Objective: Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers' nutrition knowledge and diets. Design: One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two nonhealth-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78?4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis. Results: Teachers in the HP-D group had a mean score of 21?1 on a range of 0-30 for nutrition knowledge, which was significantly higher than the mean scores of 18?5 in the HP-ND group and 19?1 in the NHP group (P , 0?001). Better dietary behaviours were also observed among HP-D teachers. Further, being a 'health education' course instructor was associated with significantly higher scores on nutrition knowledge (b 5 2?6, P , 0?001) and vegetable and fruit consumption (b 5 1?4, P 5 0?02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group. Conclusions: Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers' nutrition knowledge and dietary intake. Inadequate diet and nutrition can slow growth in childhood and increase the risk of health conditions such as obesity, hypertension and certain cancers in adulthood (1,2) . Many children exhibit intakes of food and nutrients below the recommended levels, both internationally and in Taiwan (3)(4)(5)(6)(7) . Educators have recognized the importance of promoting a healthy diet and various nutrition-education programmes have been implemented in schools (8)(9)(10) . In these school-based programmes, teachers play a central role in providing accurate nutrition information to students and responding to students' concerns about diet, nutrition and weight control. In order for schoolteachers to be a valuable source of health information, however, they must be equipped with adequate knowledge (11) . Teachers' knowledge of nutrition affects their willingness and confidence to teach a course on healthy diets (12) , which could influence the implementation of a nutritioneducation programme in their schools. In addition, teachers' unhealthy eating behaviours at school may make them inappropriate role models for students. In a study reported by Kubik et al. (13) , 62 % of teachers reported purchasing beverages from vending machines. In addition, 54 % of teachers did not consume five servings of fruits and vegetables daily. Among physical education teachers, 20 % of women and 13 % of...

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The present study examined the changes of depressive symptoms and salivary cortisol responses in 36 outpatients with major depression. These patients were randomly assigned to receive combination therapy (CT), consisting of antidepressants and body-mind-spirit group psychotherapy, or monotherapy (MT), consisting of antidepressants only. The results indicated that CT and MT had similar effects on reducing depressive symptoms. Nevertheless, the results revealed that cortisol levels at night appeared to have a greater reduction in CT than in MT, indicating a downward trend in CT but an upward trend in MT. Moreover, a steeper diurnal pattern of cortisol-a larger deviation in cortisol levels between 30 and 45 minutes postwaking and evening-was more likely associated with CT than MT. The findings suggest that CT produced a protective effect on outpatients with major depression, preventing the increased night salivary cortisol levels and the flatter diurnal cortisol pattern that tended to occur in MT.

Background: Psychotherapy added to pharmacotherapy results in greater improvement in clinical outcomes than does pharmacotherapy alone. However, few studies examined how psychotherapy coupled with pharmacotherapy could produce a long-term protective effect by improving the psychobiological stress response. Methods: The researchers recruited 63 subjects with major depressive disorder (MDD) in an outpatient department of psychiatry at a general hospital. The randomly assigned subjects formed 2 groups: 29 in combined therapy (COMB) and 34 in monotherapy (MT). The COMB included 8 weekly body-mind-spirit group psychotherapy sessions added to pharmacotherapy. MT consisted of pharmacotherapy only. The outcome measures, collected at the subjects’ homes, included the Beck Depression Inventory II (BDI-II), the State Trait Anxiety Inventory (STAI) and salivary cortisol on awakening, 45 min after awakening, and at 12.00, 17.00 and 21.00 h. Evaluation of outcome measures was at baseline condition, and at months 2 (end of additional psychotherapy), 5 and 8. Results: While the decreases in symptoms of depression were similar between COMB and MT (p > 0.05), the reductions in anxiety state were greater in COMB than in MT during the 8-month follow-up (p < 0.05). A steeper diurnal cortisol pattern more likely occurred in COMB than in MT in the 3 follow-up periods (p < 0.05, p <0.001 and p < 0.01). Conclusions: The superior outcomes of group psychotherapy added to pharmacotherapy for MDD outpatients could relate to decreasing the anxiety state and to producing long-term impacts on positive stress endocrine outcomes seen as a steeper diurnal cortisol pattern.

Purpose The aims of this study are to evaluate whether improvements in functional outcome and quality of life are sustainable 10 years after total knee arthroplasty (TKA), and the age cutoff for clinical deterioration in outcomes Methods Prospectively collected registry data of 120 consecutive patients who underwent TKA at a tertiary hospital in 2006 was analysed. All patients were assessed at 6 months, 2 years and 10 years using the Knee Society Function Score, Knee Society Knee Score, Oxford Knee Score, Short-Form 36 Physical/Mental Component Scores and postoperative satisfaction. One-way ANOVA was used to compare continuous variables, while Chi-squared test to compare categorical variables. Multivariate logistic regression and receiver operating curve analysis was performed to evaluate the predictive factors associated with deterioration of scores postoperatively. Results Significant improvements were noted in all functional outcome and quality of life scores at 6 months after TKA. Between 6 months and 2 years, the KSFS and OKS continued to improve but the KSKS, PCS and MCS plateaued. Between 2 and 10 years, there was a deterioration in the KSFS and OKS, whilst KSKS, PCS and MCS were maintained. Increasing age was noted to be a significant risk factor for deterioration of KSFS at 10 years with age ≥ 68 as the cutoff value. 91.7% of patients with KSFS Minimally Clinically Important Difference(MCID) (≥ 7 points) continued to be satisfied after 10 years compared to 100.0% who did not experience KSFS MCID deterioration (p = 0.02). Conclusion Patients ≥ 68 years experience deterioration in functional outcomes and quality of life from 2 to 10 years after TKA. Level of evidence Retrospective study, Level III.