經國管理暨健康學院

Background: Obesity is a growing global public health concern that is frequently accompanied by weight-related stigma, which negatively affects psychological well-being, social participation, and engagement in health services. Stigma represents a critical psychosocial barrier in obesity management that is often insufficiently addressed by conventional interventions focusing primarily on behavioral and clinical outcomes. Peer support has emerged as a promising approach to address psychosocial challenges through shared experiences and mutual support in community settings. Objective: This study aimed to examine the effect of peer support on stigma among patients with obesity in a community-based context. Methods: A quasi-experimental study with a pretest–posttest control group design was conducted among adults with obesity recruited from community health programs. Participants were allocated into an intervention group receiving a structured peer support program and a control group receiving usual community-based health education. Stigma was measured using a validated weight stigma instrument before and after the intervention. Data were analyzed using descriptive and inferential statistics to assess within-group and between-group differences. Results: The intervention group demonstrated a significant reduction in overall stigma scores following the peer support program, whereas the control group showed no significant change. Post-intervention stigma levels were significantly lower in the intervention group compared to the control group. Subdomain analysis revealed substantial improvements in internalized stigma and perceived social rejection, with a moderate improvement in emotional distress. The findings indicate a clinically meaningful and statistically significant effect of peer support on stigma reduction. Conclusion: Peer support is an effective community-based intervention for reducing stigma among patients with obesity. The intervention addresses key psychosocial dimensions of obesity by enhancing self-acceptance, emotional support, and social connectedness.Community obesity programs should integrate peer support as a complementary strategy to conventional interventions, and future research should explore long-term outcomes and scalability across diverse populations.

Air pollution, particularly fine particulate matter (PM2.5), has been associated with various health issues, but its effects on skin health, specifically skin redness, remain underexplored. This study aims to examine the relationship between PM2.5 exposure and skin redness, with a focus on the role of sebum production in different age groups. A total of 472 participants from two communities in Taiwan in two age groups (20-59 years, n=240; over 60 years, n=232) were included in the study. PM2.5 exposure levels were estimated using land use regression models based on participants' residential addresses. Skin redness area was assessed using the VISIA Imaging System. Linear regression analyses were conducted to examine the association between PM2.5 and redness area, adjusting for demographic, lifestyle, and ultraviolet exposure. Results showed a significant positive association between PM2.5 levels and redness area in both age groups. In the 20-59 age group, each unit increase in PM2.5 corresponded to a 1.70-unit increase in redness area (95% CI: 0.32 - 3.07, p < 0.01), while in the over-60 group, the increase was 2.63 units (95% CI: 1.19 - 4.08, p < 0.001). Additionally, porphyrins showed a positive association with redness area among the 20-59 age group (p < 0.05), while no significant association was found in the over-60 group. This study suggests a linkage between PM2.5 exposure and skin redness area, indicating that air pollution may be a contributing factor to skin health issues. The findings suggest that the interaction between lipophilic and carcinogenic substances in PM2.5 and porphyrins could elevate redness area levels and potentially increase the risk of chronic skin conditions and skin cancer.

The risk of cancer and dementia increases with age, raising complex questions about whether it is appropriate to continue cancer treatment in older patients. There is emerging research suggesting the association between cancer and dementia. However, the mechanistic underpinnings are still under investigation. Progress has already been made toward understanding the cognitive effects associated with cancer therapy. Such associations raise awareness about the need to establish better prevention methods and early screening in clinical practice. Additionally, recent studies have suggested possible therapeutic strategies for better preserving cognitive function and reducing the risk for dementia before patients start cancer treatment. We review the current literature and summarize the incidence and mechanisms of cognitive impairment in patients with lung cancer, breast cancer, head and neck cancer, gastric cancer, prostate cancer, colorectal cancer, and brain tumor/brain metastasis following different kinds of therapies. Possible risk factors are suggested to identify the early onset of cognitive changes in cancer patients and provide more insight into the pathophysiological process of dementia.

Background and aims Sarcopenia has a higher occurrence rate in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) than in the general population. Low handgrip strength—and not sarcopenia per se—is associated with clinical outcomes in patients with CKD, including cardiovascular mortality and hospitalization. The factors contributing to low handgrip strength are still unknown. Accordingly, this study aimed to determine whether uremic toxins influence low handgrip strength in patients with CKD. Materials and methods This cohort study lasted from August 2018 to January 2020. The participants were divided into three groups: the control group [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min], an advanced CKD group (eGFR = 15–60 ml/min), and an ESRD group (under maintenance renal replacement therapy). All participants underwent handgrip strength measurement, dual-energy X-ray absorptiometry, and blood sampling for myokines (irisin, myostatin, and interleukin 6) and indoxyl sulfate. Sarcopenia was defined according to the Asian Working Group for Sarcopenia consensus as low appendicular skeletal muscle index (appendicular skeletal muscle/height2 of < 7.0 kg/m2 in men and < 5.4 kg/m2 in women) and low handgrip strength (< 28 kg in men and < 18 kg in women). Results Among the study participants (control: n = 16; CKD: n = 17; and ESRD: n = 42), the ESRD group had the highest prevalence of low handgrip strength (41.6 vs. 25% and 5.85% in the control and CKD groups, respectively; p < 0.05). The sarcopenia rate was similar among the groups (12.5, 17.6, and 19.5% for the control, CKD, and ESRD groups, respectively; p = 0.864). Low handgrip strength was associated with high hospitalization rates within the total study population during the 600-day follow-up period (p = 0.02). The predictions for cardiovascular mortality and hospitalization were similar among patients with and without sarcopenia (p = 0.190 and p = 0.094). The serum concentrations of indoxyl sulfate were higher in the ESRD group (227.29 ± 92.65 μM vs. 41.97 ± 43.96 μM and 6.54 ± 3.45 μM for the CKD and control groups, respectively; p < 0.05). Myokine concentrations were similar among groups. Indoxyl sulfate was associated with low handgrip strength in univariate and multivariate logistic regression models [univariate odds ratio (OR): 3.485, 95% confidence interval (CI): 1.372–8.852, p = 0.001; multivariate OR: 8.525, 95% CI: 1.807–40.207, p = 0.007]. Conclusion Handgrip strength was lower in the patients with ESRD, and low handgrip strength was predictive of hospitalization in the total study population. Indoxyl sulfate contributed to low handgrip strength and counteracted the benefits of myokines in patients with CKD.

The most suitable and reliable inference engines for Clinical Decision Support Systems in nursing clinical practice have rarely been explored. This study examined the effect of Clinical Diagnostic Validity-based and Bayesian Decision-based Knowledge-Based Clinical Decision Support Systems on the diagnostic accuracy of nursing students during psychiatric or mental health nursing practicums. A single-blinded, non-equivalent control group pretest–posttest design was adopted. The participants were 607 nursing students. In the quasi-experimental design, two intervention groups used either a Knowledge-Based Clinical Decision Support System with the Clinical Diagnostic Validity or a Knowledge-Based Clinical Decision Support System with the Bayesian Decision inference engine to complete their practicum tasks. Additionally, a control group used the psychiatric care planning system without guidance indicators to support their decision-making. SPSS, version 20.0 (IBM, Armonk, NY, USA) was used for data analysis. chi-square (χ2) test and one-way analysis of variance (ANOVA) used for categorical and continuous variables, respectively. Analysis of covariance was done to examine the PPV and sensitivity in the three groups. Results for the positive predictive value and sensitivity variables indicated that decision-making competency was highest in the Clinical Diagnostic Validity group, followed by the Bayesian and control groups. The Clinical Diagnostic Validity and Bayesian Decision groups significantly outperformed the control group in terms of scores on a 3Q model questionnaire and the modified Technology Acceptance Model 3. In terms of perceived usefulness and behavioral intention, the Clinical Diagnostic Validity group had significantly higher 3Q model and modified Technology Acceptance Model 3 scores than the Bayesian Decision group, which had significantly higher scores than the control group. Knowledge-Based Clinical Decision Support Systems can be adopted to provide patient-oriented information and assist nursing student in the rapid management of patient information and formulation of patient-centered care plans.