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Purpose: Parents must manage their own stress and help their child with cancer during the treatment process, both physically and emotionally. With the increased involvement of fathers in caring for the family, how fathers adjust to the stress and play a role in care responsibilities is unknown. This study aimed to explore the fathers' experiences of caring for their ill child during the cancer diagnosis and treatment process., Method: This study adopted a qualitative descriptive design and conducted in-depth interviews with 21 fathers with a diagnosed child recruited from a northern Taiwan medical center. Data were managed and analysed using content analysis., Results: Two main categories in the Taiwanese fathers' experiences of caring for their ill child during the cancer diagnosis and treatment process emerged: 1) the maintainer of family stability, and 2) thoughts and value adjustment. Each main category consists of 3-4 generic categories. They make the necessary adjustments between work and family, actively participate in caring for the entire family, and redefine family values. They convey information about the illness to their children, pay attention to the physical and psychological development of the child with cancer, and cherish the time spent together as a family., Conclusions: During the cancer treatment process, fathers play the roles of the protector and maintainer of family stability and adjust their attitudes and thoughts toward the family members and family life. Healthcare professionals can offer the fathers comprehensive support and improve the family's overall well-being during this demanding period., Competing Interests: Declaration of competing interest The authors do not have any conflict of interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: There is no instrument currently available to assess the essential nursing competency of clinical reasoning (CR)., Purpose: The purpose of this study was to develop and test the psychometric properties of CR assessment instrument appropriate for use with nursing students across different types of programs., Methods: H. M. Huang et al.'s (2018) Framework of Competencies of Clinical Reasoning for Nursing Students was used to guide this study. Two rounds of Delphi study and confirmatory factor analysis (CFA) were conducted to test content and construct validity. Internal consistency was tested for reliability., Results: The four-domain, 16-item Likert-scale Clinical Reasoning Scale (CRS) was developed. One thousand five hundred four nursing students currently enrolled in three different types of nursing programs completed the CRS. The content validity index was .85-1.0, the CFA indicated goodness of fit, and the Cronbach's α score range was .78-.89., Conclusion: The CRS is a valid and reliable tool for assessing CR in nursing students in different types of nursing program., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Purpose: This study aimed to understand the difference in psychosocial adaptation among childhood cancer survivors, their healthy siblings and peers, and the factors affecting the psychosocial adaptation of these cancer survivors., Design and Methods: A total of 222 children (ages 8-17) including childhood cancer survivors, their siblings, and healthy peers participated in this cross-sectional study. All the children completed the anxiety and quality of life scales for their age groups., Results: Anxiety levels and quality of life were similar among the childhood cancer survivors, their siblings, and their peers. The anxiety of elementary school-age survivors of acute leukemia was higher than that of those with solid tumors. Elementary school-age survivors who completed three or more years of treatment had lower anxiety than those who completed treatment within the three years. For adolescent survivors, the higher their body mass index, the higher their anxiety, which was associated with low quality of life. Those diagnosed with anxiety and at an older age had lower quality of life., Conclusions: Although there were no differences in survivors' psychosocial adaptation compared to their siblings and healthy peers, more than half of these adolescents had moderate to severe anxiety. Future study may need to explore the causes of their anxiety., Practice Implications: During the follow-ups of the childhood cancer survivors, age-specific adaptive strategies can be discussed to reduce their anxiety and improve their quality of life., Competing Interests: Declaration of Competing Interest None of the authors has financial interests in the subject matter contained in this manuscript., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Retinopathy of prematurity (ROP) is considered a neurovascular disease. We investigated whether ROP, mild or severe, is associated with neurodevelopmental impairment (NDI) in extremely preterm children., Methods: We conducted a multicenter retrospective cohort study in southern Taiwan. A total of 394 children <28 weeks of gestation who survived to discharge from 2011 to 2018 received neurodevelopmental assessment at corrected age of 24 months. Severe ROP was defined as ROP of stages 2 plus or worse, or recipients of retinal therapy, and mild ROP as stage 1 or 2 in at least one eye. NDI was defined as cognitive or motor impairment using the Bayley Scales of Infant and Toddler Development, moderate to severe cerebral palsy, or profound hearing loss., Results: Among the 374 children validated for analysis, 157 children (42%) had non-ROP, 145 (39%) mild ROP, and 72 (19%) severe ROP. As ROP severity increased progressively from non-ROP, to mild ROP, and to severe ROP, the rates of NDI increased from 25%, to 46%, and to 61%. The multivariable logistic regression showed that the model included three levels of ROP, and neonatal morbidities achieved better overall performance for NDI than the model that included neonatal morbidities alone. Compared with non-ROP, mild ROP and severe ROP had adjusted odds ratios of 1.90 (95% CI: 1.10-3.28) and 2.75 (95% CI: 1.33-5.67) for NDI, respectively., Conclusion: Mild ROP and severe ROP are independent neonatal morbidities associated with NDI. Neurodevelopmental follow-up of extremely preterm children with any stage of ROP is needed., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Aim: To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation., Design: Prospective cohort design., Methods: The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation., Results: Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation., Conclusion: Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice., Impact: The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care., (© 2021 John Wiley & Sons Ltd.)

People living with HIV (PLWH) face social stigma which makes disclosure of HIV status difficult. The purpose of this descriptive qualitative study was to understand the lived experiences of stigmatization in the process of disease disclosure among PLWH in Taiwan. Analysis of the semi-structured interviews from 19 PLWH in Taiwan revealed two phases and six themes. Phase one "experiences before disclosure" involved three themes: "Struggles under the pressure of concealing the HIV Status", "Torn between fear of unemployment/isolation and desire to protect closed ones", and "Being forced to disclose the HIV status." Phase two "experiences after disclosure" included three themes: "Receiving special considerations and requirements from school or work", "Receiving differential treatments in life and when seeking medical care", and "Stress relief and restart." Healthcare professionals need to assess stigmatization in PLWH and develop individualized approaches to assist with the disease disclosure process.

Background: Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury., Purpose: The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury., Methods: Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups., Results: Six themes were delineated, including "wound care is a primary concern for patients," "ineffective health education during the hospital stay," "patients and families worry about postinjury conditions," "current continuity of care is not effective," "lack of standards for discharge planning," and "incorporation of interdisciplinary care to improve patient outcomes.", Conclusions: The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.

Purpose: To investigate the natural course, visual outcome, and risk factors for visual loss after nonarteritic anterior ischemic optic neuropathy (NAION) attack in Chinese patients from a tertiary medical center in Southern Taiwan., Methods: This is a longitudinal observational study that included sixty NAION patients, who were seen in our neuro-ophthalmology clinic from 2007 to 2016. Records of their ophthalmic history, medical history, best-corrected visual acuity (BCVA), visual field (VF) testing, and optical coherence tomography (OCT) were obtained for analysis., Results: When the first visit was within two weeks after NAION onset, 62% of patients had BCVA of less than 0.1 (logMAR BCVA ≥ 1) and 38% had at least moderate-severe depression (VF grade ≥ 3) on VF on the initial visit. VA stabilized at three months after onset and was predictive of VA at 12 months. Diabetes mellitus was a risk factor associated with VA worsening. Sixty-one percent of patients had BCVA of less than 0.1 at 12 months after onset. VF remained relatively unchanged during the disease, with 41% eyes having VF grade ≥ 3 at 12 months after onset. On OCT, all quadrants of retinal nerve fiber layer thickened initially, returned to the level of the fellow eye at one month, and continued thinning up to 12 months slowly., Conclusion: In Southern Taiwan, a higher proportion of Chinese patients (over half) presented with severe visual loss during the first two weeks of NAION attack and at 12 months after the onset of NAION as compared to the findings previously reported in Caucasians. Understanding the natural course of NAION in Chinese patients may provide insights toward a possible therapeutic window for NAION treatments in this group of patients.

In Taiwan, the prevalence of myopia in children between 6 and 18 years old is over 80%, and high myopia accounts for over 20%, which turned out to be in the leading place worldwide. Orthokeratology and low-dose atropine are proven treatments to reduce myopia progression, though the potential corneal disturbances remain an issue in young populations. The alteration of the tear film is widely discussed but there is no consensus to date, so we aim to investigate the tear film spatial instability in children with myopia control using atropine or orthokeratology. Thirty-eight treatment-naïve participants and 126 myopic children under treatments were enrolled. The ocular surface homeostasis, spatial distribution of tear break-up, and high-order aberrations (HOAs) of the corneal surface were assessed. We found out that myopic children treated with either atropine or orthokeratology showed ocular surface homeostasis similar to that in treatment-naïve children. Nevertheless, children treated with orthokeratology presented higher HOAs (p < 0.00001) and a tendency of the first tear break-up zone at the inner half of the cornea (p = 0.04). This unique spatial instability of the tear film associated with myopia treatment might provide a more focused way of monitoring the pediatric tear film instability.

Background: This study analyzed the interactions between agencies, policies, and the interest of the public using a social network analysis., Methods: Open data on the 2017 Facebook fan page of the Ministry of Health and Welfare (MoHW) in Taiwan, including 18,193 messages, were analyzed by conducting a social network analysis, NodeXL (Network Overview, Discovery and Exploration for Excel), creating visualized explorations using size volumes to present the degree of strength between agencies and policies to further calculate the network centrality indicators of agencies and policies., Results: Agencies of the "Social and Family Affairs Administration" and "Health Promotion Administration" contributed the most policy posts. The policy of "Physical and mental health promotion" entailed the most agencies to be involved. The "Department of Nursing and Health Care" received the largest public response, for which "Long-term care" received the most public interest., Conclusions: A social network analysis of fan page of Taiwan's top level health government agency can reveal the government's most emphasized core policies, the strength of correlations between agencies and policies, and provide an understanding of public interest toward the policies.

Background: Workplace violence is a phenomenon that is prevalent around the world. Nursing personnel are one of the most frequent victims of workplace attacks. Beyond the harm done to physical health, mental health, and workplace morale, workplace violence also leads to the loss of personnel and causes severe injury to institutions and nursing professionals., Purpose: The aim of this study is to improve the awareness, attitudes, and self-confidence of nurses with regard to workplace violence using clinical simulation teaching and training courses., Methods: A total of 400 clinical nurses at a tertiary hospital in Taipei City were enrolled and randomly assigned into either the experimental group, which received the education intervention, or the control group, which received no intervention. A total of 392 enrolled participants completed the study, including 200 in the experimental group and 192 in the control group. Before and after the intervention, a structured questionnaire was used to collect data, which were analyzed using a GEE model with SPSS V.23., Results: After the clinical simulation teaching course, awareness of workplace violence as well as related attitudes and self-confidence were higher in the experimental group than the control group. Moreover, the posttest scores and pretest-posttest differences in scores were significantly higher in the experimental group than in the control group (p < .001). Advanced analysis of the data showed that cognition scores, being older in age, and having a registered nurse grade of N3 were all associated with earning a higher score. In addition, in terms of attitude, registered nurse grade was found to correlate positively with score. Further, male participants earned higher self-confidence scores than their female colleagues and participants who worked in either the emergency or psychiatric departments earned higher scores., Conclusions: The "Workplace Violence Clinical Simulation Teaching and Training Course" was shown to improve the awareness, attitudes, and self-confidence of clinical nurses with regard to workplace violence and may thus help reduce the risk and harm of violence in this category. In the future, contextual teaching courses on workplace violence prevention should be developed for different nursing levels, divisions, and units based on their specific characteristics and needs.

Background: A severe dengue epidemic occurred in 2015 which resulted in over 22,000 laboratory-confirmed cases. A cross-sectional seroprevalence study was conducted during the ending phase of this epidemic to evaluate the true incidence of dengue virus (DENV) infection and the level of herd immunity., Methods: Adult residents in three administrative districts with high dengue incidence were recruited; workers in two districts with intermediate dengue incidence were also recruited for comparison. DENV-specific IgM and IgG were tested using commercial enzyme-linked immunosorbent assays. DENV RNA was detected using commercial quantitative real-time reverse transcriptase polymerase chain reaction assay. Univariate and multivariate logistic regressions were performed to identify risk factors for recent and past DENV infection., Results: The overall seroprevalence of anti-DENV IgM and IgG in 1391 participants was 6.8 and 17.4%, respectively. The risk of recent DENV infection increased with age, with the elderly having the highest risk of infection. Living in areas with high incidence of reported dengue cases and having family members being diagnosed with dengue in 2015 were also independent risk factors for recent DENV infection. One sample was found to have asymptomatic viremia with viral load as high as 10 5 PFU/ml., Conclusions: Comparing the seroprevalence of anti-DENV IgM with the incidence of reported dengue cases in 2015, we estimated that 1 out of 3.7 dengue infections were reported to the surveillance system; widespread use of rapid diagnostic tests might contribute to this high reporting rate. The results also indicate that the overall herd immunity remains low and the current approved Dengvaxia® is not quite suitable for vaccination in Taiwan.

Background: Nurses in intensive care units (ICUs) must be capable of employing appropriate conflict handling styles in order to communicate with medical teams, patients, and patient family members effectively. There is a current lack of research on the interpersonal communication competence and conflict handling styles of ICU nursing staffs in Taiwan., Purpose: This study aimed to: (1) explore the interpersonal communication competence and conflict handling styles of ICU nurses and related factors and (2) examine the relationship between the interpersonal communication competence and conflict handling styles of ICU nurses., Methods: A cross-sectional correlational research approach was adopted and convenience sampling was used to recruit 351 ICU nurses from three hospitals in southern Taiwan. Data were collected using a demographic questionnaire, interpersonal communication competence scale, and conflict handling styles scale., Results: (1) ICU nurses demonstrated a moderate or higher level of overall interpersonal communication competence, with "integrating" identified as the most commonly used conflict handling style. (2) Higher educational attainment and job position were both associated with better interpersonal communication competence. (3) The adoption of "compromising" and "avoiding" styles was significantly affected by age; the adoption of "obliging", "compromising", "avoiding", and "integrating" styles was significantly affected by education level; the adoption of "obliging", "compromising", and "integrating" styles was significantly affected by job position; and the adoption of "dominating", "compromising", and "integrating" styles was significantly affected by seniority. (4) Interpersonal communication competence correlated significantly and positively with the adoption of "dominating", "obliging", "compromising", and "integrating" styles., Conclusions / Implications for Practice: Future study of the views of ICU nurses toward their own styles in handling interpersonal conflicts is needed. Furthermore, holding training courses annually to orient ICU nurses with the advantages and disadvantages of interpersonal conflict handling styles is recommended.

Background: Characteristics associated with acceptance of dataset linkages and health data linkage data quality were analyzed., Methods: Participants from the 2011 Taiwan Longitudinal Study on Aging were asked to link their epidemiological data with concurrent and future medical claim datasets. Characteristics associated with acceptance of data linkage, data consistency, under-reporting, and over-reporting of disease conditions were identified., Results: Among the 3727 respondents, 3601 (96.6%) accepted data linkage. Middle-aged adults with worse functional health accepted data linkage. Older adults (65+) with better health behavior and social support were more likely to accept data linkage. Consistency between self-reports and medical data was very good to satisfactory (Kappa = 0.80 and 0.67, respectively, for diabetes and hypertension). Comorbidities were common risk factors resulting in inconsistency between self-reports and medical data (OR = 1.58 and 1.27, respectively, for diabetes and hypertension). Living alone was another risk factor resulting in inconsistency for diabetes. Male, older, and not living alone were other risk factors resulting in inconsistencies for hypertension. Under-reporting of illness was associated with poor health and older age. Over-reporting of illness was associated with better health and younger age., Discussion: The findings suggest different adjustment methods for middle-aged versus older respondents when considering self-report data validity.

Purpose: To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities., Design: Multi-area, cluster-randomized intervention controlled trial., Participants: A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group., Methods: Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires., Main Outcome Measures: Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures., Results: The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28-0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (≥200 minutes) showed significantly less myopic shift (measured by light meters; ≥1000 lux: 0.14 D; 95% CI, 0.02-0.27; P = 0.02; ≥3000 lux: 0.16 D; 95% CI, 0.002-0.32; P = 0.048)., Conclusions: The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years., Methods: We investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis., Results: Influenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63-0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64-0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57-2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69-1.18)., Conclusions: The risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality., (Copyright © 2018. Published by Elsevier B.V.)

Background: Most senior veterans who live in veterans' homes in Taiwan are single and have few intimate, interpersonal relationships. Aging is often accompanied by solitude and illness, which causes senior veterans to doubt the meaning of life and to lose confidence in the value of life., Purpose: This study investigated the personal characteristics that influence interpersonal intimacy and the meaning of life as well as the relationship between interpersonal intimacy and the meaning of life among senior veterans living in veterans' homes., Methods: A cross-sectional design was used, and 120 senior male veterans were convenience sampled from three veterans' homes in southern Taiwan. Three structured questionnaires were used in this study: personal characteristics questionnaire, interpersonal intimacy scale, and purpose in life test., Results: (a) Interpersonal intimacy was influenced by source of income or funds, type of residence institution, religious affiliation, and the quality of the participant's relationships with family, friends, and fellow residents. Educational level and self-perceived health status correlated positively with interpersonal intimacy, and period of residence correlated negatively with interpersonal intimacy. (b) Meaning of life was influenced by the quality of relationships with family and friends. Educational level and self-perceived health status correlated significantly and positively with meaning of life, and period of residence correlated negatively with meaning of life. (c) Significant, positive correlations were found among interpersonal intimacy, the four domains of interpersonal intimacy, and meaning of life., Conclusions/implications for Practice: Health professionals involved in the care of senior veterans in institutions may use the results of this study to develop and implement interventions that promote a higher degree of interpersonal intimacy and a higher appreciation of the meaning of life, thus enabling senior veterans to confront old age in a more positive manner.

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is widely accepted as a treatment for advanced Parkinson disease (PD). However, published studies were conducted mainly in Western centers and recruited small numbers of patients. This study presents 1-year outcomes in Taiwanese patients with PD., Methods: Sixty-two consecutive patients underwent STN-DBS surgery during a 7-year period. Their median drug-off Hoehn and Yahr stage was 3 and mean illness history was 8 years. Clinical outcomes were evaluated by the change in drug-off/DBS-on Unified Parkinson Disease Rating Scale (UPDRS) scores relative to presurgical drug-off baseline and change in daily levodopa-equivalent dose (LED)., Results: After 1 year of DBS therapy, patients showed significant improvements with a clinically high effect size in cardinal signs, particularly in tremor (63%). Posture instability was also improved, whereas speech dysfunction was hardly corrected. The LED need was significantly reduced, therefore preoperative drug-induced complications were prominently (51%) ameliorated after surgery and drug-induced dyskinesia was remarkably (63%) diminished. No serious adverse effects were encountered after surgery. Overall, motor functions declined by 15% within 1 year in drug-off state., Conclusions: Bilateral STN-DBS therapy provided effective and sustained benefits to Eastern patients with PD over a 1-year period., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To investigate the association of eight connexin genes (GJB2, GJB4, GJA1P1, GJB6, GJB3, GJA1, GJB1, and GJC3) and the SLC26A4 gene with congenital hearing impairment among infants in a universal newborn hearing screening program., Method: From September 2009 to October 2013, the consecutive neonates born in all six branches of Taipei City Hospital were enrolled. Infants who failed the newborn hearing screening and were diagnosed with hearing impairment underwent the genetic analyses., Result: 15,404 neonates were born at Taipei City Hospital, and 15,345 neonates underwent newborn hearing screening. Among them, 32 infants were diagnosed with unilateral or bilateral hearing impairment. 26 of them underwent analyses of the connexin genes and the SLC26A4 gene. Of the connexin genes, two infants carried a GJB3 mutation (heterozygous c.580G>A and heterozygous c.520G>A, respectively). Only one infant carried a GJB2 mutation (homozygous c.235delC). One infant carried a GJA1P1 mutation (heterozygous c.929delC) and another carried a GJB4 mutation (heterozygous c.302G>A). Additionally, one infant carried a GJA1P1 novel variant (heterozygous c.1081C>T). Another infant carried a GJA1 novel variant (heterozygous c.1-33C>G). Of the SLC26A4 gene, one infant carried heterozygous c.919-2A>G mutation and a novel variant (heterozygous c.164+1G>C), and high-resolution computed tomography (HRCT) of the temporal bone revealed bilateral enlarged vestibular aqueducts. One infant carried heterozygous c.919-2A>G mutation and no inner ear anomalies were demonstrated by HRCT of the temporal bone. Another infant carried a novel variant (heterozygous c.818C>T)., Conclusion: These results provide a genetic profile of the connexin genes and SLC26A4 gene among infants with hearing impairment detected by a universal newborn hearing screening program in Taiwan. Further studies and long-term follow up of this cohort are warranted to determine the pathogenicity of each variants and the long-term hearing consequence., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: This study explored the relationship between sudden sensorineural hearing loss (SSNHL) and prior tension-type headache (TTH) in a large nationwide population-based data set in Taiwan., Methods: In this case-controlled study in Taiwan, participants with SSNHL (n = 4,683) were identified, and controls (n = 18,732) were randomly selected from the National Health Insurance database. Cases of TTH were identified by having been diagnosed as TTH prior to the index date of SSNHL diagnosis. A conditional logistic regression model was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CI) for the association of sudden deafness with TTH among the sampled patients., Results: Among the 23,415 patients, 2.5% (600/23,415) had TTH diagnoses prior to the index date; TTH was diagnosed in 4.5% (209/4,683) of the SSNHL group and 2.1% (391/18,732) of the control group. After adjusting for sociodemographic characteristics and comorbid medical disorders, we found that patients with SSNHL were more likely to have had a previous TTH than controls (OR, 1.86; 95% CI, 1.54-2.24; p < 0.01)., Conclusion: Both male and female patients with SSNHL had a higher proportion of prior TTH than controls without SSNHL., (© 2015 S. Karger AG, Basel.)

Suicide caring competence is important for family caregivers to care their relatives with suicidal tendencies. The purpose of this study was to develop and test the psychometric properties of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan. A 20-item SCCS was tested on 165 family caregivers. Confirmatory factor analysis indicated that five subscales with 19 items best fit the data. The Cronbach's α and test-retest reliability of the SCCS was 0.90 and 0.81, respectively. The SCCS demonstrated acceptable construct validity and reliability. Nurses can use the SCCS to assess the suicide caring competence of family caregivers., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Liability attribution and professional negligence in pediatric nursing are topics that have been neglected in Taiwan., Purpose: (1) Identify the definitions of related criminal activities in accordance with domestic criminal law; (2) Elucidate the facts and the dispute in a current case involving a pediatric nurse; (3) Elucidate the principle of 'no punishment without law'; (4) Explore the reasons why the pediatric nurse in the current case received a verdict of 'not guilty'., Methods: A literature review and case study approach were used to analyze a sentence reconsideration of the first instance No. 1 (2011) issued by the Taiwan high court, Kaohsiung branch court., Results: The conditions for the scrutiny of criminal activity under Taiwan criminal law are statement of facts, illegality (justifiable cause), and liability (excuse). In this case, the pediatric nurse was accused of failing to prevent an infant from suffocation and of not discharging her obligations as a nurse. The pediatric nurse rebutted the charge of criminal negligence. The intervening behaviors of the pediatric nurse were found to be legal and not culpable. In this case, the High Court and Supreme Court made a final criminal judgment based on the presumption of innocence, and the pediatric nurse was pronounced innocent of the charge., Conclusions: This article intends to assist pediatric nurses understand their liabilities under Taiwan's criminal law. Pediatric nurses should gain a better understanding of the nature of liability for professional negligence in order to clarify how actions that may be illegal do not necessarily make nurses culpable.

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals., (© 2014.)

Background: Psychiatric nurses have a special obligation and legal duty as guarantor against criminal negligence. The guarantor role and medical negligence in psychiatric nursing are topics that have been neglected in Taiwan., Purpose: (1) Identify the status of psychiatric nurses as guarantors; (2) Understand the causal relationship in a legal context between this status and Non-Genuine Omission in the current case; (3) Understand the facts and the dispute in the current case. (4) Explore the reasons why the psychiatric nurse was convicted for criminal negligence in the current case., Methods: A literature review and case study were used to analyze the high court criminal judgment and sentence reconsideration of the first instance No. 122 (2005)., Results: (1) Psychiatric nurses hold two guarantor roles in Taiwan. One role is as legally protected interest guarantor and the other is as supervisors' dangerous source guarantor. (2) The three sources of guarantor status relevant to the current case are: nurses' voluntary commitments; medical contract; duty of care of supervisors. (3) In this case, the psychiatric nurse did not discharge her obligations as guarantor and failed to prevent the patient from committing suicide. Negligence resulted in patient death and the psychiatric nurse was found guilty., Conclusions: In order to prevent criminal acts, psychiatric nurses should gain a better understanding of their status as guarantor and the obligations entailed in this status. This article is intended to assist psychiatric nurses understand their responsibilities under current laws.

Objectives: To establish a hearing screening program with high coverage, low referral rate, high follow-up rate, and early intervention in Taipei City., Methods: From September 2009 to December 2010, 85% delivery units in Taipei City, which includes 20 hospitals and 14 obstetrics clinics, were recruited into the screening program in two stages. A total of 15,930 babies were born in these participating hospitals and clinics during the program period. Among these neonates, 15,790 underwent hearing screening test with automatic auditory brainstem response (AABR). The screening was free of charge to the parents. The hearing screening examination was performed 24-36 h after birth. The same test was repeated between 36 and 60 h of age if the baby failed the first hearing test. The neonate was referred to the diagnostic hospitals for further investigations if he failed the second test., Results: The screening coverage rate was 99.1% (15,790/15,930). The incidence of bilateral moderate to severe and unilateral hearing loss was 1.4 per 1000 (22/15,790) and 1.5 per 1000 (24/15,790), respectively. Four percent (626/15,790) of newborns failed to pass the initial screening test and 1.0% of newborns failed to pass the second screening test. Therefore, 1.0% newborns were referred for diagnostic assessments. The follow-up rate was 94.4% (151/160). Sixty-four percent (14/22) of babies with bilateral hearing loss completed the full diagnostic hearing tests within 3 months of birth., Conclusions: The universal newborn hearing screening program is an adequate program for Taipei City with high coverage, low referral rate, and good follow-up rate. Screening fees covered by third parties, two-stage screening steps with AABR strategy, and the stringent monitoring system proved to be effective., Level of Evidence: 2b, individual cohort study., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Increased media viewing such as watching television and videos and playing on/using computers has been associated with childhood obesity. Guidelines from the American Academy of Pediatrics recommend limiting children's total media time to no more than 2 hours per day. Information about media usage and school-aged obesity in Taiwan is lacking., Purpose: The purpose of this study was to investigate whether media viewing after school is associated with the total and centralobesity in school-aged children in Taipei, Taiwan's capital and largest city., Methods: A case-control study was designed, and a control approach was used to recruit participants. Two hundred seventy-five obese and 275 normal-weight children currently in the fourth grade were enrolled from 29 elementary schools in Taipei City. Media viewing after school was measured using a 3-day self-reported physical activity log and the daily sedentary activity component of the National Health Interview Survey in Taiwan. The latter was completed by the participants' parents., Results: Participants with total obesity had significantly more television watching time (60.24 minutes vs. 43.50 minutes, p < .05) and total media watching time (73.61 minutes vs. 52.67 minutes, p < .001) than normal-weight participants. Similar results were found for participants with central obesity. Total television and total media watching durations greater than 2 hours a day correlated significantly with total and central obesity. Time spent using computers did not differ significantly between obese and normal-weight control participants on weekdays., Conclusions/implications for Practice: Childhood obesity may be multifactorial in origin. Excessive sedentary activity such as watching television may have a variety of consequences beyond the putative effect on body habitus. School nurses should promote health programs targeted to prevent excessive weight and obesity in children, recommend reducing media viewing, and encourage patient participation in extracurricular outdoor activities.

Objectives/hypothesis: To establish an ideal operative procedure of universal newborn hearing screening and to investigate whether a government-funded program increases compliance with such screening., Study Design: Individual cohort study., Methods: Of the 3,373 neonates born at the Taipei City Hospital during the period August 2009 to July 2010, there were 3,361 who received hearing screening with automatic auditory brainstem response (AABR) 24 to 36 hours after birth. The cost of each procedure (US $16.70) was covered by the Taipei City Health Bureau. The control group comprised 6,582 neonates born at the same hospital during the period January 2003 to December 2004, of whom 5,749 had been screened with transient-evoked otoacoustic emission (TEOAE). The cost of each procedure (US $26.70) was paid by the parents of each newborn., Results: The incidence of bilateral moderate to severe hearing impairment was 0.06% (two out of 3,361) and 0.10% (six out of 5,749) in the study and the control group, respectively. The incidence of unilateral hearing impairment was 0.09% (three out of 3,361) and 0.19% (11 out of 5,749) respectively. The coverage rate of the study was significantly higher than that of the control group (99.64% vs. 87.34%, P < .001). A significant decrease of the referral rate was achieved in the study group when compared with the control group (0.95% vs. 2.82%, P < .001). The follow-up rate of the study group was significantly higher than that of the control group (100.00% vs. 40.74%, P < .001)., Conclusions: The government-funded AABR program resulted in markedly better parental compliance with newborn hearing screening than the self-pay TEOAE screening program., Level of Evidence: 2b., (Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.)

Background: Disaster-related mental health problems have been a focus of recent international scholarly interest. Typhoon Morakot caused exceptional destruction in Southern Taiwan, and victims suffered physically, psychologically and financially in its aftermath., Purpose: This study investigates the post-traumatic response and coping behaviors of victims one year after Typhoon Morakot., Methods: Researchers used a phenomenological method with purposive sampling and interviewed 10 Typhoon Morakot victims. Data were collected using deep, semi-structured interviews. All interview sessions were tape-recorded. Researchers used Colaizzi's seven-step phenomenological method to analyze data., Results: Three common themes emerged in subjects following their disaster experiences. The first was residual traumatic response, including fear of continued flooding, fear of future flood recurrence, indifference in responses, and living on alert; The second was insecurity in daily life due to changed surroundings, including anxiety and a heavy sense of loss; The third was conformity in coping behaviors, including shifting attention away from the disaster, turning to a pluralistic support system, having an optimistic outlook on life, and living in the moment., Conclusion: Investigating traumatic response experiences and coping behaviors one year after the Typhoon Morakot disaster can help guide healthcare professionals to promote evidence-based health and nursing services. Findings also provide information to healthcare providers essential to improving nursing quality for victims of disasters.

Aim: Reference ranges of haematological parameters in preterm infants are limited. The aim of this study is to determine the reference values of haematological parameters in preterm infants in Taiwan, and to assess the impact of gestational age and mode of delivery on these parameters., Method: Medical records were retrospectively reviewed in preterm infants admitted to National Taiwan University Hospital from January 2001 to December 2004. The inclusion criteria included infants with <37 weeks of gestation who had blood sampling within 24 h of birth. The exclusion criteria included those with maternal history of antepartum haemorrhage, chorioamnionitis, fever, sepsis, preeclampsia and hypertension; and perinatal history of twin-to-twin transfusion syndrome, feto-maternal transfusion, injury and infection., Results: Of 568 preterm infants with blood cell counts, 337 were available for analysis. There were trends of increase in red blood cell counts, haemoglobin levels and haematocrit values as gestation increased up to 34 weeks. In contrast, a trend of decrease was noted in mean corpuscular volume values. There was an initial trend of decrease in white blood cell counts and then increased after 31 weeks gestation. The platelet counts were essentially unchanged. Infants born by vaginal delivery generally had higher haematological parameters than those born by Caesarean section at different gestational ages except for mean corpuscular volume values., Conclusions: We established the reference ranges of haematological parameters in Taiwanese preterm infants. Health-care professionals must be cautious in clinical application of the haematological values because of varying antenatal and perinatal risk factors., (© 2009 The Authors. Journal compilation © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Aim: This paper is a report of a study to explore family carers' and suicidal ex-patients' perceptions of the home environment and the provision of care in the home., Background: Worldwide, in 2000 approximately one million people died from suicide, which is among the three leading causes of death among those aged 15-44 years. Internationally, epidemiological trends show that there has been a rapid increase in suicide rates in many countries, including Taiwan. Families have an important role in caring for a member who is at risk of suicide., Methods: Using a grounded theory approach, data were collected in 2006-2007 in two Taiwanese hospitals. Interviews were conducted with suicidal patients who had just been discharged (n = 15) and family members (n = 15). Data were analysed using open, axial and selective coding., Findings: For the purpose of a larger study a substantive theory was formulated, which families could use to guide them in the care of a member who is at risk of suicide. Here we report the findings related to the 'context' and 'intervening conditions' of the grounded theory. Two categories emerged in the 'context' element, namely 'the family environment' and 'the Chinese culture'. One category surfaced in the 'intervening condition' namely, 'The provision of care in the home'. This category included three sub-categories: support systems; coping mechanisms and helping skills., Conclusion: Family carers experienced difficulties when caring for a member who had previously attempted suicide. Before patients are discharged from hospital, nurses should educate families on the preventive and caring approaches that they could use in their homes.

Peroxiredoxins (Prxs) play important roles in antioxidation and cell signaling. A gene encoding a novel 2-Cys Prx was identified based on sequence homology in an expressed sequence tag database of the Antrodia camphorata, a medicinal mushroom found only in Taiwan. The 2-Cys Prx cDNA (940 bp) encodes a protein of 188 amino acid residues with calculated molecular mass of 20,965 Da and a pI of 5.89. The coding region was subcloned into pAVD10, transformed into Escherichia coli, and expressed as a His-tagged fusion protein. The purified enzyme was characterized under various conditions. The Prx retained 68% activity after being heated at 60 degrees C for 2 min. It was stable under a broad pH range from 5 to 11. The enzyme activity was slightly decreased in the presence of 1% sodium dodecyl sulfate. The enzyme was somewhat susceptible to chymotrypsin treatment but resistant to digestion by trypsin.

To verify the association between APOE4 frequency and various dementias in Taiwan Chinese individuals, APOE genotypes were determined in patients with dementia of Alzheimer's type (AD), vascular dementia (VD), dementias due to other general medical conditions (OD), and dementia of Alzheimer's type with cerebral vascular disease (mixed type dementia; MD). Only AD patients exhibited higher APOE4 frequency (OR = 2.95, p = 0.001) than controls after Bonferroni correction to control the overall type I error rate for the multiple testing. No such difference was observed among VD, OD, MD and control groups. The lack of association between VD and APOE4 allele frequency suggests that APOE4 allele does not associate with cerebrovascular pathology related dementia in Taiwan Chinese.