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There were few papers for interdisciplinary integration of Scratch programming, English learning, and local cultures as far as the digital animated E-book creation of elementary schools was concerned. This article proposes an interdisciplinary innovative teaching mode, with college students as teachers, Scratch programming and English learning as tools, and a local legend The Wind Chasers of Siraya as material for schoolchildren in a remote area of Taiwan. Schoolchildren were divided into four groups, and each group was responsible for a part, and finally these four parts were integrated into a complete animated English picture book with images, sound, music, and games. The purpose is to enhance the acquisition and learning of information technology and English application among schoolchildren in the remote area. Participants were evaluated in accordance with their learning motivation, self-efficacy, and learning effect. The self-efficacy scale was designed from three dimensions of the self-efficacy theory presented by Bandura and the syllabus of five functions in Scratch. The teaching effects were investigated with paired sample t test. The results of these assessments revealed that schoolchildren's learning motivation has been elevated, with a significant improvement of self-efficacy and overall learning achievement. In addition, the post-test revealed that Scratch programming and English learning from the culture-based illustration book had significant correlation, which suggested that the overall program successfully integrated these two subjects.

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This study seeks to understand the impact on the forest biomass of different kinds of environmental disturbance, including high winds from typhoons, land‐use/land‐cover changes (LULCC), and CO2 fertilization. A series of factorial experiments addressing the impact of different types of environmental disturbance on the forest biomass in Taiwan was conducted using the advanced ORCHIDEE‐CAN land surface model with a recently developed wind‐throw module. The climatic forcing driving the ORCHIDEE‐CAN land surface model was first simulated by an atmospheric general circulation model, then dynamically downscaled to a more satisfactory spatial and temporal resolution. The initial and boundary conditions applied in the numerical simulations were based on the long‐term CO2 concentration and LULCC reconstruction, respectively. The model simulation showed an increase in the aboveground wood volume from 209 m3 ha−1 in 1979 to 229 m3 ha−1 in 2017, and the dynamics were consistent with those recorded in the national forest inventory. The annual average carbon sequestration rate over the past 39 years was 0.5 m3 ha−1 yr−1 for a forested area of 2.4 M ha. The most surprising finding was the contribution of the wind disturbance to wood loss, which was at almost the same level as the annual carbon sequestration rate. The LULCC experiment showed a trade‐off between afforestation and deforestation in forest biomass accumulation in Taiwan from 1979 to 2017. The CO2 fertilization effect contributed to an enhancement of forest biomass stock of around 39%, while the CO2 concentration increased from 296 to 406 ppm over 39 years. Plain Language Summary: Forest biomass is one of the main carbon pools found in terrestrial ecosystems. Its storage capacity is, however, vulnerable to climate change and anthropogenic and natural disturbances. In this study, simulation experiments were carried out to understand the impact of tropical cyclones, land use and land cover change, as well as increasing atmospheric CO2 concentrations on the forest biomass in Taiwan. The simulation experiments were made possible thanks to century‐long country‐specific land cover and climate reconstructions, and recent developments of the ORCHIDEE model by the addition of a module capable of simulating the effects of windstorms on forest biomass. Studies show that wind disturbance has a big impact on carbon sequestration rates. In the absence of wind disturbance, the annual sequestration rate would be double that of the present‐day rate. In other words, not considering wind disturbances could lead to a significant overestimation of the forest biomass in regions prone to frequent tropical cyclones, some of which can reach typhoon strength. Key Points: Findings show a greater decrease in forest biomass due to tropical cyclones than to the effects of changes in LULC, CO2 and climateModels which do not consider wind disturbance may greatly overestimate the forest biomass in regions prone to frequent tropical cyclones [ABSTRACT FROM AUTHOR]

Hereditary angioedema (HAE) is an autosomal dominant disease characterized clinically by recurrent episodes of swelling in the tissues of the extremities, face, abdomen, and respiratory tract. It is most often caused by C1 esterase inhibitor (C1 INH) gene mutation. This swelling may lead to bradykinin release, resulting in recurrent, paroxysmal, painful angioedema. Blister formation is an uncommon cutaneous manifestation of HAE. Herein, we report a case of a patient with HAE who developed linear wrist blisters on her skin, with swelling, as a rare complication of HAE. She was treated with attenuated androgens (Danazol) for two weeks at our clinic, after which the blisters showed dramatic improvement. To date, only a few HAE cases have been reported across the world. Therefore, it is important to focus on and recognize the development of edema blisters as a flare of HAE, which could consequently avoid unnecessary dermatological diagnostic workup and treatment. [ABSTRACT FROM AUTHOR]

Aims: This study was to explore the student nurses' bullying, social support and their health status during clinical practicum programmes and the predictors of health status among student nurses during clinical practicum programmes. Methods: A cross‐sectional design with structured questionnaires was used, recruiting 200 student nurses in a 5‐year junior college programme in south Taiwan. Results: The significant predictors of nursing students' health status during clinical practicum programmes were 'whether experiencing bullying situations during clinical practicum' and 'low social support'. Conclusion: In order to prevent bullying during clinical practicum, encouraging nursing students to report all the clinical practicum bullying incidents, providing counselling to nursing students and arranging clinical practicum bullying prevention courses to students were important. Moreover, providing instructors and nursing staff with teaching, communication and feedback skills might help nursing students prevent bullying incidents during clinical practicum programmes. A longitudinal study design was suggested for the future study in order to assess the cause–effect relationship of the bullying and social support on health among students during clinical practicum SUMMARY STATEMENT: What is already known about this topic? Nurses' exposure to workplace bullying will result in their health problems. What this paper adds? Student nurses' exposure to bullying during clinical practicum and low social support might impact on their health status. The implications of this paper: Establishing supportive practicum environments is important to help nursing students prevent bullying incidents during clinical practicum programmes.Nurse educators might include the results of this study into the contents of the educational programmes to increase students' knowledge on student nurses' bullying and its risks. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore nurses' demographic data, assertiveness, psychosocial work condition, and workplace bullying, and find the predictors of workplace bullying. Methods: This study adopted a cross‐sectional design. A stratified sample comprising 241 nurses from a regi onal teaching hospitals in Taiwan was selected from the 10th to the 23rd September, 2018. Data were analysed by using the SPSS Statistics 17.0. Descriptive statistics (frequency, percentage, mean, and standard deviation), one‐way Anova, t test, Pearson's correlation, and multiple linear regressions were used. Results: The results showed that the participants with "past bullying experience," "lower self‐assertiveness," "higher work psychological demands," "lower workplace justice," "lower labour participation," and "lower overall social support" are more likely to experience workplace bullying. Conclusions: Hospital managers should pay attention to the problem of nursing workplace bullying. First of all, hospital managers should encourage curriculum on nursing workplace bullying and incorporate nursing workplace bullying prevention training courses in curriculum planning. SUMMARY STATEMENT: What is already known about this topic? Workplace bullying can cause physical and psychological disorders in nurses and affect patients' safety.Understanding the affecting factors related to workplace bullying may be beneficial for decreasing the incidence of workplace bullying in nurses. What this paper adds? Past bullying experience, self‐assertiveness, work psychological demands, workplace justice, labour participation, and overall social support were predictors of workplace bullying. The implications of this paper: The establishment of a friendly workplace environment is important, such as, building up justice policies and involving nurses' opinions whilst setting up all policies.Nurse managers may provide educational programs to nurses in order to improve their knowledge and skills to deal with workplace bullying. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the perceived work stress and its influencing factors among hospital staff during the novel coronavirus (COVID‐19) pandemic in Taiwan. A web‐based survey was conducted at one medical center and two regional hospitals in southern Taiwan, targeting physicians, nurses, medical examiners, and administrators. The questionnaire included items on the demographic characteristics of hospital staff and a scale to assess stress among healthcare workers caring for patients with a highly infectious disease. A total of 752 valid questionnaires were collected. The hospital staff reported a moderate level of stress and nurses had a highest level of stress compared to staff in the other three occupational categories. The five highest stress scores were observed for the items "rough and cracked hands due to frequent hand washing and disinfectant use," "inconvenience in using the toilet at work," "restrictions on eating and drinking at work," "fear of transmitting the disease to relatives and friends," and "fear of being infected with COVID‐19." Discomfort caused by protective equipment was the major stressor for the participants, followed by burden of caring for patients. Among participants who experienced severe stress (n = 129), work stress was higher among those with rather than without minor children. The present findings may serve as a reference for future monitoring of hospital staff's workload, and may aid the provision of support and interventions. [ABSTRACT FROM AUTHOR]

Background: Ineffective medical treatment could be avoided if patients had completed advance directives documents in advance. Aims: This study aimed to explore the predictors for the intentions of signing advance directives among dialysis patients. Methods: This cross-sectional study recruited 209 dialysis patients by using structured questionnaires. The Statistical Package for the Social Sciences (Version 17) (SPSS/IBM Inc., Chicago, IL, USA) was used for data analysis. Results: The predictors for the intention of signing the advance directives documents were having information on palliative care, the participants' knowing about the advanced directives documents, and their having more knowledge of advance care plans. Conclusions: Health care workers may strengthen the patient's knowledge of an "advance care plan" by health education during the dialysis treatment and provide information on websites for the patients. Impact statement: Hospital managers should train their staff to provide health teachings for an advance care plan. [ABSTRACT FROM AUTHOR]

Aims and objectives: To analyse the relationship among hospital nurses' socio‐demographic data, work stress, humor and health conditions, and to determine the predictors of nurses' health status. Background: Humor can decrease the feelings of helplessness, fear and anxiety, and that may result in the development of positive emotions, which might have a good impact on health. Design: This research applied cross‐sectional designs and used structured questionnaires which included socio‐demographic data, an Effort‐Reward Imbalance questionnaire (ERI), humor and 12‐item Chinese health questionnaires (CHQ). A total of 236 nurses in a regional hospital in Taiwan were recruited. SPSS was used for the data analysis in the study. The STROBE was chosen as a checklist for this study. Results: The results showed that the significant predictors of the participants' health were "whether experienced significant life events during the past 3 months," "the degree of work stress" and the level of "humor." Conclusions: It is recommended that administrators pay attention to the cultivation of nursing staff's humor, such as providing nurses with musical CDs or humorous books and providing stress management training courses to nurses. Relevance to clinical practice: It is necessary for hospital managers to determine and deal with the causes of work stress to avoid the development of health problems in the nursing personnel. Furthermore, in order to develop stress‐releasing strategies, it is necessary to provide nurses with stress management and resilience enhancement courses. Cultivating a humor competency of nurses is also recommended to alleviate the work stress. [ABSTRACT FROM AUTHOR]

Background: Nurses with obesity will lead to health problems as well as their high turnover rate and low retention rate. Objectives: This study explored the associations with female nurses' work stress, social support and overweight/obesity, and tried to find the predictors of the female nurses' overweight/ obesity. Methods: The study applied a cross-sectional and correlational design. Findings: The results of this study showed that "regular exercise frequency lower than or equal to 2 days a week", "rotating night shifts greater than or equal to 4 times a month", "nursing working hours higher than 44 hours a week", "high work stress", and "low social support" were the main predictors of "overweight/ obesity". Conclusions: Conducting workshops were recommended to nurse managers to motivate female nurses" exercise frequency, remind female nurses of keeping a healthy diet during night shifts, and provide female nurses with some relaxing skills to release their work stress. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study was to investigate bullying among hospital nurses and its correlates. Background. Chinese people were unlikely to express their opinions or pursue individual rights. Workplace bullying took place more easily among the educated people within Chinese culture. However, studies related to workplace bullying among hospital nurses in Taiwan were still limited. Design. A cross-sectional design. Methods. Two hundred and eighty-five nurses who worked in the regional teaching hospital in south Taiwan were recruited. The significant predictors of workplace bullying were identified by using linear regression analysis. Results. The mean of overall bullying was 1-47, showing that the frequency of the nurses having experienced workplace bullying was between 'never' and 'now and then'. The most frequent bullying item was 'being yelled at or being the target of anger', followed by 'being the objects of untruthful criticism' and 'having views ignored'. Hospital nurses working in the Emergency room would gain 10-888 points more in the overall bullying scale compared with those who worked in operation rooms or haemodialysis rooms. They were more likely to be bullied. Hospital nurses with one year increase in nursing experience were 0-207 points less likely to be bullied. Conclusions. Reducing workplace bullying among hospital nurses was an essential method to provide quality assurance to health care. Nurse managers should build up zero tolerance policy to decrease nurses' exposure to workplace bullying. Relevance to clinical practice. Training programmes related to bullying prevention are suggested to avoid workplace bullying. The contents of the educational training programmes or workshops should incorporate the characteristics and consequences of the workplace bullying, and the strategies to deal with bullying. [ABSTRACT FROM AUTHOR]

Background: The fatigue and symptom distress of cancer patients have been researched extensively. However, few studies have focused on the fatigue and symptom distress experienced by hepatic cancer patients following transcatheter arterial embolization (TAE) treatment. Purpose: This study explores the levels of symptom distress and fatigue in hepatic cancer patients and related factors. Methods: This cross-sectional study used purposive sampling to recruit 100 hepatic cancer patients who had received TAE treatment from a medical center in southern Taiwan. Structured questionnaires were used to collect the data from the irst, second, and third days following the TAE treatment. Results: Notable reductions in fatigue and symptom distress levels were observed in post-TAE-treatment patients. The 5 main symptoms were abdominal pain, fatigue, sleeplessness, fever, and abdominal distention. Factors identiied as inluencing the level of fatigue were marital status, family members' accompaniment during the TAE treatment, physical performance status, age, and symptom distress. Conclusions / Implications for Practice: Physicians treating hepatic cancer patients should better explain to patients the symptoms and fatigue associated with TAE treatment. Physicians should also provide interventions that may reduce the related symptoms, fatigue levels, and mental distress. [ABSTRACT FROM AUTHOR]

Background: The benefits of feeding human milk to infants, even in prematurity, have been well documented. Well-organized donor milk processing has made the milk bank a good source of nutrition for premature or sick infants if their own mother''s milk is not sufficient or suitable. The Taipei City Hospital Milk Bank was established in 2005 and is the first nonprofit human milk bank to operate in Taiwan. Methods: The milk bank has adopted standards of practice laid down by the Human Milk Banking Association of North America and United Kingdom Association for Milk Banking. The clinical characteristics of the eligible milk donors, the recipients, and the donor milk were reviewed retrospectively. Results: In the past 6 years, 816 eligible donors donated a total or 13,900 L (mean 17.03 L/donor) of breast milk. The mean age of these donors was 31.3 years, and 79.7% of them had college education. Most had term delivery (91.2%), with mean birth weight of their babies being 3120 g; 68.9% of the donors were primiparas. A total of 551 infants had received bank milk, with these indications: prematurity (65.4%), malabsorption (7.6%), feeding intolerance (7.2%), maternal illness (5.1%) and post-surgery (4.6%). The pass rate of raw donor milk was around 72.1%. The most common reasons to discard raw milk were Gram-negative rods contamination (72.8%) and ≥104 colony-forming units/mL of coagulase-negative Staphylococcus (62.3%). Only 0.63% of donor milk post pasteurization showed bacterial growth. Conclusion: Proper management and operation of a human milk bank can support breastfeeding, and provide a safe alternative to artificial formula for feeding preterm or ill infants in Taiwan. Sustainability of the milk bank needs more propagation and financial support by health authorities. [Copyright &y& Elsevier]

Aims and objectives. This study was conducted in Taiwan on couples for a month in the postpartum period to investigate the correlated factors that affect their health status. Background. Most studies have focused on the postpartum health status of mothers, but few of them mention about the postpartum health status of fathers. Design. A cross-sectional design. Methods. This study was carried out on a cross-section of couples, and the data were collected through telephone interviews conducted by a research assistant using structured questionnaires. A total of 201 couples who had given birth to a healthy single baby at a medical centre in southern Taiwan were recruited between 1 August 2007-31 November 2007. Results. The two most important factors correlated with mothers' health statuses, during the month-long postpartum period, were mothers' educational and postpartum stress levels. The result also showed that baby's Apgar score at the first minute was the main factor related to father's health status during the month-long postpartum period. Conclusions. Educational programmes should incorporate factors that affect couples' health status during the one month postpartum period to promote postnatal couples' health. Relevance to clinical practice. To improve the couples' health status during the one month postpartum period, we need to strengthen the stress-coping skills of mothers and provide them with coping resources to support their maternal roles, to provide social support to fathers and to incorporate issues of marital intimacy and parental attachment into the couples' educational programmes. Also, a father's presence at his infant's birth is encouraged to enhance parental attachment. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to examine whether the application of cryotherapy with ice in a plastic bag is effective in reducing the severity of wound pain after arthroscopy. Background. In most studies, analgesic medication were administered prior to surgery; postoperative pain may be reduced by analgesics, but they are known to confound the effects of cryotherapy. Cryotherapy by Cryocuff system has commonly been used to manage post arthroscopy patients' pain. Few studies have tested the effects of cryotherapy by simply applying ice in a plastic bag to relieve postarthroscopy pain. Design. This was a prospective, double-blinded, quasi-experimental study with two groups, interrupted time-series design and multiple treatment replications. Method. Fifty-nine patients who received arthroscopy between July-August 2007 were assigned to receive cryotherapy (the experimental group, 33 people) or no cryotherapy (the control group, 26 people). For the experimental group, three 10-minute sessions of ice packing were conducted over a three-hour period, with 50-minute intervals between each session. The first session of ice packing was applied immediately after recovery from anaesthesia. Results. Cryotherapy with ice in a plastic bag was shown to be effective in lessening the degree of pain in postarthroscopy patients. The pain score of the experimental group decreased from 5·12-1·82 after cryotherapy, representing a significant decrease, while the pain score in the control group decreased from 4·04-2·88 ( p = 0·047, 0·012 and 0·005). Conclusions. Cryotherapy with ice in a plastic bag can be applied in standard protocols for patients who have just undergone arthroscopic surgery. Relevance to clinical practice. Cryotherapy with ice in a plastic bag is a simple, readily attainable and cost-effective technique for relieving postarthroscopy pain. We recommend that it be included in standard treatment protocols. Techniques for cryotherapy should be incorporated into in-service education. [ABSTRACT FROM AUTHOR]

Background/Purpose: All children should have some developmental screening periodically throughout childhood, especially those who were born prematurely. There is limited information about the development of children with very low birth weight (VLBW; birth weight < 1500 g) beyond the preschool age in Taiwan. We evaluated intelligence quotient (IQ) and cognitive ability of prematurely born school-aged children in Taiwan. Methods: This was a multicenter study of VLBW and full-term children born between 1995 and 1997 at four hospitals in northern Taiwan. We used the Wechsler Intelligence Scale for Children, 3rd Edition (WISC-III), to assess these children. Demographic data were recorded including maternal and paternal age, education, birth weight, gestational age, and gender. Results: A total of 189 children (130 with VLBW born prematurely and 59 born at full term) were recruited. There were significant differences in performance IQ (PIQ; 90.16 ± 17.05 vs. 108.51 ± 15.65, p < 0.001), verbal IQ (VIQ; 97.43 ± 15.62 vs. 111.78 ± 13.65, p < 0.001), full-scale IQ (FSIQ; 93.14 ± 16.33 vs. 111.05 ± 14.81, p < 0.001), verbal comprehension index score (VCIS; 98.06 ± 15.53 vs. 112.47 ± 13.74, p < 0.001), perceptional organization index score (POIS; 92.39 ± 17.13 vs. 109.42 ± 14.87, p < 0.001) and freedom from distractibility index score (FDIS; 98.34 ± 17.71 vs. 110.53 ± 10.94, p = 0.008). There was no correlation between perinatal outcomes and FSIQ. Conclusion: Our results suggest that VLBW children have significantly lower PIQ, VIQ, FSIQ, VCIS, POIS and FDIS at primary school compared with full-term children. [Copyright &y& Elsevier]

This study employed the PRECEDE model to investigate the correlates of behavior to avoid environmental tobacco smoke (ETS) in adolescents. A total of 208 adolescents who were non-smoking and aged between 15 and 19 years old enrolled in junior programs in technical colleges in southern Taiwan were selected as participants. An anonymous questionnaire including demographic data, ETS avoidance scale, knowledge of ETS scale, attitude toward avoiding ETS scale, self-efficacy of avoiding ETS scale, perceptions of health resources for avoiding ETS in school scale, perceptions of ETS avoidance in families, perceptions of ETS avoidance in peers scale, whether the family smoke, and whether close friends smoke were used to collect data. The results showed: (1) behavior to avoid ETS for female adolescents was better than that of male adolescents; (2) attitude toward avoiding ETS, self-efficacy of avoiding ETS, perception of ETS avoidance in families, and perception of ETS avoidance in peers were significantly positive related to behaviors of avoiding ETS; (3) adolescents with close friends not smoking had a better behavior to avoid ETS; and (4) hierarchical regression analysis shows that gender, attitude toward avoiding ETS, perception of ETS avoidance in peers, and perceptions of ETS avoidance in families were the significant predictors, and could explain 54.5% of the total variance in behaviors to avoid ETS. Results of this study can serve as a reference on improving ETS avoidance among adolescents. [ABSTRACT FROM AUTHOR]

Busulfan has been used as a conditioning regimen in allogeneic hematopoietic cell stem transplantation (HSCT). Owing to a large inter-individual variation in pharmacokinetics, therapeutic drug monitoring (TDM)-guided busulfan dosing is necessary to reduce graft failure and relapse rate. As there exists no TDM of busulfan administration for HCT in Taiwan, we conducted a pilot study to assess the TDM-dosing of busulfan in the Taiwanese population; Seven patients with HCT from The Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, received conditioning regimens consisting of intravenous busulfan and other chemotherapies. After the initial busulfan dose, blood samples were collected for busulfan TDM at 5 min, 1 h, 2 h, and 3 h. Busulfan was extracted and detected by performing stable-isotope dilution LC–MS/MS. Plasma busulfan concentration was quantified and used for dose adjustment. Potential adverse effects of busulfan, such as mucositis and hepatic veno-occlusive disease (VOD), were also evaluated; The LC–MS/MS method was validated with an analyte recovery of 88–99%, within-run and between-run precision of <15%, and linearity ranging from 10 to 10,000 ng/mL. Using TDM-guided busulfan dosing, dose adjustment was necessary and performed in six out of seven patients (86%) with successful engraftments in all patients (100%). Mild mucositis was observed, and VOD was diagnosed in only one patient; This single-center study in Taiwan demonstrated the importance of busulfan TDM in increasing the success rate of HCT transplantation. It is also necessary to further investigate the optimal busulfan target value in the Taiwanese population in the future. [ABSTRACT FROM AUTHOR]

This study aimed to identify factors that significantly affect the behavioral intention of nursing staff to practice telenursing, applying the decomposed theory of planned behavior (DTPB) as the research framework. This cross-sectional survey study collected data from a valid sample of 203 responses from nurses from a regional hospital in Taipei City, Taiwan. The results of data analysis showed that nursing staff's attitude, subjective norms, and perceived behavioral control toward telenursing correlated positively with behavioral intention to participate in telenursing. Decomposing the main concepts identified two significant predictive determinants that influence nurses' behavioral intentions: (a) facilitating conditions (β = 0.394, t = 5.817, p = 0.000 < 0.001) and (b) supervisor influence (β= 0.232, t = 3.431, p = 0.001 < 0.01), which together explain 28.6% of the variance for behavioral intention. The results of this study indicated that support and encouragement from nursing supervisors are important factors affecting nurses' intention to practice telenursing. Education and training, health policies advocacy and the provision of adequate facilitating technologies and recourses are important factors for improving intention to practice telenursing. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Intervention studies of developmental care for preterm infants in Western societies have shown early but unsustainable effects on child outcomes, however only a limited of studies have examined if developmental care interventions produce similar effects in Eastern cultural contexts. Aims: To examine the effectiveness of in-hospital developmental care on neonatal morbidity, growth and development of preterm infants with very low birth weight (VLBW; birth weight<1500g) in Taiwan. Methods: One hundred and seventy-eight VLBW preterm infants were randomly assigned to the clinical trial during hospitalization at three hospitals in Taiwan; the control group received five sessions of standard child-focused developmental care and the intervention group received five sessions of child- and parent-focused developmental care. Sixty-two normal term infants were also included as a comparison group. Infants were examined for morbidity, growth and developmental outcomes at term age. Results: At study entry, more infants in the intervention group were twins or multiples than those in the control group (29% vs. 16%, p =0.05). After adjusting for birth set, the intervention group had lower incidences of stage II–III retinopathy (odds ratio [OR]=0.34 [95% confidence interval (CI): 0.15–0.79]; p =0.01) and feeding desaturation (OR=0.32 [95% CI: 0.10–1.00]; p =0.05) and had greater daily weight gains (difference=2.0g/day [95% CI: 0–4.0g/day]; p =0.05) as compared with the control group. However, the intervention and control groups did not differ in any of the neurodevelopmental measures. Conclusions: In-hospital developmental care has short-term benefits for Taiwanese VLBW preterm infants in reducing the risk of retinopathy and feeding desaturation as well as in enhancing weight gains at term age. [Copyright &y& Elsevier]

Neonicotinoid insecticides (NEOs) dominate the global pesticide market because of their low cost and effectiveness. However, epidemiological studies regarding the potential adverse health effects of exposure to NEOs before birth and in early childhood are limited. Therefore, this study investigated the associations between NEO exposure before birth and during early childhood and neurodevelopment. A total of 273 mother-child pairs were enrolled in this study. Mothers provided urine samples in the third trimester and breast milk during the first and third months of lactation. Their children provided urine samples and were evaluated for neurodevelopment by using the Bayley Scales of Infant and Toddler Development, Third Edition at 2-3 years (N = 96) and the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) at 4-6 years (N = 63). The sum of the concentrations of seven NEOs (ΣNEOs) and the relative potency factor of NEOs, based on comparison with imidacloprid (IMI RPF ), were used to assess total exposure to NEOs. Multivariate linear regression analyses were conducted to assess the associations between prenatal and childhood exposure to NEOs and neurodevelopment. The results of the analysis revealed that clothianidin (CLO) and thiamethoxam were the most common NEOs to which children in the Taipei metropolitan area were exposed and that exposure concentrations were high in the Taipei metropolitan area. Imidacloprid was the most frequently detected NEO during the postnatal period. Additionally, exposure to NEOs through breast milk was low. Exposure to CLO, ΣNEOs, and IMI RPF in boys aged 4-6 years was negatively correlated with WPPSI-IV Fluid Reasoning Index. The results of this study indicate that exposure during the third trimester to NEOs does not affect neurodevelopment but that childhood exposure to NEOs may, especially for boys. Further studies with larger sample sizes are required to confirm the sex-specific associations between NEO exposure and neurodevelopment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The recurrence rate of Henoch-Schönlein purpura (HSP) is 2.7%-30%, with varied average intervals between the first and second episodes. Few studies have explored the incidence and risk factors for recurrent HSP., Methods: We used a 16-year nationwide database to analyze the incidence of recurrent HSP. Patients with HSP were identified, and risk factors for recurrent HSP were explored. Kaplan-Meier and Cox regression model analyses were performed, and covariates were adjusted in the multivariate model., Results: From January 1, 1997 to December 31, 2012, among 2,886,836 individuals in the National Health Insurance Research Database, 1002 HSP patients aged < 18 years were identified. Among them, 164 had ≥2 HSP episodes (recurrence rate, 16.4%; incidence of recurrent HSP, 7.05 per 100 person-years); 83.6% patients with one HSP episode remained free of secondary HSP. The average time intervals between the first and second and second and third HSP episodes were 9.2 and 6.4 months, respectively. After adjusting for demographic parameters, comorbidities, and socioeconomic status, recurrent HSP was found to occur more frequently in patients who had renal involvement (adjusted hazard ratio, 2.41; 95% confidence interval [CI], 1.64-3.54; p < 0.001), were receiving steroid therapy for > 10 days (adjusted hazard ratio, 8.13; 95%CI, 2.51-26.36; p < 0.001), and had allergic rhinitis (adjusted hazard ratio, 1.63; 95%CI, 1.06-2.50; p = 0.026)., Conclusions: The annual incidence of recurrent HSP was low. However, children who had underlying allergic rhinitis, presented with renal involvement, and received steroid treatment for > 10 days should be notified regarding the possibility of recurrence.

Workplace-related stress has become today's most serious occupational hazard. Aromatherapy is a simple, convenient and non-invasive method of stress relief. There is little research regarding the efficacy of aromatherapy by means of inhaling essential oil in reducing workplace stress-related symptoms among nurses. Therefore, this study was to examine the effectiveness of lavender oil inhalation in reducing job stress-related symptoms among nurses. The 53 nurses in the experimental group pinned small bottles containing 3% lavender oil on the clothes of their right chests, whereas 57 participants in the control group pinned bottles with no lavender oil. Aromatherapy was shown to be effective in the reduction of the number of stress symptoms for 3 or 4 days. The stress symptoms of the experimental group decreased from 6.1 to 2.8 after aromatherapy was carried out (P = 0.126, 0.159, 0.035 and 0.026). This represented a significant decrease in stress, whereas the stress symptoms in the control group increased from 5.6 to 5.8. Hospital staff managers are still encouraged to include aromatherapy concepts and techniques in the continuing education of nursing staff. Concurrently, future research should focus on the possible side effects of aromatherapy to assure safety., (© 2013 Wiley Publishing Asia Pty Ltd.)

Cystic fibrosis (CF) is one of the most common autosomal recessive inherited disorders among Caucasians. Comparatively, it is considered to be a rare disease among Asians. To date, only a few cases of Taiwanese CF have been published. We report four CF cases from three families. Case 1 was the first report of CF associated with a homozygosity for the CF transmembrane conductance regulator gene (CFTR gene) mutation 3849+10kb C->T in a Taiwanese patient. Cases 2 and 3 had heterozygous c. 1898+5 G->T and heterozygous p. I1023R (novel mutation) for the CFTR gene mutation. Case 4 was homozygous for the CFTR gene mutation R553X being reported in 2005 and complicated with cor pulmonale. These four patients had received 300 mg bid aerosolized tobramycin treatment every other month., (Copyright © 2012. Published by Elsevier B.V.)

Background: The goal of this study was to compare the growth and effect of growth on cognitive performance at 5 years of age of a group of very-low-birth-weight (VLBW) infants and a group of healthy full-term infants., Methods: Beginning in 1995, under the sponsorship of the Premature Baby Foundation, the Society of Neonatology, Taiwan, conducted a multicenter follow-up study of VLBW infants in Taiwan. The study enrolled 322 VLBW infants and 103 controls for assessment of growth data and cognitive performance at several time points from birth through to 5 years of age. Growth data were assessed with measurements of weight, height, and head circumference taken at the ages of 6 months, 12 months, 24 months, and 60 months. Cognitive performance was assessed at the age of 5 years. The VLBW infants were regarded as "failed" if a measurement was 2 standard deviations below the mean measurement of the control group. Neonatal and perinatal data had been collected prospectively as part of a longitudinal study. Cognitive performance was assessed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R)., Results: From 6 months to 5 years, VLBW infants had lower weight, height, and head circumference than the controls. Two hundred twenty-four VLBW infants (69.6%) returned for assessment at 5 years old. Of the 224 VLBW infants, complete sets of measurements of weight, height, and head circumference were obtained for 126 cases (56.3%), 127 cases (56.7%), and 106 cases (47.3%), respectively. Of these, 13 patients (10.3%) failed in weight, 11 patients (8.7%) failed in height, and 17 patients (16.0%) failed in head circumference at the age of 5 years. The mean WPPSI-R scores at the age of 5 years for VLBW children were: 94.1 ± 16.4 (performance IQ), 87.2 ± 12.8 (verbal IQ), and 89.5 ± 14.6 (full IQ). All of these values were also lower than those of the control group, with the differences being statistically significant (p < 0.05). The WPPSI-R scores of VLBW children who failed in head circumference were notably lower than those of VLBW children whose head circumference had caught up with that of their peers., Conclusion: The growth of VLBW infants was lower than that of healthy full-term infants through 5 years of age. The cognitive performance for VLBW children was also decreased compared to that of the control group, and there was an association between slower growth and decreased cognitive ability., (Copyright © 2013. Published by Elsevier B.V.)

The purpose of this study was to investigate the factors affecting the unplanned peripheral intravenous reinsertion in pediatric inpatients at a teaching hospital in Taiwan. Researchers recruited 206 pediatric inpatients and their caretakers for the study and used multivariate regression in calculating their results. The results showed the following: whether pediatric patients received drugs (P < .001), whether the appropriate height of the drops was adhered to (P = .053), and whether the adjustment of the drip rate was done by the clients or caretakers themselves (P = .046) were significant determinants of unplanned peripheral intravenous reinsertions. It may be worthwhile to incorporate the findings regarding factors affecting the unplanned peripheral intravenous reinsertion into pediatric nurses' educational programs.

Purpose: The purpose of this study was to compare expectations of nurse practitioner (NP) job competencies among physicians, nurse managers, and NPs., Data Sources: A quantitative survey was designed using the Analytic Hierarchy Process to determine the essential NP job competencies based on a checklist of 38 daily activities of NPs, which were recorded for a 10-day period. Using purposive sampling, a demographic data tool and a Nurse Practitioner Job Competency Questionnaire were completed by 56 participants from 13 hospitals in Taiwan, for which they prioritized and assigned percentage weights for NP competencies. A qualitative open-ended interview was undertaken to establish the meaning of the hierarchy outcomes that had been obtained., Conclusions: NPs face the pressure of whether medical staff and nurses agree with NPs' perceptions of their role, which can result in conflicts between nurses and doctors. Taiwanese NPs are still seen as assistants to doctors and, as such, the benefits of the creation of this new field of nursing are not being fully utilized., Implications for Practice: NPs should be aware of discrepancies among health professionals as to their role, make efforts to communicate what their competencies include to avoid conflicts, and use their abilities effectively.

The Ministry of Health in Taiwan has promoted the award campaign to assure the health web information since 2002. The 98 ever-awarded web sites were reexamined with the new set of quality indicators in 2007. The results show that the overall quality only at an acceptance level and much work needs to be done in credibility and site interaction.

Aim: The purpose of the study is to explore the collecting factors for the haemolysis of the blood specimens in a regional hospital in South Taiwan., Background: Blood collecting is one of the most common procedures used in hospital. However, it often faces the risk of haemolysis of blood specimens during laboratory testing and the specimens collected can be easily rejected by the laboratory., Methods: This is a descriptive and cross-sectional study. The purposive samples were collected from the blood specimens of the hospitalized patients or the emergency-room patients by using structured observational checklists which included demographic characteristics, caring factors and material factors. A total of 274 blood specimens was collected., Results: Specimens obtained from non-antecubital sites were 3.35 times at risk of haemolysis as many as those from antecubital sites (p = 0.001). Blood collected into tubes through steel needles were 3.7 times more at risk of haemolysis as that through syringes (after removing needles) (p = 0.002). Specimens delivered by ward assistants were 8.7 times more at risk for haemolysis as those by the laboratory staff (p < 0.01)., Conclusions: These findings suggest that nurse supervisors establish a protocol related to preventing haemolysis. Future research should explore the effectiveness of this protocol to verify the relationship between different gauges of steel needles or catheters and haemolysis., Relevance to Clinical Practice: Nurse educators are encouraged to include the factors affecting and preventing haemolysis into the in service education. Therefore, findings may assist healthcare professionals in minimizing the risk of haemolysis and improve the quality of care.

Objectives: To establish the normative data of the Bayley Scales of Infant Development-Second Edition (BSID-II) on Taiwanese infants from age 6 to 24 months and to explore the factors that relate to their mental and motor development., Methods: Five hundred and seven Taiwanese full-term infants were prospectively examined with the BSID-II at 6, 12, 18, and 24 months of age., Results: Taiwanese infants' Bayley mental and motor raw scores were lower than the United States norms from age 6 to 24 months, however, the discrepancy gradually declined with increasing age. Gender, intrauterine growth status, birth order, region of residence, maternal education, and paternal occupation were shown to have longitudinal associations with their mental and/or motor scores., Conclusions: Differences existed in the mental and motor development among Taiwanese and American infants. Our preliminary norms of the BSID-II may be more appropriate than the United States norms for Taiwanese children.

Survival rate of very-low-birth-weight (VLBW) infants has much improved in recent years. However, neurodevelopmental outcomes are still of the most concerned to such infants' parents. In order to survey survival rate, neurodevelopmental outcome and prognostic factors in these infants, we did a retrospective study of VLBW infants who were admitted to neonatal intensive care unit of Taipei City Hospital, Branch for Women and Children from 1st January 2001 to 31th October 2004. We reviewed their medical records and analyzed the data. A total of 68 cases were enrolled in this study, and overall one-year survival rate was 70.3% (45/64). The unfavorable outcome group had lower birth weight, lower gestational age, lower Apgar scores at 1-minute and 5-minute, higher rate of vaginal delivery, more respiratory distress syndrome (RDS), and higher IVH grades (all p value < 0.05). However, with multiple logistic regression analysis, only low birth weight and higher IVH grades were the significant predictors of unfavorable outcome. Univariate analysis showed that RDS increased but Cesarean section (C/S) decreased the risk of severe IVH. According to the result, we can make the conclusion that the survival rate of VLBW infants in our hospital was similar to that in other medical centers in Taiwan. In order to prevent severe grades of IVH and subsequent unfavorable outcome in VLBW infants, prenatal therapies to prevent RDS and perhaps choice of C/S as delivery mode are the best strategies.