯示聲調空間和音高範圍的擴展， 此變化主要由高頻範圍的增加驅動。另外，雖然清晰言語利用音高和時間線索， 但不同聲調對各線索的使用有所不同。例如，增強一聲和二聲是利用提高基頻平均值，而增強三聲和四聲則是利用更陡的基頻斜率。清晰言語普遍呈現提高的基頻平均、更陡的基頻斜率、更廣的聲調範圍、更長的持續時間、更早的相對轉折點以及較少的喉嘎音。主成分分析表明主要的心理聲學參數是與音高變化相關的線索(如基頻斜率、聲調範圍、相對轉折點)，而音高高度相關的線索(如基頻平均、喉嘎音)則為次要。邏輯迴歸分析顯示，在自然言語中持續時間和音高變化會互相協調，而在清晰言語中，說話者會在拉長時長下盡量維持音高變化。這一發現支持自主音段音系學和 Soft TEMplate Mark-up model。 最後，本研究未發現元音對聲調過度清晰化有顯著影響。這些發現有助於深入理解臺灣中文清晰言語中的母音和聲調處理，並具有潛在應用，包括改善語音識別和合成系統。[[abstract]]Speakers modify acoustic cues for effective communication under challenging conditions. Such “clear speech” is understudied among speakers of Mandarin. Studying Mandarin clear speech addresses fundamental questions about language processing and tonal encoding, providing insights for speech recognition and synthesis technologies. This study examines vowel and tonal cue enhancement in clear speech, and the impact of vowels on tonal enhancement. Thirty female speakers produced both casual and clear speech, with target words embedded in carrier sentences. First, vowel analysis revealed an expansion and dispersion of vowel space in clear speech, driven by higher /a/ F1 and lower /u/ F2. Second, tonal analysis showed an expansion in tone space area and pitch range, driven by an increase in the higher frequency range. Clear speech utilizes pitch and temporal cues, but not equally across tones. In general, clear speech tones exhibit higher fo mean, steeper fo slope, wider tonal range, longer duration, an earlier relative turning point, and less creakiness. Principal component analysis identified pitch change cues (fo slope, tonal range, relative turning point) as primary psychoacoustic parameters, while pitch height cues (fo mean, HNR) are secondary. More importantly, logistic regression revealed an apparent coupling between duration and pitch change in casual speech that was not apparent in clear speech. This finding supports the autosegmental phonology framework and Soft TEMplate Mark-up model. Lastly, no significant effect of vowels on tonal hyperarticulation was found in this study. These findings contribute to a deeper understanding of Mandarin speech processing and have potential applications in improving speech technologies
[[alternative]]A comparison of the effects of situated simulation and e-learning on dementia communication among clinical nurses
No full text[[abstract]]背景：根據衛生福利部統計，2024年台灣65歲以上約有35萬人罹患失智症，且隨著年齡越長，發生率越高。失智症者之平均住院天數為非失智症者之5倍，且一半以上之失智症者有再住院之情形，因此，加強醫院護理人員與失智症者之溝通能力已刻不容緩。目的：本研究旨在比較兩種失智溝通教育方式，對護理人員失智溝通知識、溝通態度及溝通技能之成效。方法：本研究採類實驗研究設計，以台北市某區域醫院之臨床護理人員為研究對象，方便取樣60人，分為兩組，模擬組(30人)接受情境模擬溝通課程，線上組(30人)接受線上非同步教學。兩組均於課程教學前、後填寫失智溝通知識、態度問卷，由標準化病人進行溝通技能評量，並接受課後滿意度調查。回收量性資料以統計套裝軟體SPSS 24.0版進行統計分析，包含：描述性統計、獨立樣本t檢定、成對樣本t檢定、ANCOVA、詹森內曼法、Pearson χ2 test、多元線性回歸分析等。結果：（一）兩組之基本資料及失智症溝通經驗具同質性(p>.05)；(二)兩組之溝通知識後測得分皆顯著高於前測( p .05). (2) Communication knowledge scores significantly improved from pre-test to post-test in both groups (p < .001), with the simulation group outperforming the online group (p < .001). (3) Positive communication attitudes significantly increased from pre-test to post-test (p < .001), with the simulation group showing higher scores than the online group (p < .001). Negative attitudes decreased significantly from pre-test to post-test (p < .001), with no significant difference between the groups (p = .16). (4) Differences in communication skills were observed between the two groups at pre-test, and when pre-test scores were < 8.18, post-test scores and item scores significantly differed between the groups, with the simulation group scoring higher than the online group (p < .001). (5) After controlling for confounding variables, differences in communication knowledge and skills persisted between the simulation group and the online group (p < .001). (6) Communication knowledge correlated moderately positively with positive attitudes (r = .46, p < .001), as did positive communication attitudes with dementia communication skills (r = .48, p < .001). (7) Clinical nurses reported higher satisfaction with simulation teaching compared to online teaching (p < .001).Conclusions: Both teaching methods improved nursing staff's knowledge, attitudes, and skills in dementia communication, and the effect of simulation teaching was better than online teaching. This confirms that scenario-based simulation is an effective clinical teaching method. The study's results can be used as a reference for clinical dementia communication education. Communication courses can be developed into diverse scenarios based on the progression of dementia. Future research can extend the follow-up period or increase qualitative data collection to better understand learners' competence changes and learning experiences.Key words: dementia, situated simulation, e-learning, standardized patien
[[alternative]]The Effect of Using Anchored Instruction on Nursing Students’ Electrocardiogram Interpretation Competency
No full text[[abstract]]背景 心電圖的正確判讀與解釋是複雜的學習任務且在臨床上具有挑戰性，錯誤解釋可能導致不良結果，心電圖判讀結果會依照不同臨床情境而有所不同處置，有效地建構護理人員心電圖判讀知識為一重要教學策略思考方向，因此面對心電圖判讀之難題，要如何有效透過教學策略，建立正確判讀心電圖的能力為護理實習生重要學習課題之一。目的 本研究旨在探究融入「錨式情境教學」時，對提升臨床護理實習生心電圖判讀知識、學習動機和臨床推理能力之學習成效的改變。方法 本研究為類實驗設計(quasi-experimental research design)，進行雙組重複測量之研究。研究參與者為96位北台灣某醫院護理系實習學生，所有參與者均修習過內外科護理學，並具有臨床內外實習經驗，而後進行隨機分組，實驗組(n= 48) 接受「錨式情境教學」模式，對照組(n= 48) 接受「課室講述教學」模式，各組的教學實驗時間均為100分鐘，由研究者擔任教師。本研究設計了三個依變項探究不同教學模式的學習成效，分別為「心電圖判讀知識」、「心電圖判讀學習動機」、「心電圖判讀臨床推理能力」。此外，設計「是否具備ACLS證書」與「三個月內心電圖學習經驗」為調節變項。在評量資料部分，實驗教學前後分別進行前測、後測與延宕測，做為資料分析的依據。研究工具包括：自行設計的Thinglink互動多媒體工具、自擬心電圖判讀認知量表、學習動機量表和臨床推理能力量表與實驗教學現場的觀察與訪談。結果 透過GEE統計分析結果，發現兩組護理學生在實驗教學介入後，後測與延宕測的心電圖判讀認知結果均高於前測，且達顯著差異(p < 0.01)，在時間與組別的交互作用下，實驗組學生的心電圖判讀認知在延宕測與前測成績相較達顯著差異(p < 0.05)，研究結果顯示心電圖判讀教學課程，不論是採用「課堂講授教學」或是「錨式情境教學」，皆能提升護理學生對於心電圖判讀認知、學習動機量表和臨床推理能力，而融入錨式情境教學策略更具有知識保留效果。在調節變項的分析中，發現是否具ACLS證書，對護理學生於心電圖判讀課程融入錨式情境教學有顯著影響，而近期有心電圖判讀學習經驗的學生在學習動機和臨床推理能力上表現優於近期沒有學習經驗的學生。結論與建議 融入錨式情境教學模式可以增加學生對於心電圖判讀時臨床實際感受的體驗，在情境中將知識與臨床實務結合，提升學習成效。學習過程中可以透過互動方式提高參與度及專注力，並透過在情境中的錨點，強化護理實習生的臨床推理能力與學習動機。結合多媒體互動工具學習，可以讓學生反覆練習，促進護理學生在實習期間面對不可預測情境時的應變能力，能融貫所學知識，運用於臨床實際場景中，在面對病人照護上更有自信心，促進護理品質。建議未來可運用錨式情境教學設計於對不同護理主題相關課程，增進護理學生學習動機及臨床推理能力，提升學習成效。關鍵字：錨式情境教學、心電圖判讀知識、學習動機、臨床推理能力、Thinglink [[abstract]]Background Correct interpretation of electrocardiograms (ECGs) is complex and clinically challenging, as errors in interpretation can lead to adverse outcomes. ECG interpretations and management vary based on different clinical scenarios. Effectively constructing nursing students' knowledge of ECG interpretation is an important pedagogical strategy. Therefore, addressing how to effectively build the ability to interpret ECGs through teaching strategies is a crucial learning topic for nursing students.Objectives This study aims to investigate the effects of integrating "Anchored Instruction" on improving student nurses’ knowledge of ECG interpretation, learning motivation, and clinical reasoning abilities.Methods This study employed a quasi-experimental research design to investigate the effects of two different teaching methods on learning outcomes through repeated measurements in two groups. The participants were 96 nursing student interns from a hospital in northern Taiwan. All participants had completed courses in both medical-surgical nursing and had clinical internship experiences. They were randomly assigned to either the experimental group (n=48), which received the "anchored instruction" approach, or the control group (n=48), which received the "lecture-based instruction". Each instructional session lasted for 100 minutes and was conducted by the same researcher. The study examined three dependent variables to assess the learning outcomes of different teaching methods, including "knowledge of ECG interpretation," "motivation for learning” and "clinical reasoning ability in ECG interpretation." Additionally, "possession of ACLS certification" and "experience with electrocardiogram learning within the past three months" were included as moderating variables. Assessment data were collected through pre-tests, post-tests, and delayed post-tests conducted before and after the instructional sessions. Research tools included a self-designed Thinglink interactive multimedia application, a self-developed cognitive scale for electrocardiogram interpretation, motivation scale, and clinical reasoning scale, as well as observations and interviews conducted during the experiment.Results Based on the results of the Generalized Estimating Equations (GEE) statistical analysis, it was found that both groups of nursing student interns showed significantly higher cognitive results in electrocardiogram interpretation in the post-test and delayed post-test compared to the pre-test (p < 0.01). Furthermore, there was a significant interaction effect between time and group, indicating that the experimental group's cognitive performance in ECG interpretation in the delayed post-test significantly differed from the pre-test (p < 0.05).The results suggest that the ECG interpretation teaching, whether employing "lecture-based instruction" or "anchored instruction," can enhance nursing students' cognitive understanding of ECG interpretation, motivation for learning, and clinical reasoning ability. Additionally, incorporating anchored instruction showed greater knowledge retention effects. In the analysis of moderating variables, it was found that possession of ACLS certification significantly influenced nursing student interns’ engagement with anchored instruction in ECG interpretation. Moreover, students with recent experiences in ECG interpretation learning demonstrated better performance in motivation for learning and clinical reasoning ability compared to those without recent learning experiences.Conclusion and Recommendations Incorporating an anchored instruction approach can enhance students' learning in ECG interpretation by integrating knowledge with clinical practice scenarios, thereby improving learning outcomes. Through interactive curriculum materials, students can increase their engagement and focus during the learning process. By providing anchor points within the scenarios, this anchored approach strengthens nursing interns' clinical reasoning abilities and motivation for learning. Utilizing multimedia interactive tool such as Thinglink for learning allows students to practice repeatedly, promoting their adaptability in facing unpredictable situations during their clinical internships. This integration of learning enables nursing students to apply their knowledge to real clinical scenarios, boosting their confidence in patient care and enhancing nursing quality. It is recommended to apply anchored instruction design to various nursing-related courses to enhance students' motivation for learning and clinical reasoning abilities, ultimately improving learning outcomes.Keywords: Anchored Instruction, ECG Interpretation Knowledge, Learning Motivation, Clinical Reasoning Ability, Thinglin
[[alternative]]Association Between First-Time Father’s Depression, Anxiety, Parenting Stress, And Social Support in Postpartum Period
No full text[[abstract]]研究背景: 迎接新生命，男性雖不會經歷分娩之苦或產後身體恢復不適，但新生兒的出現隨之帶來生活重大改變。育兒的疲憊與新手父親不知所措的壓力，加上男性被期望成為家庭經濟與心理上的後盾，父親也會經歷產後憂鬱且容易被忽視。男性產後憂鬱對本身心理健康、婚姻關係及嬰兒發展皆有不良影響，且有可能傷害整個家庭。目前台灣較少針對男性產後心理狀況進行研究且造成台灣男性產後憂鬱相關影響因素的文獻也不多。研究目的:探討新手父親焦慮、親職壓力、產後社會支持與產後憂鬱之相關性。方法: 採描述相關性研究，資料收集期間為2024年04月至2024年06月，以方便取樣選取年滿18歲(含)以上已婚之新手父親，配偶妊娠週數超過37週且新生兒無異常，排除有精神病史之個案、配偶有精神病史及新生兒在中重度病房或加護病房住院者，共計收案142位。研究工具包括個案基本屬性問卷、中文版愛丁堡產後憂鬱量表(Edinburgh Postnatal Depression Scale, EPDS)、中文版特質焦慮(STAI-T)量表、中文產後社會支持量表(Postpartum Social Support Questionnaire, PSSQ)以及親職壓力量表(第四版簡易中文版)(PSI-4-SF)。研究結果: 本研究結果顯示個案平均年齡為34.78歲(SD±5.17)。教育程度以大專及大學佔最多(n=90，63.38%)。月收入方面>75000元佔最多(n=50，35.21%)。全職工作者佔大多數(n=141，99.3%)。產科學變項分佈，計畫懷孕佔多數(n=109，76.76%)。胎兒性別以男嬰佔多數(n=78，54.93%)。妻子之生產方式，自然產較多(n=82，56.20%)。是否計畫懷孕、胎兒性別、妻子生產方式、教育程度、月收入與產後一週憂鬱之間未達統計上顯著差異(p >.05)。胎兒性別、妻子生產方式教育程度、月收入與產後一個月憂鬱之間未達統計上顯著差異(p >.05)。是否計畫懷孕與產後一個月憂鬱之間達統計上顯著差異(ｔ=-2.22，p 75,000 yuan accounted for the most (n=50, 35.21%). Full-time authors accounted for the majority (n=141, 99.3%). The distribution of obstetric variables was planned for pregnancy (n=109, 76.76%). Male babies were the majority (n=78, 54.93%). The wife’s mode of delivery was more natural(n=82，56.20%)。There was no statistically significant difference between whether pregnancy was planned, fetal sex, wife's mode of delivery, education level, monthly income and depression in the week after giving birth (p>.05). There was no statistically significant difference between fetal sex, wife's mode of birth, education level, monthly income and depression in the first month after giving birth (P >.05). There was a statistically significant difference between whether or not to plan pregnancy and depression in the first month after giving birth (t=-2.22, P<.05), and the depression score of new fathers who did not plan pregnancy was higher in the first month of giving birth than those who planned to become pregnant. One week after postpartum, anxiety was positively correlated with depression (r=.74, P<.01) and parenting stress (r=.51, p<.01). That is, the more anxious the new father is in the week after giving birth, the more depressed and the higher the parenting pressure. There was a positive correlation between parenting stress and postpartum depression in the first week (r=.56, p<.01). That is, the greater the parenting pressure in the first week after giving birth, the more depressed the tendency. There was a positive correlation between depression in the first postpartum week and depression in the first postpartum month (r=.85, P<.01), that is, the depression in the first postpartum month was more significant in the cases with depression in the first postpartum week. Depression in the first month was positively correlated with anxiety in the first month (r=.76, p<.01) and parenting stress in the first month (r=.55, p<.01). In other words, the more anxious the patients with depression in first month after giving birth, the higher the parenting pressure. Furthermore, anxiety in first postpartum week (t=9.72, p<.001) and parenting stress in first postpartum week (t=3.45, p<.001) had significant predictive effects on depression in first postpartum week. Depression in first week postpartum (t=18.13, p<.001) and anxiety in first month postpartum (t=5.32, p<.001) predicted depression in first month postpartum. Conclusion: In this study, anxiety and parenting stress in the first week of postpartum anxiety and parenting stress in the first week of postpartum mothers were predictive, and depression in one week postpartum and anxiety in one month after childbirth were important predictors of depression in one month after childbirth. To understand whether the father has a tendency to postpartum depression and the risk factors for it at an early stage
[[alternative]]The Development of Critical Elements of Childbirth Education
No full text[[abstract]]研究背景：生產教育源起1933年，在歐美各國生產教育講師的培訓與認證制度已經發展具規模性，但反觀台灣多數產前教育的舉辦在知識與技能的傳遞成效遠不如協辦廠家的產品促銷。是否因為台灣並沒有對生產教育教學內涵的規範依據，讓生產講師在執行的過程展現教學能力與教學成效是有所依據標準。因此，引發研究者希望進行具有信效度的「生產教育關鍵教學內涵」之研發，作為生產講師的教學內容指引，同時也爲台灣的生產教育課程的關鍵內涵提供標準，以達成生產教育的教學品質與執行成效，進而提供高品質的孕產照護服務與親善生產照護品質的提升。研究目的：本研究目的是進行具有信度與效度的「生產教育關鍵教學內涵」之研發。研究方法：本研究設計採修正型德菲法（Modified Delphi Technique）的研究方法，邀請九位德菲專家成立專家小組發展以能力為基礎並具有信度和效度的「生產教育關鍵教學內涵」，並招募六位國立臺北護理健康大學護理健康及婦女健康系的碩士班研究生進行生產教育關鍵教學內涵在評估考核者之間的一致性。研究發現：本研究經由準備期與研發期二階段的研究過程，發展出教學準備階段的完成課前評估與繳交教學計畫（教案）、教學執行階段的教學活動，以及教學評值階段的教學成效評值等應具備三十四個教學內涵，確立｢生產教育關鍵教學內涵」之研發的結果。結論與應用：分娩對父母與家庭而言是足以令人興奮的人生重大事件。本研究結果發現生產教育講師孕產家庭在孕/產/哺/育的道路上的教育者、諮詢者、支持者，甚至是照護者，透過系統性、連續性、實證支持的生產教育關鍵教學內涵展現其教學能力，協助與引領孕產家庭將待產、生產、產後、育兒與哺育等生活未知所導致的害怕、擔憂與恐懼，進而轉換為應對的能力和自信的賦權展現。[[abstract]]Background: Childbirth education originated in 1933, the training and certification system of childbirth education instructors (childbirth educators) in most Western countries has developed on a scale, but most prenatal education in Taiwan is far less effective in the transmission of knowledge and skills than the product promotion of co-organizers. Is it because there is no standard for the teaching content of childbirth education in Taiwan, there is a basis for the teaching ability and teaching effectiveness of childbirth education instructors (childbirth educators) in the implementation process? Therefore, the researchers hope to carry out "Development of Critical Elements of Childbirth Education" with reliability and validity, as the teaching content guidance of childbirth education instructors (childbirth educators), and also provide standards for the key connotations of childbirth education courses in Taiwan, so as to achieve the teaching quality and implementation effectiveness of childbirth education, so as to provide high-quality maternity care services and improve the quality of friendly childbirth care.Purpose: The purpose of this study is to research "The Development of Critical Elements of Childbirth Education" with reliability and validity.Method: This research design adopts the Modified Delphi Technique, and invites nine Delphi experts to set up an expert group to be "The Development of Critical Elements of Childbirth Education" with reliability and validity based on competence. At the same time, in order to establish "The Development of Critical Elements of Childbirth Education" developed by different examiners, three examiners applied the key teaching connotation of this research to examine the performance of production education teaching of 6 master students. Findings: Through the research process of the two stages of preparation and research and development, this study developed 34 critical elements of childbirth education in the teaching preparation stage, the teaching activities in the teaching implementation stage, and the teaching effectiveness evaluation stage, so as to establish the research results of "Development of Critical Elements of Childbirth Education".Conclusion and Application: Childbirth is an exciting life event for parents and families. The results of this study found that childbirth education instructors (childbirth educators), counselors, supporters, and even caregivers of maternity families on the path of pregnancy/birth/feeding/childbearing demonstrate their ability to teach through systematic, continuous, and empirically supported key teaching elements of birthing education. Assist and lead the pregnant family to transform the fear, worry and fear caused by the unknown life such as childbirth, childbirth, postpartum, parenting and feeding into an empowering display of coping ability and confidence
[[alternative]]Effects of Aromatherapy on Sleep Quality and Quality of Life for Older Adults at Risk of Metabolic Syndrome in the Community
No full text[[abstract]]背景: 隨著邁入超高齡社會的縣市逐年增加，老人健康成為我國公共衛生關注的重要議題。統計指出，國人慢性失眠盛行率為11.3%且隨著年齡增長而增加，而老人睡眠障礙可能造成慢性疾病如代謝症候群之罹患及控制不良，進而影響其生活品質。目的：主要欲了解社區據點代謝症候群危險群老年人使用芳香療法對改善其睡眠品質及生活品質之成效。方法：採雙組前後測隨機對照試驗(RCT)，以新竹市東區社區關懷據點(振興據點、科園據點)作為研究地點。實驗組長者使用2%薰衣草複方精油，對照組長者則使用甜杏仁油；受試者於據點接受每週2次、每次50分鐘的擴香，另每晚睡前使用滾珠瓶於兩側肩頸，進行為期四周的介入。於介入前後，採一對一訪談完成中文版匹茲堡睡眠品質量表(CPSQI)、台灣版世界衛生組織老人生活品質問卷(WHOQOL-OLD TW)、台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF TW)與人口學屬性等資料蒐集。結果：本研究中收案實驗組29人，對照組26人。以獨立樣本t檢定及卡方檢定檢視實驗組與對照組人口學基本資料，僅在喝咖啡習慣、慢性病規律控制、過去半年內使用社區或據點服務的頻率有顯著差異。介入後，以成對樣本t檢定，分別檢測兩組前後測差別，實驗組CPSQI量表總分為10.17±3.67 vs. 6.17±3.06(t=3.96,p<0.001)、WHOQOL-BREF TW總分54.09±6.21 vs. 58.23.±6.10(t=3.81,p<0.001)，以上達統計上顯著差異，但WHOQOL-OLD TW總分87.03±11.50 vs. 90.93.±9.30(t=1.73,p=0.09)，雖有進步，但未達統計上差異；在對照組CPSQI量表總分為10.65±3.71vs.9.27±4.02(t=-2.09,p<0.05)、WHOQOL-BREF TW總分52.76±6.34 vs. 55.66±5.96(t=2.30,p=0.03)，WHOQOL-OLD TW總分83.15±12.08 vs. 88.19±10.33(t=2.03, p=0.04)，在統計上皆達顯著差異。再以前測得分作為共變量，後測得分為依變項，以ANCOVA共變數分析實驗組與對照組在CPSQI平均得分為6.22±.65 vs. 9.22±.69(F =10.03, p<0.001)，實驗組CPSQI分數高於對照組且達統計顯著差異；以次量表來看，實驗組與對照組在主觀睡眠品質1.09±.10 vs. 1.48±.11(F=6.91,p<0.01)、睡眠遲滯1.07±.17 vs. 1.54±.16(F=3.83, p<0.05)及睡眠總時數 .10±.21 vs. 1.62±.22(F=4.12,p<0.05)，實驗組得分皆高於對照組在統計上有顯著差異。實驗組與對照組在生活品質各量表的得分如下: WHOQOL-BREF TW得分57.92±.98 vs. 56.00±1.03(F=1.82,p=0.18)、WHOQOL-OLD TW得分90.39±1.73 vs. 88.80±1.83(F=0.40,p=0.53)；實驗組在兩個量表得分皆較對照組高，但未達統計上之差異。結果顯示，實驗組及對照組長者在參與芳香療法後，實驗組CPSQI後測較對照組明顯可改善睡眠品質，而在生活品質部分兩組分數皆有提升，且實驗組長者分數高於對照組。結論：經本研究證實，四週的2%薰衣草複方精油芳香療法介入可有效改善社區據點代謝症候群危險群長者的睡眠品質，但在生活品質改善上僅部分改善。建議後續可進行縱貫性研究，以評估芳香療法對長者睡眠及生活品質改善之長期效益及變化趨勢。[[abstract]]Background: As there are more cities and counties become super-aged society in Taiwan, the health and wellbeing of the older adults has become an important public health concern. The prevalence of chronic insomnia among adults in Taiwan was estimated approximately 11.3% and increases as aged. There is evidence to suggest that sleep disorders increase the risk of developing chronic diseases such as metabolic syndrome and may lead to poor control of health conditions in older adults thus affecting their quality of life.Objective: The study aims to evaluate the effects of using aromatherapy in improving sleep quality and quality of life among older adults who are at risk of metabolic syndrome in the community.Methods: A randomized controlled trial (RCT) was conducted at the selected community care centers in the Eastern District of Hsinchu City, Taiwan. The experimental group used a 2% lavender essential oil blend while the control group used sweet almond oil. Participants received aromatherapy twice a week for 50 minutes each session at the centers and applied a roller bottle to the sides of their necks before bedtime for four weeks. Data were collected through one-on-one interviews pre-and posttreatment. The instruments used in the study were the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), the Taiwanese version of the World Health Organization Quality of Life Questionnaire for Older Adults (WHOQOL-OLD TW), and the Taiwanese Short Version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF TW) as well as items for socio-demographics.Results: A total of 55 participants were recruited in the study, 29 participants in the experimental group and 26 in the control group. Independent samples t-test and chi-square tests were used to examine demographic differences between the two groups, revealing significant differences only in coffee consumption habits, regular control of chronic diseases, and frequency of using community or center services in the past six months. Significant differences between the two groups in the total scores of CPSQI (10.17±3.67 vs. 6.17±3.06,t=-3.96,p<0.001) and WHOQOL-BREF TW (54.09±6.21 vs. 58.23.±6.10,t=3.81,p<0.001) were observed using Paired-Samples T Test after the 4-week intervention. Although there was improvement in the total score of WHOQOL-OLD TW (87.03±11.50 vs. 90.93.±9.30, t=1.73,p=0.09), it did not reach statistical significance. For the control group, there were significant differences in total scores of CPSQI (10.65±3.71 vs. 9.27±4.02,t=-2.09,p<0.05), WHOQOL-BREF TW (52.76±6.34 vs. 55.66±5.96,t=2.30,p=0.03), and WHOQOL-OLD TW (83.15±12.08 vs. 88.19±10.33, t=2.03,p=0.04). Using the pre-test score as covariate and the post-test score as dependent variable in the ANCOVA analysis, the results showed that the experimental group had significantly higher CPSQI score compared to the control group (6.22±0.65 vs. 9.22±0.69,F=10.03,p<0.001). Subscale analysis indicated significant differences between the two groups in subjective sleep quality (1.09±0.10 vs. 1.48±0.11,F=6.91,p<0.01), sleep latency (1.07±0.17 vs. 1.54±0.16, F=3.83,p<0.05), and total sleep time (1.10±0.21 vs. 1.62±0.22,F=4.12,p<0.05), with higher scores in the experimental group. Regarding quality of life, there were no significant differences in total score of neither WHOQOL-BREF TW (57.92±0.98 vs. 56.00±1.03, F=1.82, p=0.18) nor WHOQOL-OLD TW (90.39±1.73 vs. 88.80±1.83,F=0.40,p=0.53) between the two groups.Conclusion: This study confirms that a four-week intervention with 2% lavender essential oil blend aromatherapy effectively improves the sleep quality of older adults who are at risk of metabolic syndrome in the community. However, only the effects on the improvement of their quality of life were insignificant. A longitudinal study is recommended in evaluating the long-term benefits and trends of aromatherapy on sleep and quality of life in the target population
[[alternative]]Factors associate with re-fracture within one year after hip fracture surgery in the elderly
No full text[[abstract]]國際骨質疏鬆症基金會(International Osteoporosis Foundation, IOF) 於1992年提出全球有18%的女性及6%的男性發生髖部骨折。預測發生率的關鍵是人口老齡化。國外統計65 歲以上老年人發生髖部骨折後會有可能再次髖部骨折。髖部骨折是老人住院最常見的原因之一，也是最常見的再骨折部位。而老年髖部骨折病人的遵從性差、多種合併症、使用藥物治療、低骨質密度或體重過輕都與再骨折風險增加有關。研究目的為描述髖部骨折老年病人術後一年內再次骨折的發生率，及其可能影響因素包括人口學特性、生活習慣、術前因跌倒而骨折病史、骨質疏鬆症相關變量、身體質量指數、疾病與治療特性、術後檢驗數據、術後接受早期復健計畫、術後一年內接受營養諮詢、骨科回診及復健科回診次數的顯著差異情形。以及探討髖部骨折老年病人在術後一年內發生再次骨折的重要預測因子。研究方法採回溯性研究，以自行設計之病歷資料登錄表進行資料收集。收案場所為台灣東部某區域教學醫院，收案對象為年齡65歲(含)以上，2018/01/01~2021/12/31因跌倒所導致髖部骨折並接受復位內固定手術或髖關節置換手術治療首次髖部骨折患者。排除條件：車禍(高能創傷)所致之髖部骨折患者、腫瘤導致病理性骨折患者、髖部開放性骨折患者、選擇非手術治療之髖部骨折患者以及一年內未持續在本院追蹤或死亡之患者。研究統計包含描述性統計分析、卡方分析、無母數檢定 (Mann-Whitney U test )及邏輯斯回歸 (Logistic Regression)。本研究涵蓋了522位患者，排除掉高能創傷患者23位，病理性骨折2位，一年內過世47位以及未持續回診追蹤者43位，總共407位患者收錄在本研究中。而其中有再骨折的患者為135人。研究結果發現再次骨折患者與無再次骨折患者之間，高血壓的發生率有顯著差異，而其餘體況因子則無統計學上的意義。而本研究也發現一年內回診次數較多的患者，有顯著的再次骨折風險。本研究結論為髖部骨折老年病人在術後一年內發生再次骨折的重要因子為「高血壓」及「髖部骨折術後一年內骨科回診次數」。[[abstract]]The International Osteoporotic Foundation had pointed out that hip fractures occur to eighteen percent of female and six percent of male population on earth. Increasing lifespan contributes to a high incidence rate of hip fracture. It’s reported that re-fracture after hip fracture may happen in geriatrics over sixty-five-year-old. Hip fracture is one of the most common causes resulting in admission. Hip is also the most common anatomical area of re-fracture. The risk factors of patients with re-fracture may include poor compliance, multiple co-morbidity, concomitant medication, low bone mineral density, or low body weight.The purposes of this research is to investigate incidence of re-fracture after hip fracture in geriatric patients and its related factors including demogrphics, life style, co-morbidity, medical illness, falling related fracture, osteoporosis, body mass index, fracture characteristics, post-operational laboratory data, early rehabilitation program, nutrition counseling within one year, times of returning to outpatient department of rehabilitation and orthopedics. This study is a retrospective study. Data was collected from one regional hospital in east Taiwan. Including criteria are patients who had received surgery for first hip fracture and who were older than sixty-five-year-old from January, 1, 2018 to December 31, 2021. High energy trauma, pathologic fracture due to neoplasm, hip open fracture, and patients who underwent conservative treatments were excluded. Descriptive statistical analysis, Mann-Whitney U test, and logistic regression were chosen as statistical methods. Totally 522 patients were collected and 407 patients were included in our research, excluding 23 high-energy trauma patients, 2 pathologic fracture patients, 47 patients died in one year and 47 patients’ loss follow up. There were 135 patients suffered from re-fracture. Our investigation revealed that high blood pressure was predisposing somatic factor of re-fracture in one year after hip fracture. Besides, frequency of returning to orthopedic outpatient clinic was another significant difference in patients having re-fracture
[[alternative]]Using of extra virgin olive oil in patient with hemodialysis to improve the effect of pruritus and sleep disorders
No full text[[abstract]]尿毒性皮膚搔癢是晚期與末期腎臟病人常見的症狀，其發病機制與原因極為複雜，至今仍然無法獲得完全的根治，嚴重的皮膚搔癢會影響睡眠與降低生活品質。本研究旨在塗抹特級初榨橄欖油，改善血液透析病人的皮膚搔癢與睡眠品質之成效探討。本研究為介入型研究採前、中、後測研究設計，研究對象為新北市某一所醫學中心的洗腎室，接受透析時間超過三個月以上的病人，共81位透析病人參與此研究，以隨機方式，分實驗組42人、對照組39人，於進行介入措施前，先給予問卷前測與心率變異分析(HRV)檢測及皮膚過敏測試，實驗組塗抹特級初榨橄欖油，對照組塗抹生理食鹽水，於皮膚搔癢區域一天塗抹2次，於執行介入措施開始之後的第14天(2週)及28天(4週)，進行問卷後測與心率變異分析(HRV)檢測。研究工具包括: 5-D搔癢評估量表、搔癢視覺類比量表(VAS)、匹茲堡睡眠品質表與心率變異分析檢測器。資料收集的結果，以SPSS統計軟體進行建檔，以描述性統計分析、卡方檢定、獨立樣本t檢定與廣義估計方程式(GEE)，進行資料的處理與分析。在介入措施的實驗組，於皮膚搔癢部位，塗抹特級初榨橄欖油後的第14天與第28天，以5-D搔癢量表檢測，皆達顯著差異(ρ0.05)；在(VAS)的部分，實驗組的第二次後測與第三次後測比前測，皆達顯著差異，(ρ0.05)，經由本研究結果證實，血液透析病人在接受塗抹特級初榨橄欖油，可有效改善皮膚搔癢問題及增進睡眠品質，且優於塗抹生理食鹽水。塗抹特級初榨橄欖油為有效的天然方法，且低經濟負擔的方式，經由本研究結果可提供另類的護膚護理方式，與提升尿毒性皮膚搔癢病人的照護品質。[[abstract]]Uremic pruritus is common in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD). Its pathogenesis and causes are highly complex, and a complete cure is still unavailable. Severe pruritus can affect sleep and reduce quality of life. This study investigated the efficacy of applying extra virgin olive oil to improve pruritus and sleep quality in hemodialysis patients. An interventional study with a pre-, mid-, and post-test design was conducted. The subjects were patients who had undergone dialysis for over three months at the dialysis centre of a medical center in New Taipei City, Taiwan. Eighty-one dialysis patients were randomly assigned to either the experimental group (n = 42) or the control group (n = 39). Before the intervention, all participants underwent a pre-questionnaire, heart rate variability (HRV) test, and skin allergy test. In the experimental group, participants applied extra virgin olive oil twice daily to the itchy areas of the skin, while the control group received normal saline. A post-questionnaire and HRV tests were performed on the 14th day (second week) and the 28th day (fourth week) after the intervention. This study used the 5-D Itch Scale, Itch Visual Analog Scale (VAS), Pittsburgh Sleep Quality Scale, and HRV Analyzer as the research tools. The collected data were documented using SPSS statistical software. Data processing and analysis were performed using descriptive statistical analysis, chi-square tests, independent sample t-tests, and generalized estimating equations (GEE). In the intervention group, significant differences in the 5-D itch scale scores were found on day 14 and day 28 after applying extra virgin olive oil on itchy skin areas (ρ0.05) after intervention. Moreover, the VAS scores were significantly different between the second post-test, the third post-test, compared to the pre-test (ρ0.05). These data demonstrated that applying extra virgin olive oil to itchy skin can improve pruritus and enhance sleep quality in hemodialysis patients and is more effective than applying normal saline. Thus, extra virgin olive oil is an effective, low-cost natural treatment method. This study may offer an alternative skin care in uremic pruritus patients
[[alternative]]The Correlation between Physical Function, Health Literacy, and Health-Related Quality of Life Among Older Adults with Hypertension in Indonesia
No full text[[abstract]]背景：健康素养可以使老年人更好地了解和管理自己的健康，而身体机能的改善可以增强他们的整体幸福感。这反过来又可以带来更积极的健康相关生活质量。目的：本研究探讨了高血压老年人的身体机能、健康素养和健康相关生活质量之间的关系。设计：本研究采用横断面调查。参与者：印度尼西亚布鲁区 60 岁以上患有高血压的老年人，从农村和城市的六个公共卫生中心选取样本。方法：本研究采用了几个关键测量指标，包括 Barthel 指数、欧洲健康素养调查问卷 (HLS-EU-Q16) 和世界卫生组织生活质量简明版 (WHOQOL-Brief)。采用分层线性回归分析检验身体机能、健康素养和健康相关生活质量之间的关联。结果：招募了 300 名患有高血压的老年人。老年人平均年龄为71.1岁，平均巴氏指数为95.3分（范围0-100），HLS-EU-Q16为42.2分（范围16-64），WHOQOL-Brief为3.40分（范围1-5）。第一层层次回归分析显示，婚姻状况、职业和年龄与老年人健康相关生活质量相关（p < .05）。当将健康素养和身体机能添加到第二层层次回归分析时，结果显示老年人健康相关生活质量的解释变异从9.8%增加到63.2%。健康素养（β = .112，p < .003）和身体机能（β = .794，p < .001）是高血压老年人健康相关生活质量的两个主要预测因素。结论：研究结果强调维持良好身体机能及具备足够的健康素养的重要性，因此，开展社区老年人体能促进活动以减轻残疾，并开展相关健康讲座，可提高高血压老年人的健康相关生活质量，研究结果可作为高血压老年人健康促进政策的参考。[[abstract]]Background: Health literacy can empower older adults to understand better and manage their health, while improvements in physical function can enhance their overall well-being. This, in turn, can lead to a more positive health-related quality of life. Aims: This study examined the relationship between physical function, health literacy, and health-related quality of life among older adults with hypertension.Design: A cross-sectional survey was used in this study.Participants: Older adults over 60 years with hypertension in the Buru district, Indonesia, selecting samples from six public health centers in rural and urban areas were included. Methods: The study employed several key measurements, including the Barthel index, the European Health Literacy Survey Questionnaire (HLS-EU-Q16), and the World Health Organization Quality of Life Brief Version (WHOQOL-Brief). The hierarchical linear regression analysis was used to test the association between physical function, health literacy, and health-related quality of life. Results: 300 older adults with hypertension were recruited. The average age of older adults was 71.1 years old, the average barthel index was 95.3 points (range 0-100), the HLS-EU-Q16 was 42.2 points (range 16-64), and the WHOQOL-Brief was 3.40 points (range 1-5). The first layer of hierarchical regression showed that marital status, job, and age, were associated with health-related quality of life among older adults (p < .05). When adding health literacy and physical function to the second layer of hierarchical regression, it showed that the explained variation in older adults' health-related quality of life increased from 9.8% to 63.2%. Health literacy (β = .112, p < .003) and physical function (β = .794, p < .001) are two major predictors for health-related quality of life among older adults with hypertension. Conclusion: The findings highlight the importance of maintaining good physical function and adequate health literacy. Therefore, developing community physical fitness promotion activities for older adults to alleviate disability and implementing relevant health lectures can promote the health-related quality of life for older people with hypertension. The results can be considered by a policy of health promotion for older adults with hypertension