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While there is a strong assumption of a direct link between family climate and school bullying victimization, studies on such a direct link have shown inconsistent results. Furthermore, family climate and children's social relationships with teachers and peers at school have been considered potential protective factors against school bullying victimization among adolescents. However, not much is known about how these factors function as protectors against school bullying victimization among children early in middle childhood. Studies examining how these protective factors work together to reduce school bullying victimization are also lacking. This paper attempts to fill the gap by studying how children's social relationships with peers and teachers at school mediate the association of family climate with school bullying victimization among children in the early period of their middle childhood in Taiwan. It also examines how sex influences the mediating effects and interrelationships among family climate, children's school social relationships at school, and school bullying victimization. Data were obtained from a nationally representative sample of 1230 third graders (about 8 years old) in Taiwan. The results showed that family climate had a nonsignificant direct link with school bullying victimization, but a significant indirect link with school bullying victimization mediated through relationships with peers and teachers. These findings are relevant for both sexes. Findings provide empirical support that family climate has an indirect link with school bullying victimization through relationships with teachers and peers. The study indicated that to reduce school bullying victimization among those who are early in middle childhood, potential intervention programs may consider promoting students' relationships with teachers and peers.

Children in foster care face a heightened risk of poor educational outcomes, yet published research on programs designed to improve outcomes remains scant. Findings from an evaluation of the Educational Advocacy Program (EAP) that works with foster and adoptive caregivers and educators to address unmet educational needs are presented to help fill this gap. Youth, services data, and contact information for caregivers and educators were drawn from EAP files for cases closed during 2018–2019 (n = 234). Surveys of identified educators and caregivers as well as district foster care liaisons were conducted. Youth information was linked to state administrative data on foster care placements. Descriptive and bivariate analyses of program outcomes, program satisfaction, and placement stability were completed. Caregivers and educators perceived benefits for themselves and youth served. EAP staff ratings of post-service youth function were congruent with caregiver ratings of youth school outcomes. Statistically significant decreases in youth placement moves were found during and after services compared to before EAP onset. While not a causal design, results indicate that EAP holds promise for supporting caregiver and educator collaboration and improving youth school and placement outcomes. Implications for future research and practice are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The National Child Abuse and Neglect Data System (NCANDS) Child File, the only national dataset cataloging child maltreatment reports. It includes variables representing economic distress frequently used in published research. At the national level, these variables are demonstrably implausible, substantially underestimating economic distress. Method: This paper reviews recent work using these variables, analyzes the NCANDS data directly, demonstrates why the economic variables in NCANDS are unusable at a national level, and provides recommendations for incorporating economic measures using NCANDS. Results: We find 19 articles that have used these variables within the past 10 years. Most states provide implausible estimates. Economic measures can be incorporated into NCANDS data by either subsetting to s states with plausible estimates of these variables in given years, or appending county-level economic Census data. Discussion: Without addressing these variables' issues in plausibility, use of them will yield biased estimates. [ABSTRACT FROM AUTHOR]

Simple Summary: Radiofrequency ablation is a curative treatment for early-stage hepatocellular carcinoma (HCC), but many factors influence the survival of these patients and should be taken into consideration during treatment planning. Our retrospective study reports the outcome of radiofrequency ablation (RFA) as primary treatment and analyzes seven factors related to a poorer prognosis: Age greater than 65 years, albumin-bilirubin (ALBI) grades 2 and 3, AST-to-platelet ratio index (APRI) greater than 1, tumor size larger than 3 cm, diabetes mellitus, end-stage renal disease, and tumor number greater than 1. By incorporating these variables, we developed a simplified nomogram that enables personalized predictions of overall survival following RFA for HCC. This tool can support physicians in clinical decision-making by providing individualized prognostic information. Our objective was to develop a predictive nomogram that could estimate the long-term survival of patients with very early/early-stage hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA). For this retrospective study, we enrolled 950 patients who initially received curative RFA for HCC at Barcelona Clinic Liver Cancer (BCLC) stages 0 and A between 2002 and 2016. Factors predicting poor survival after RFA were investigated through a Cox proportional hazard model. The nomogram was constructed using the investigated variables influencing overall survival (OS). After a median follow-up time of 6.25 years, 400 patients had died, and 17 patients had received liver transplantation. The 1-,3-,5-,7-, and 10-year OS rates were 94.5%, 73.5%, 57.9%, 45.7%, and 35.8%, respectively. Multivariate analysis showed that age greater than 65 years, albumin-bilirubin (ALBI) grades 2 and 3, AST-to-platelet ratio index (APRI) greater than 1, tumor size larger than 3 cm, diabetes mellitus, end-stage renal disease, and tumor number greater than 1 were significantly associated with poor OS. The nomogram was constructed using these seven variables. The validation results showed a good concordance index of 0.683. When comparing discriminative ability to tumor, node, and metastasis (TNM), BCLC, and Cancer of the Liver Italian Program (CLIP) staging systems, our nomogram had the highest C-index for predicting mortality. This nomogram provides useful information on prognosis post-RFA as a primary treatment and aids physicians in decision-making. [ABSTRACT FROM AUTHOR]

Background: Many nursing home residents lack autonomous decision-making capacity and rely on family members to make do-not-resuscitate (DNR) decisions. Making DNR decisions can be difficult and complicated for surrogates. However, surrogates' psychological experience in making these decisions for older relatives is not well studied. Aim: To understand the surrogates' psychological experience of making DNR decisions for older relatives in a nursing home. Methods: The study subjects of this qualitative study were family surrogates of older residents in a nursing home of Taiwan. A self-constructed, semistructured interview guided in-depth interviews, which were recorded. Content analysis was used to discover themes from verbatim record. Results: Four themes were revealed: lack of psychological preparation, considering issues when making a decision, ambivalent emotional responses and impact of cultural factors. Fifteen subthemes were also found. Conclusions: Surrogates who must decide whether to make a DNR decision for older relatives experience great emotional conflict. Understanding surrogates' struggles may assist nursing and care staff in managing this difficult situation. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground:To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.Methods: A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.Results: One core theme emerged: "protective preparation." This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.Conclusions: Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the predictors for health monitoring system utilization of residents in an elderly village. The residents of this study were divided into study group and control group based on the frequency of how they used electronic blood pressure monitoring devices. In evaluating the resident's client singularity and health monitoring system utilization, predictors were developed. The study also constructs telehealth system that is web-based system and connecting SQL (Structured Query Language) server database. The theoretical framework of this study is based on the interaction model of client health behavior (IMCHB) proposed by Cox. This is a quantitative study with case control design and using purposive sampling divided samples into study group and control group. The study had a total of 76 residents above the age of 60 years enrolled from the Chang Gung Elderly Village. Description and statistical analysis of the differences in characteristics of both groups were done and developed predictors. Results of the study showed no differences in the client singularity of the resident and control group, and the health behaviors in the control group were found to be better. The predictors of health monitoring system utilization including China main lander (odds ratio 0.23), blood pressure greater than 140/90 mmHg at the time of moving-in (odds ratio 10.57), higher level of self-actualization (odds ratio 0.23). The telehealth system database is based on Server of Microsoft SQL (Structured Query Language), the webpage editing software is FRONT PAGE and DREAMWEAVER, the procedure language is mainly Hypertext Markup Language (HTML), with Active Server Page (ASP) as the written language of the database. The website uses web based questionnaire as the infrastructure. It is hoped that with the development of telehealth system, residents can have access to web information, immediate communication, and appropriate medical intervention. The results of this study will also serve as a reference for future research. [ABSTRACT FROM AUTHOR]

Background: Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively., Purpose: To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia., Methods: This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression., Results: The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression., Conclusions / Implications for Practice: Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.