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Analogies and modelling have been developed and applied in learning and teaching science to facilitate students' understanding of abstract concepts, such as atomic structure. Considering few studies focus on comparing the effects of two teaching strategies--analogy-based teaching (ABT) and modelling-based teaching (MBT)--this study aims to compare the effects of ABT and MBT on high school students' content understanding and transferability of atomic concepts in science. Implementing a quasi-experimental design with pre-post-delayed tests, the study compared learning outcomes achieved by the MBT group (N = 68) and the ABT group (N = 69). The results showed both MBT and ABT could improve students' content understanding and promote transferability. However, the MBT group significantly outperformed the ABT group in terms of generating initial models and overall transferability. Although there was no difference in content understanding, or near or far transferability, at post-test between the two groups, the MBT group maintained more extended memory of atomic structure on the delayed post-test. Moreover, qualitative analysis of students' drawings of atomic models revealed that both groups were able to develop and transfer their models, but inadequate scientific knowledge affected the quality of the transfer product. These findings have implications for designing and implementing instructional approaches that leverage analogy and modelling in the science class.

This article explores a narrative approach adopted by three Taiwanese children's books that feature old trees as storytellers and memory-keepers to address aspects of emotional and psychological adaptation when facing drastic life changes. Although these stories are told from the perspective of old trees, the nostalgic tone serves a specific purpose: to present a private and intimate connection between trees and humans, which sets them apart from sapient trees in mythology or talking trees in fantasy stories. The nostalgic form of storytelling addresses aspects of pain and transformation when handling uncontrollable changes. Drawing on research from the psychology of nostalgia and the social-cultural relationship between trees and people, the three books are analysed for their underlying meanings of intimate and nostalgic connection. It is proposed that the connection is a medium for the characters to seek meanings from life changes; the memories of the past are materialized in these old trees, and through them the characters look back to retrieve memories and make sense of changes. These stories to a certain extent also reflect political and social changes in Taiwan. Young readers are given an 'old' perspective to see the comfort and strength embodied in old trees that stand steadfastly throughout time and change.

The study investigated American and Taiwan undergraduate students' attitudes toward biodiversity. The survey questionnaire consisted of statements prompted by the question "To what extent do you agree with the following statements about problems with the biodiversity issues." Students indicated strongly disagree, disagree, agree, strongly agree, or no opinion. The questionnaire inquired students' awareness of biodiversity and the impact of human activity on biodiversity. The students' attitudes were analyzed by frequency of response and average value of response. The t-test was conducted to examine the difference among students of different backgrounds. The results showed that both American and Taiwan undergraduate students had consensus that they expressed lower level of confidence in the ability of science and technology to solve biodiversity problems, and they did not agree that people worry too much about the problem of biodiversity issue. There were also significant differences between different groups (gender, with or without experience of conservation activities). Understanding students' attitudes is important for educators to plan curriculum and instruction.

Care aides in long-term care (LTC) institutions care for older disabled residents at high risk for COVID-19. However, they experienced many stressors during the COVID-19 pandemic. This study aims to explore the working experiences of care aides in LTC institutions following the relaxation of COVID-19 regulations in Taiwan. This qualitative descriptive study included 20 care aides who had cared for residents with COVID-19. Data were obtained via semi-structured interviews. Caring for residents with COVID-19 and the difficulties, resources and teamwork, and impact of care aides' work on their lives were discussed. Consequently, four themes were identified. First, difficulties in care, which included physical limitations by protection, workload, and impact of work schedule on the lives of the care aides. Second, psychological impact, such as worry, social isolation, and burnout. Third, interpersonal relationships with supervisors, colleagues, residents, and their families. Fourth, infection control policy from the institution and government. When infection control policies were relaxed, care aides had difficulties in caring for residents; furthermore, their family and social lives were also affected. They were required to learn knowledge of and skills for COVID-19 management. Institutions were required to provide support in materials, care processes, environment, and management. [ABSTRACT FROM AUTHOR]

Background: Establishing a nurturing bond with the unborn child is essential for expectant mothers throughout pregnancy. While the influence of family support and pregnancy adaptation on maternal-fetal bonding is evident, these factors remain unexplored in the early stages of pregnancy. This study aims to elucidate the dynamic interaction between family support, pregnancy adaptation, and maternal-fetal bonding during the first trimester, explicitly investigating the mediating role of pregnancy adaptation. Method: A cross-sectional design was conducted to recruit expectant mothers between 8 and 12 weeks of gestation without significant complications. Results: Family support and pregnancy adaptation emerged as significant predictors of maternal-fetal bonding, and pregnancy adaptation mediated the relationship between family support and maternal-fetal bonding in the first trimester. Conclusions: The study confirms the critical role of family support and pregnancy adaptation in facilitating maternal-fetal bonding during early pregnancy, with pregnancy adaptation fully mediating this relationship. Healthcare providers are encouraged to involve family members in early interventions, focusing on assessing family support and engaging them in education and activities to strengthen the emotional bond between the mother and her unborn child. [ABSTRACT FROM AUTHOR]

Respiratory diseases have been global public health problems for a long time. In recent years, air pollutants as important risk factors have drawn lots of attention. In this study, we investigate the influence of |$\pm2.5$| (particulate matters in diameter less than 2.5 |${\rm{\mu }} m$|⁠) on hospital visit rates for respiratory diseases in Taiwan. To reveal the spatiotemporal pattern of data, we propose a Bayesian disease mapping model with spatially varying coefficients and a parametric temporal trend. Model fitting is conducted using the integrated nested Laplace approximation, which is a widely applied technique for large-scale data sets due to its high computational efficiency. The finite sample performance of the proposed method is studied through a series of simulations. As demonstrated by simulations, the proposed model can improve both the parameter estimation performance and the prediction performance. We apply the proposed model on the respiratory disease data in 328 third-level administrative regions in Taiwan and find significant associations between hospital visit rates and |$\pm2.5$|⁠. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to explore the ways in which social smoking expectations mediate the relationship between adolescent smoking behaviour and the smoking behaviour of family and peers. Design: Descriptive, cross-sectional survey. Setting: Taiwan, Republic of China. Method: The participants were 921 senior high school students who completed a questionnaire to measure smoking status, family and peer smoking and social smoking expectations. The survey was conducted from November to December in 2009. Structural equation modelling was performed to test a mediation model. Analysis was performed using PRELIS 2 and LISREL 8.7 software. Results: After adjusting for students' gender, age and school type, it is clear that social expectations mediate the relationship between sibling smoking, peer smoking and adolescent smoking. The path coefficients of sibling and peer smoking on social expectations in the mediator model were moderate, ß = 0.15-0.41, p < 0.05, but the coefficient of social expectations on adolescent smoking was strong, ß = 0.95, p < 0.001. The total indirect effects between exogenous latent variables and adolescent smoking were 0.54, indicating a strong association that, in this model, is explained by the mediation of social expectations. Conclusion: Determining the mechanisms that influence adolescent smoking is of scientific interest because knowledge of these mechanisms is a prerequisite for the development of recommendations aimed at prevention. With this knowledge, health professionals can develop smoking-prevention policies and education programmes based on reducing the mediating effect of social smoking expectations on the relationship of family smoking and peer smoking with adolescent smoking.

Background and Aim: Fecal microbiota transplantation (FMT) is used to treat recurrent or refractory Clostridioides difficile infection (CDI). In the past, screening of fecal donors required surveillance of personal behavior, medical history, and diseases that could be transmitted by the blood or fecal–oral route. In addition, the exclusion of multidrug‐resistant organisms (MDROs) has been recommended since 2018. This task has become more complicated in the era of the coronavirus disease‐2019 (COVID‐19) pandemic. To prevent fecal transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), it is crucial to commence screening for SARS‐CoV‐2, alongside other traditional tests. Our aim was to investigate whether hidden carriers of SARS‐CoV‐2 were enrolled for stool donation, and the status of the presence or incidence of MDRO during fecal donation in Taiwan. Methods: Fecal products collected from March 2019 to December 2022 were tested for MDRO and nucleic acid amplification tests for SARS‐CoV‐2 using the pooling method. The period of fecal product collection crossed the time before and during the COVID pandemic in Taiwan. Results: A total of 151 fecal samples were collected. The fecal products were tested using polymerase chain reaction (PCR) to detect SARS‐CoV‐2. The results were negative for all stocks. This was similar to the results of MDRO testing. The safety of FMT products has been guaranteed during the pandemic. Conclusion: Our FMT center produced MDRO‐free and COVID‐19‐free products before and during the COVID‐19 outbreak in Taiwan. Our protocol was effective for ensuring the safety of FMT products. [ABSTRACT FROM AUTHOR]

This study examined the associations between children's and adolescents' autistic-like social deficits and school and social adjustment as well as the moderating roles of age and gender in these associations. The sample consisted of 1321 students (48.7% boys) in Grade 1 to Grade 8 from northern Taiwan. Children's and adolescents' autistic-like social deficits were assessed using the Social Responsiveness Scale (SRS), and their school and social adjustment (i.e., academic performance, negative attitudes toward schoolwork/teachers/classmates, behavioral problems at schools, negative peer relationships, and problems with peers) were assessed using the Social Adjustment Inventory for Children and Adolescents (SAICA). Both measures were completed by the mothers of the participants. Results from the linear mixed models demonstrated that autistic-like social deficits were associated with poor academic performance, negative attitudes toward schoolwork, teachers, and classmates, behavioral problems at schools, negative peer relationships, and problematic peer interactions. Moreover, gender and/or age moderated the associations between autistic-like social deficits and school and social adjustment problems. For example, autistic-like social deficits were more strongly related to negative school attitude, school social problems, and negative peer relationships in boys than in girls. Further, autistic-like social deficits were more strongly related to problems with peers in older girls than in older boys or younger children (regardless of gender). In conclusion, the present study suggests that autistic-like social deficits may place children and adolescents at increased risk for social and school maladjustment and that the extent of maladjustment may vary with the child's age and gender and the domains of adjustment under discussion. (Contains 4 tables and 1 figure.)

Whole exome sequencing (WES) has been used to detect rare causative variants in neurological diseases. However, the efficacy of WES in genetic diagnosis of clinically heterogeneous familial stroke remains inconclusive. We prospectively searched for disease-causing variants in unrelated probands with defined familial stroke by candidate gene/hotspot screening and/or WES, depending on stroke subtypes and neuroimaging features at a referral center. The clinical significance of each variant was determined according to the American College of Medical Genetics guidelines. Among 161 probands (mean age at onset 53.2 ± 13.7 years; male 63.4%), 33 participants (20.5%) had been identified with 19 pathogenic/likely pathogenic variants (PVs; WES applied 152/161 = 94.4%). Across subtypes, the highest hit rate (HR) was intracerebral hemorrhage (ICH, 7/18 = 38.9%), particularly with the etiological subtype of structural vasculopathy (4/4 = 100%, PVs in ENG, KRIT1, PKD1, RNF213); followed by ischemic small vessel disease (SVD, 15/48 = 31.3%; PVs in NOTCH3, HTRA1, HBB). In contrast, large artery atherosclerosis (LAA, 4/44 = 9.1%) and cardioembolism (0/11 = 0%) had the lowest HR. NOTCH3 was the most common causative gene (16/161 = 9.9%), presenting with multiple subtypes of SVD (n = 13), ICH (n = 2), or LAA (n = 1). Importantly, we disclosed two previously unreported PVs, KRIT1 p.E379* in a familial cerebral cavernous malformation, and F2 p.F382L in a familial cerebral venous sinus thrombosis. The contribution of monogenic etiologies was particularly high in familial ICH and SVD subtypes in our Taiwanese cohort. Utilizing subtype-guided hotspot screening and/or subsequent WES, we unraveled monogenic causes in 20.5% familial stroke probands, including 1.2% novel PVs. Genetic diagnosis may enable early diagnosis, management and lifestyle modification. Among 161 familial stroke probands, 33 (20.5%) had been identified pathogenic or likely pathogenic monogenic variants related to stroke. The positive hit rate among all subtypes was high in intracerebral hemorrhage (ICH) and ischemic small vessel disease (SVD). Notably, two previously unreported variants, KRIT1 p.E379* in a familial cerebral cavernous malformation and F2 p.F382L in familial cerebral venous sinus thrombosis, were disclosed. CVT cerebral venous thrombosis; HTN Hypertensive subtype; LAA large artery atherosclerosis; SV structural vasculopathy; U Undetermined. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID-19) pandemic has resulted in significant changes in nursing education. Maintaining social distance could slow down the spread of COVID-19, and it was necessary, but it significantly reduced students' hands-on clinical practice experience in healthcare settings. Traditional classroom teaching in schools has transitioned to distance or online learning methods, which significantly reduced students' hands-on clinical practice experience in healthcare settings. Although distance education had been implemented for a long time, there are many problems and challenges to be resolved. The experiences and needs of nursing students in remote clinical training urgently require further understanding. Purpose: To understand the stress and coping strategies of online nursing practicum courses for Taiwanese nursing students during the COVID-19 pandemic. Methods: A qualitative research approach with purposive sampling was supplemented by snowball sampling. Semi-structured interviews were conducted, and the data were collected following the eight-step process outlined by Waltz, Strickland, and Lenz (2010). The participants were 12 nursing students on a two-year nursing RN-to-BSN program at a university in Eastern Taiwan, consisting of 11 females and 1 male student. Findings: The stress and coping behaviors of nursing students consist of four main themes, each with three subthemes, including "urgent changes", "the gaps between online courses and practical operations", "mixed feelings of joy and anxiety" and "unexpected gains". Conclusions: The pandemic has impacted nursing students' learning and living. Engaging in online nursing practicum brought about significant stress; nevertheless, students employed various coping strategies to navigate through this challenging period. The findings of this study would also help nursing educators understand the learning gaps in clinical practicum among students. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effectiveness of using procedural scaffoldings in fostering students' group discourse levels and learning outcomes in a paper-plus-smartphone collaborative learning context. All participants used built-in camera smartphones to learn new knowledge by scanning Quick Response (QR) codes, a type of two-dimensional barcode, embedded in paper-based learning materials in this study. Sixty undergraduate and graduate students enrolled at a four-year university in southern Taiwan participated in this study. Participants were randomly assigned into two different groups, using procedural scaffoldings learning and non-procedural scaffoldings learning. The learning unit about the "Long Tail", an important concept used in products sales, was the learning task that participants were expected to complete. During the experiment, pretest-posttest and the completed group worksheets were used to collect data. The researchers applied content analyses, chi-square test, "t"-test, and ANCOVA to answer research questions. The findings indicated that participants in the experimental group using procedural scaffoldings achieved better learning outcomes than their counterparts in the control group in terms of group discourse levels, group learning, and individual learning. (Contains 3 tables and 5 figures.)

Although many studies have explored emergency services for children, there are few published reports of the utilization of emergency services by children with disabilities. The present study attempts to provide data regarding the utilization of, and factors affecting, emergency department visits by disabled children in Taipei. A general census of 1006 children with disabilities, identified from the Taiwan National Disability Registry System in Taipei, was conducted. The overall response rate was 38%, yielding a sample of 340 disabled children. The results showed that 30.1% of children with disabilities had utilized emergency department services over the past 4 months with an average of 1.4 visits per child. The most common reasons for emergency visits were fever (34.7%), respiratory symptoms (24.2%), abdominal pain (15.8%), injury (7.4%), and epilepsy seizures (7.4%). This study also found, using a logistic regression model, that emergency department utilization may be associated with household economic status and the reported physical health of children with disabilities. The "deficit" and "balance" household economic status groups gave odds ratios of 3.902 (95% CI = 1.469-10.364) and 3.311 (95% CI = 1.249-8.779), relative to the "surplus" group. The model also indicated that those children with disabilities who were reported as being in poor physical health had 11.359 times (95% CI = 2.968-43.469) the likelihood of using emergency care than those whose physical health was in excellent condition. The study suggests that in order to maximize the health of children with disabilities, medical care stakeholders should consider who are the most likely groups to use emergency department services and develop anticipatory guidance or preventive services for this vulnerable population. (Contains 5 tables.)

Aims: The purpose of this study was to identify health characteristics of people with intellectual disabilities (ID) and to assess the use of emergency care facilities by these people and factors affecting this utilization. Method: A cross-sectional study was employed. Subjects were recruited from the Taiwan National Disability Registration System. A total of 1071 people registered with ID in Taiwan were recruited for this study in 2001. Data were collected via a structured mail-out questionnaire that was completed by the main carers of people with ID. Results: Most of the carers subjectively characterized the overall health status of people with ID as good-excellent. However, people with ID carry a burden of diseases greater than that of the general population. Nearly half (47.7%) of the subjects reported having an illness in the past 7 months. Most of the morbidity was associated with neurological, psychiatric, digestive, dermatological and cardiovascular diseases or disorders. One-third of subjects took medication regularly and 15% were "Major Illness" card beneficiaries of the Taiwan National Health Insurance scheme. About two-thirds of individuals with ID were classified as having multiple disabilities and 24.5% needed to be provided with frequent rehabilitative therapies to maintain their normal daily functions. Respondents indicated that 18.4% of the subjects had used emergency care in the past 7 months. A stepwise logistic regression model highlighted that the following need factors were significantly related to the utilization of emergency care: having an illness (OR=2.1, 95% CI=1.2-3.6), taking medicine regularly (OR=1.8, 95% CI=1.1-2.9) and self-reported health status (poor health: OR=9.9, 95% CI=2.1-45.7; bad health: OR=8.2, 95% CI=1.3-49.8). Conclusions: To ensure that people with ID minimize their utilization of emergency care, it is necessary to establish in appropriate community systems to monitor individuals with ID with poor health status, diseases and who take medicine regularly.

To evaluate the kinetics of serum and urinary hepcidin levels along with anemia-related parameters during the infection course of infants with febrile urinary tract infection (UTI), we enrolled febrile infants aged one to four months in this prospective study. Febrile patients with UTI were allocated into Escherichia coli (E. coli) or non-E. coli groups according to urine culture results. Septic workup, blood hepcidin, iron profile, urinalysis, and urinary hepcidin–creatinine ratio were collected upon admission and 3 days after antibiotic treatment. In total, 118 infants were included. On admission, the febrile UTI group showed a significant reduction in serum iron level and a significant elevation of urinary hepcidin–creatinine ratio compared to the febrile control counterpart. Moreover, urinary hepcidin–creatinine ratio had the highest odds ratio, 2.01, in logistics regression analysis. After 3 days of antibiotic treatment, hemoglobin and the urinary hepcidin–creatinine ratio were significantly decreased. Patients with an E. coli UTI had a significantly decreased urinary hepcidin–creatinine ratio after 3 days of antibiotics treatment, whereas the non-E. coli group showed insignificant changes. Our study suggested that the urinary hepcidin–creatinine ratio elevated during acute febrile urinary tract infection and significantly decreased after 3 days of antibiotics treatment, especially in E. coli UTI. [ABSTRACT FROM AUTHOR]

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers stand on the frontline for pandemic prevention, and preventive behaviors are essential measures to protect their health and safety. The purpose of this study was to propose an integrative model that explained and predicted COVID-19 preventive behaviors among healthcare workers. The study integrated workplace safety climate and the health belief model (HBM) to verify the impact of workplace safety climate and health belief factors on the safety attitude, safety compliance, and safety satisfaction of healthcare workers performing COVID-19 pandemic prevention behaviors. A cross-sectional study was conducted from March to August 2021 with a self-administered online questionnaire. The sample of the study was drawn from healthcare workers of a famous medical institution in Taipei City as research subjects. After collecting 273 valid questionnaires and verifying them through the analysis of structural equation modeling (SEM), the findings revealed that workplace safety climate had an impact on health belief factors, and then health belief factors had impacts on safety attitudes. In addition, safety attitude affected safety compliance, while safety compliance further affected safety satisfaction. The study showed that workplace safety climate can strengthen healthcare workers' health beliefs and further affect their safety attitudes, safety compliance, and safety satisfaction. The study attempted to propose a model of healthcare workers' pandemic prevention behaviors as a reference for medical facility administrators in real practice. [ABSTRACT FROM AUTHOR]

Background/purpose: Clostridium difficile infection (CDI) leads to a significant cause of hospital-acquired morbidity and mortality. Fecal microbiota transplantation (FMT) is effective to treat recurrent or refractory CDI (rCDI). However, the change of microbial composition contributed by FMT and its association with treatment outcomes is not well determined in Taiwan. We aimed to investigate the efficacy of FMT and the association with microbial alteration endemically.Methods: Twelve patients who received FMT for rCDI in Taipei Veterans General Hospital were prospectively enrolled from April 2019 to July 2020. The clinical assessments and fecal microbial analyses in comparison with fecal materials of unrelated donors were conducted before and after FMT.Results: The overall success rate of FMT for rCDI was 91.7%. A prominence of Proteobacteria, Gammaproteobacteria and Enterobacteriales were observed in the feces of patients with rCDI. Increased fecal phylogenetic diversities and a significant microbial dissimilarity were provided by successful FMT compared to patients before treatment. However, the distinctness was not obvious between patients' feces at baseline and after unsuccessful FMT. Moreover, dynamic change of fecal microbial composition after FMT was observed during follow-up but did not interrupt the treatment effects of FMT.Conclusion: Gut dysbiosis commonly co-exists in patients with rCDI. Restoration of gut microbial communities by FMT provides a promising strategy to treat antibiotic-failed CDI, and the extent of microbial change would be related to the treatment outcomes of FMT. Besides, the effectiveness of FMT for CDI could be maintained even the gut microbiota has diverged over time. [ABSTRACT FROM AUTHOR]

Objectives: This evidence implementation project aimed to identify barriers leading to needle-stick injuries (NSIs) and to develop implementation strategies to prevent NSIs in the acute ward of a hospital in central Taiwan. Introduction: The incidence rate of NSIs was 5.6% in the acute ward of a hospital in Taiwan. NSIs commonly occur during the drawing of blood, intravenous insertion, needle recapping, or performing any procedure involving sharp medical devices. NSIs are critical occupational risks among healthcare workers, possibly leading to transmission of infectious diseases, especially blood-borne viruses, such as HIV, hepatitis B, and hepatitis C. Methods: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) approach. Five audit criteria that represented best practice recommendations for prevention of NSIs were used. Baseline data were collected from 177 nurses in five acute wards, followed by the implementation of multiple strategies during a 20-week period of the project. Both baseline and postimplementation audits were undertaken to determine changes in practice. Results: According to the pre-audit concerning the use of safety-engineered injection devices and safe use and disposal of needles, there was 14–15% compliance, which indicated poor compliance with current best-practice criteria. Following the project implementation, the nursing staff were educated about the well tolerated use and disposal of sharps and the improved compliance rate ranged from 40 to 96.6%, with safety needle use increasing from 16 to 95.5%, safety needle operation procedure awareness increasing from 14 to 96%, needles not recapped after use increasing from 47 to 85%, and placing used needles in the sharps collection box increasing from 75 to 80%. Conclusion: This article suggests that standardized puncture prevention education and training enhanced nurses' awareness in the acute ward. [ABSTRACT FROM AUTHOR]

Background: Communication is a core competency for outpatient nurses. This study investigated the effectiveness of a mobile technology–supported self-reflective (MTS) course in communication behaviors among outpatient nurses. Method: This quasi-experimental study used a convenience sample of 78 outpatient nurses (experimental group = 39; control group = 39). The experimental group completed the MTS communication course. Communication behaviors were evaluated before, 1 week after, and 1 month after the course. Results: There was no significant difference in communication behaviors between the groups before the intervention. One week after the intervention, communication behavior scores significantly increased in both groups without significant between-group differences (p >.05). One month after the intervention, the experimental group showed significantly higher communication behavior scores (p <.05). Both groups demonstrated high learning satisfaction. Conclusion: The MTS communication course was successful in promoting effective outpatient nurse–patient communication. Health care facilities may want to incorporate the MTS course into their orientation program. [J Contin Educ Nurs. 2022;53(6):279–288.] [ABSTRACT FROM AUTHOR]

Introduction: Dialectical behavior therapy (DBT) is the most commonly used treatment for patients suffering from borderline personality disorder (BPD). However, data on its applications in Asian countries remain lacking. This pilot study aims to evaluate the feasibility and effectiveness of applying Mandarin‐translated DBT among suicidal Chinese patients with BPD in Taiwan. Methods: An open‐label trial design was implemented for the 1‐year standard DBT model. Patients from a psychiatric outpatient department in a general hospital in Taiwan with a history of ≥2 episodes of suicidal behavior within the previous year and who scored >40 on the Borderline Symptom List were invited to participate in this trial. Outcomes of suicidal behaviors, severity of BPD and depression symptoms, suicidal ideation, hopelessness, and quality of life were assessed at the beginning of the treatment and every 3 months until 12 months. Results: Eighteen patients participated, three of whom (16.7%) dropped out. Significant improvements were found in the frequency and severity of suicidal behaviors and ideations, depressive symptoms, and BPD symptoms beginning as early as the third month after initiating DBT. Discussion: This pilot study found that DBT may be an effective and feasible intervention for Mandarin‐speaking individuals with a recent history of suicidal behaviors with BPD. Future randomized controlled trials with comparison groups are needed to further determine the efficacy of DBT on this population. [ABSTRACT FROM AUTHOR]

Sleep disturbance is highly prevalent among shift‐working nurses. We aimed to evaluate whether aerobic exercise (i.e., walking combined with jogging) improves objective sleep parameters among female nurses who met eligibility criterion as poor sleepers at the end of an 8‐week exercise program and 4 weeks after study completion. This single‐blinded, parallel‐design, randomized controlled trial was conducted in a classroom of a hospital in northern Taiwan. Sixty eligible female nurses were randomly assigned to either the aerobic exercise (n = 30) or usual activity status (n = 30) group. A moderate‐intensity aerobic exercise program was administered over 5 days (60 min per day) a week for 8 weeks after the nurses' day shifts. Objective sleep outcomes including total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were retrieved using an actigraph device. A generalized estimating equation model was used for data analysis. The aerobic exercise group exhibited improvements in TST and SE at 4 and 8 weeks compared with the baseline evaluation (TST: B = 70.49 and 55.96; SE: B = 5.21 and 3.98). Between‐group differences were observed in SOL and WASO at 4 weeks but not 8 weeks compared with the baseline evaluation (SOL: B = −7.18; WASO: B = −11.38). Positive lasting effects for TST were observed only until the 4‐week follow‐up. To improve sleep quality and quantity, we encourage female nurses who sleep poorly to regularly perform moderate‐intensity aerobic exercise. [ABSTRACT FROM AUTHOR]

Background: Patients with functional dyspepsia (FD) are more likely to have persistent depression, yet whether depression and antidepressant treatments are associated with subsequent risk of FD remain unclear. Methods: Using population‐based insurance administrative data of Taiwan, an 11‐year historic cohort study was assembled, comparing cases aged 18 and above with the diagnosis of depressive disorder, to a propensity score‐matched sample of adults without depression. Incident FD as a primary diagnosis was ascertained. Hazard ratios of FD were calculated using Cox regression models by age, gender, other comorbidities, nonsteroidal anti‐inflammatory medications, antidepressants and antidiabetic agents. Results: A total of 20,197 people with depressive disorder and 20,197 propensity score‐matched comparisons without depression were followed up. The incidence of FD was 1.7‐fold greater in the depressive cohort than in comparisons (12.9 versus 7.57 per 1000 person‐years), with an adjusted hazard ratio (aHR) of 2.16 (95% confidence interval (CI) 1.93~2.41). Increased risks were significant regardless of comorbidities or medication uses, the highest in the untreated depression group compared to the group without depression, with an aHR of 2.51(95% CI 2.15~2.93). Conclusions: This population‐based study showed that patients with depressive disorder are at elevated risk of FD. Antidepressant treatment could reduce the risk of FD. [ABSTRACT FROM AUTHOR]

Background. This study conducted exploratory research using artificial intelligence methods. The main purpose of this study is to establish an association model between metabolic syndrome and the TCM (traditional Chinese medicine) constitution using the characteristics of individual physical examination data and to provide guidance for medicated diet care. Methods. Basic demographic and laboratory data were collected from a regional hospital health examination database in northern Taiwan, and artificial intelligence algorithms, such as logistic regression, Bayesian network, and decision tree, were used to analyze and construct the association model between metabolic syndrome and the TCM constitution. Findings. It was found that the phlegm-dampness constitution (90.6%) accounts for the majority of TCM constitution classifications with a high risk of metabolic syndrome, and high cholesterol, blood glucose, and waist circumference were statistically significantly correlated with the phlegm-dampness constitution. This study also found that the age of patients with metabolic syndrome has been advanced, and shift work is one of the risk indicators. Therefore, based on the association model between metabolic syndrome and TCM constitution, in the future, metabolic syndrome can be predicted through the syndrome differentiation of the TCM constitution, and relevant medicated diet care schemes can be recommended for improvement. Conclusion. In order to increase the public's knowledge and methods for mitigating metabolic syndrome, in the future, nursing staff can provide nonprescription medicated diet-related nursing guidance information via the prediction and assessment of the TCM constitution. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT). Methods and Results: We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P =.007), larger PL (P =.025), and more negative TCRT (P =.015) had better response to CRT. A large TMD (P =.018) and large PL (P =.003) were also independent predictors of the clinical outcome endpoint. Conclusions: Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT. [ABSTRACT FROM AUTHOR]

Background: The Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, a regular faculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a new intervention module, the roles and associated responsibilities of clinical instructors to conduct, design, and lead CC-based education were emphasis. Aims: This follow-up explanatory case study compares the effectiveness of intervention module with that of the previous regular module. Methods: The regular group (n = 28) comprised clinical instructors who participated in the FD module during the 2013–2014 year while the intervention group (n = 28) was composed of 2015–2016 participants. Prior to the formal (hands-on) training, participants in the intervention group were asked to study the online materials of the regular module. These participants then received a 30-h hands-on training in conducting, designing, and leading skills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices. Results: Following the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among the intervention FD group, compared with the regular FD group. In the intervention group, senior academicians (associate and full professor) are more substantially involved in designing and leading CC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in the intervention FD group, the follow-up degree of sustained involvement in delivering, designing and leading CC-based courses was significantly higher than that of the regular group. Conclusions: Our study demonstrated that leadership training in the intervention FD modules substantially motivated clinical instructors to become leaders in CC education. [ABSTRACT FROM AUTHOR]

Background. To evaluate the feasibility and applicability of using office hysteroscopy in women with intact hymen. Methods. We recruited 836 patients with intact hymen with different indications who underwent diagnostic hysteroscopy without anesthesia in an outpatient setting from 2007 to 2016 at Chang Gung Memorial Hospital at Linkou. Results. Patients' mean age was 35 ± 10.6 years (range 3–69 years). Most patients (86.4%) with postmenopausal bleeding had intrauterine lesions, and they were especially at high risk (50%) for endometrial hyperplasia or malignancy. Five hundred thirty (63.3%) patients had histologic findings confirming concordance between hysteroscopic and histologic findings. Submucosal myoma had the highest concordance (96.3%), whereas endometrial hyperplasia had the lowest concordance (50%). Forty-eight patients (5.7%) had endometrial hyperplasia, and 35 patients (4.2%) had endometrial malignancy. Two patients who were thought to have nonspecific endometrial thickening actually had endometrial pathology. Conclusions. Hysteroscopy through vaginoscopic approach is feasible and well-tolerated in the patients with intact hymen. This outpatient procedure provides accurate evaluation of lesions of the genital tract and should be considered in patients without a history of intercourse. [ABSTRACT FROM AUTHOR]

Background: To investigate the benefits of adjunctive Chinese herbal medicine (CHM) for patients with nasopharyngeal carcinoma (NPC). Methods: We included all patients diagnosed with NPC during 1997‐2009 and followed until 2011 in Taiwan. We used 1:1 frequency matching by age, sex, comorbidity, conventional treatment, and index year to compare the CHM users and non‐CHM users (n = 2542 each). The prescribed CHM was further investigated with regard to its cytotoxicity. Results: Compared with non‐CHM users, adjunctive CHM users had a lower hazard ratio of mortality risk, and a better survival probability. Gan‐Lu‐Yin (GLY) was the most commonly prescribed CHM, and it reduced cell viability, inhibited tumor proliferation, and induced apoptosis through the poly (ADP‐ribose) polymerase and caspase‐3‐dependent pathway in human NPC TW01 cells. Oral administration of GLY retarded NPC‐TW01 tumor growth in the xenograft nude mouse model. Conclusion: Real‐world data and laboratory experiments implied that adjunctive CHM might be beneficial for NPC patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effectiveness of a stage-matched intervention performed at outpatient clinics. Participants were randomly assigned to an intervention group (IG) or usual care group (UCG). The trial was targeted on smoking patients with coronary heart disease or diabetes. After completing the 3-month intervention, both groups received a telephone follow-up at 6 months. This analysis showed that the outcomes of the IG for the 7-day point prevalence (PP) of abstinence (odds ratio [OR] = 2.00; p =.001) and 30-day PP (OR = 2.27; p =.004) at 6 months were significantly better than the UCG. Stage of change (OR = 4.06; p <.001) and decreased daily cigarette consumption by 50% at 6 months (OR = 2.26; p =.019) outcomes also improved significantly. The preliminary results showed that a nurse-led cessation intervention in clinics may be an effective approach to help outpatients quit smoking. [ABSTRACT FROM AUTHOR]

Background: Dystonia is a neurological syndrome typically resulting in abnormal postures. Objectives: We tested the role of physical injury as potential risk factor for development of dystonia using The National Health Insurance Research Database of Taiwan. Methods: We identified 65704 people who were coded in the database as having had peripheral traumatic injuries (ICD-9-CM 807–848 and 860–959) in the year 2000. Patients with traumatic brain or spine injuries were excluded from analysis. We matched them using purposive sampling with 65704 people in the database who had not suffered peripheral trauma. We looked then at the incidence of dystonia occurring at least 1 year from the date of the peripheral trauma until 2011. Psychiatric symptoms (depression and anxiety) and sleeps difficulties have been investigated as potential covariates. Results: We found 189 patients with dystonia (0.28%) in the trauma group, and 52 patients with dystonia (0.08%) in the non-trauma group. Trauma was independently associated with dystonia (adjusted HR = 3.12, 95% CI = 2.30–4.24). The incidence density of dystonia in the trauma group was 2.27 per 10000 person-years, while it was 0.71 per 10000 person-years in the non-trauma group Beyond the peripheral trauma, other variables associated to the incidence of dystonia included female sex, aged 40 years and above, depression and sleep disorders. Conclusion: These data from a large population dataset support traumatic injury as a risk factor for the development of dystonia. [ABSTRACT FROM AUTHOR]

Objective: To examine the role of protective factors and risk factors in suicidal ideation among adolescents in Taiwan based on a resilience protective model. Design and Sample: A cross‐sectional design was employed. A total of 390 adolescents aged 15–19 years were recruited from four high schools in Taiwan by stratified random sampling. Methods: An anonymous self‐report questionnaire was used to collect demographic characteristics, suicidal ideation, depressive symptoms, life stress, emotion‐focused coping, self‐esteem, and problem‐focused coping. Hierarchical multiple regression was used to test the hypotheses. Results: Depressive symptoms were significantly and positively correlated with suicidal ideation. The interaction between depressive symptoms and self‐esteem as well as between emotion‐focused coping and problem‐focused coping were significantly and negatively correlated with suicidal ideation. Conclusions: Depressive symptoms were a risk factor of suicidal ideation. Self‐esteem can moderate the negative effect of depressive symptoms on suicidal ideation. Problem‐focused coping can moderate the negative effects of emotion‐focused coping on suicidal ideation. Public health nurses could cooperate with school nurses to periodically screen depressive symptoms and provide early interventions. Teaching parents and teachers methods for improving self‐esteem of adolescents and enhancing adolescents to apply problem‐focused coping strategies could be useful to reduce suicidal ideation of adolescents. [ABSTRACT FROM AUTHOR]

Background/purpose: A deleterious effect of complete left bundle-branch block (cLBBB) on left ventricular (LV) function has been established. The underutilization of cardiac resynchronization therapy has been noted in Taiwan and the Asian-Pacific area, but the reasons remain unclear. This study aimed to evaluate the prevalence and association of cLBBB and impaired LV ejection fraction (LVEF) in patients at the National Taiwan University Hospital (NTUH).Methods: We enrolled 164,049 patients who underwent standard 12-lead electrocardiography (ECG) between January 2010 and December 2013 at NTUH. Echocardiographic examinations within one year of the index ECG were analyzed. Baseline clinical characteristics, electrocardiography and ECG parameters, in patients with cLBBB were compared among those with three different LVEFs (EF <35%, 35%≤ EF<50%, and EF ≥50%). Multivariable logistic regression analysis were conducted to identify independent predictors of impaired LVEF in patient with cLBBB.Results: The prevalence of cLBBB was 0.4% (648 patients), and it increased with age. The estimated prevalence of cLBBB and LVEF <35% was about 0.1%. The effects of age on the distributions of patients with cLBBB by three different EF statuses were significantly disparate. In patients with cLBBB aged >80 years, 64% had a normal EF. However, in those aged between 40 and 60 years, the risk of EF <35% was as high as 45%, and the risk of EF <50% was even higher at 60%.Conclusion: Patients in Taiwan had a low prevalence of LVEF<35% and cLBBB. About three-fourth of patients with cLBBB did not experience HF events, and 56% of them had a normal LVEF. The development of an effective triage strategy for these patients is warranted. [ABSTRACT FROM AUTHOR]

Abstract Many nurses in Taiwan use quantitative research for their master's thesis. However, qualitative research explores humankind in depth providing a more holistic approach relating to nursing. The purpose of this study was to explore the rationale postgraduate students used to choose the research methods for their masters' theses in Taiwan. A descriptive qualitative research design was used. Data were collected through semi-structured interviews of sixteen nursing students studying a master's from seven different Universities in Taiwan in 2016. Data were analyzed using thematic analysis. Finding revealed three themes (1) Students' personal and professional backgrounds; (2) Myths about quantitative research; (3) Misperceptions about qualitative research. Nurse educators could use these findings as a reference to design post-graduate nursing courses. It is essential to provide a balanced educative experience between delivering qualitative and quantitative modules to enhance respect of research method, knowledge and skills. Further, this could facilitate students' choice in research methods when designing their master's theses. Highlights • Choice of research method has its inherent and external difficulties. • Quantitative research was perceived as easy because of their training. • Qualitative research was difficult because of a lack of qualitative training. • Misunderstanding that quantitative research would achieve their master's degree more quickly. [ABSTRACT FROM AUTHOR]

Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach's α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Background: The assessment of symptoms distress is an important strategy for symptoms management and treatment of patients with liver cirrhosis (LC); however, appropriate instruments are limited. Objective: The objective of this study was to validate a symptoms distress scale (SDS) by confirming the appropriateness of each item using item response theory. Methods: A cross-sectional and convenience sampling was conducted to recruit eligible cirrhotic outpatients from the gastroenterology outpatient department of a single medical university hospital. In total, 163 patients with LC completed the 21-item SDS. A graded response model with two-parameter (discrimination and difficulty) estimation was used for data analysis. Results: The item response theory model identified the validity of the SDS and found that most of the items in the SDS represented a high level of symptoms distress; moreover, three items of bruising, drowsiness, and dark urine were reported in cirrhotic patients with severe symptom distress. Four items comprising bodily pain, right upper quadrant pain, muscle cramps, and change in appearance can be appropriately represented in cirrhotic patients with mild symptoms distress. Moreover, the amount of test information in the SDS was >0.70, indicating acceptable reliability. Discussion: Items of the SDS can be useful for assessing different levels of symptoms distress; however, using the scale to assess mild symptoms distress in populations with LC should be done with great caution. [ABSTRACT FROM AUTHOR]

Background: Health-promoting behaviors could serve as a major strategy to optimize long-term outcomes for adolescents with congenital heart disease. The associations assessed from a positive perspective of knowledge, attitudes, and practice model would potentially cultivate health-promoting behaviors during adolescence. Aim: The purpose of this study was to examine the relationships between disease knowledge, resilience, family functioning, and health-promoting behaviors in adolescents with congenital heart disease. Methods: A total of 320 adolescents with congenital heart disease who were aged 12–18 years were recruited from pediatric cardiology outpatient departments, and participated in a cross-sectional survey. The participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease; Haase Adolescent Resilience in Illness Scale; Family Adaptability, Partnership, Growth, Affection, and Resolve; and Adolescent Health Promotion scales. The collected data were analyzed using descriptive statistics and three multiple regression models. Results: Greater knowledge of prevention of complications and higher resilience had a more powerful effect in enhancing health-promoting behaviors. Having symptoms and moderate or severe family dysfunction were significantly more negatively predictive of health-promoting behaviors than not having symptoms and positive family function. The third model explained 40% of the variance in engaging in health-promoting behaviors among adolescents with congenital heart disease. Conclusion: The findings of this study provide new insights into the role of disease knowledge, resilience, and family functioning in the health-promoting behavior of adolescents with congenital heart disease. Continued efforts are required to plan family care programs that promote the acquisition of sufficient disease knowledge and the development of resilience for adolescents with congenital heart disease. [ABSTRACT FROM AUTHOR]

Aim: To explore the associations of the professional quality of life and social support with health in nurses. Background: Physical and mental health may be associated with absence from work among nurses. Few studies have explored the associations of professional quality of life and social support on the physical and mental health of nurses. Methods: This was a cross‐sectional study. In total, 294 nurses were recruited from a hospital in Southern Taiwan. A self‐report questionnaire was used to collect data. Results: Burnout, secondary traumatic stress and social support from relatives or friends were important factors of physical and mental health. Interactions between support from relatives or friends and secondary traumatic stress are important factors in physical health. Conclusion: Reducing burnout and secondary traumatic stress is important for physical and mental health of nurses. Increasing social support from relatives or friends may be useful to reduce the negative effects of secondary traumatic stress on the physical health of nurses. Implications for Nursing Management: Nurse managers could design interventions to reduce and prevent nurses from being influenced by burnout and secondary traumatic stress. Educating nurses to build effective social networks with relatives or friends and to seek support when experiencing secondary traumatic stress may also be needed. [ABSTRACT FROM AUTHOR]

The objectives of this study were to develop the Self-Awareness of Falls in Elderly (SAFE) scale and test its reliability and validity among elderly inpatients. A cross-sectional study design and convenience sampling were used to test the validity and reliability of the SAFE scale. Explanatory factor analysis and confirmatory factor analysis yielded an acceptable goodness of model fit, confirming the 21 items in the SAFE scale that were distributed among four factors: awareness of activity safety and environment, awareness of physical functions, awareness of medication, and awareness of cognitive behavior. The values of interrater reliability and Cronbach’s alpha were at least .70, indicating that reliability of the SAFE scale was acceptable. The SAFE scale is the first instrument to measure self-awareness of fall risk among high-risk groups. Further management and fall prevention can then be designed to reduce the incidence of falls among elderly people in clinical care. [ABSTRACT FROM AUTHOR]

Objective To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan. Method A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments. Results Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B = − 2.60, P < 0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio = 4.65, 4.12, and 2.06, respectively; all P s < 0.05). However, both groups did not differ significantly in quality of life. Conclusion CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan. [ABSTRACT FROM AUTHOR]

Families in Taiwan are considered central in caring for frail older people. However, rapid social changes are reshaping Taiwanese family values and structures. In this study, we explored the challenges of intergenerational families in caring for frail older people in Taiwan. Using a multiple-case study, 32 participants representing 12 families comprising three or more generations participated in individual, semistructured interviews. A grounded theory technique was used for the data analysis. Four themes emerged in the findings: intergenerational and intragenerational disharmony, restrictions in the physical environment, financial caregiving burdens, and lack of support from the healthcare system. The findings can help raise awareness of filial caregiving obligations of aging family members that have shifted from a parent-child dyad to being shared across multiple generations in Taiwan. Intergenerational caregiving for frail older people has become a challenge for policies aimed at keeping the aging population in the community. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Both epilepsy and tic disorders may share common mechanisms with the involvement of abnormal cortical-basal ganglion circuit connection and dopaminergic dysfunction. However, the association between epilepsy and tic disorders has never been studied. This study investigated the risks of developing tic disorders among children with epilepsy using databases of a universal health insurance system in Taiwan. The data analyzed in this study were retrieved from the National Health Insurance Research Database in Taiwan. The study cohort included children with epilepsy between 2001 and 2007 (n=2629) and a three-fold age- and gender-matched controls (n=7887). All subjects were followed up for 3 years from the date of cohort entry to identify their admissions due to tic disorders (ICD-9-CM codes 307.2, 307.20-307.23). Cox hazard regression analysis was performed to estimate the effect of epilepsy on the occurrence of tics. The epilepsy cohort had a higher prevalence of tics (1.7% vs. 0.2%), and a 8.70-fold increased risk of developing a tic disorder compared with the controls (adjusted hazard ratio (AHR) 8.70, 95% confidence interval (CI) 4.26-16.37, p<0.001). Male patients were observed to have a higher risk of developing a tic disorder (AHR 1.90, 95% CI=1.04-3.46, p<0.001) compared to female individuals. Patients with multiple antiepileptic drugs treatment also exhibited higher crude OR for developing tic disorders. This nationwide population-based cohort study, for the first time, demonstrated that there is a significantly increased risk for tic disorders among children with epilepsy. We also found males, attention deficit disorder and the use of multiple AEDs to be independent risk factors of tic disorders. Closely evaluating possible tic disorders would be crucial for improving the outcome and life quality in children with epilepsy. [ABSTRACT FROM AUTHOR]

The association between epilepsy and Tourette syndrome has rarely been investigated. In this retrospective cohort study, we analyzed a dataset of 1,000,000 randomly sampled individuals from the Taiwan National Health Insurance Research Database to determine the risk of epilepsy in children with Tourette syndrome. The study cohort consisted of 1062 patients with Tourette syndrome aged ≤ 18 years, and the control group consisted of three times the number of age- and sex-matched patients without Tourette syndrome, who were insurants, from the same database during the same period. The Tourette syndrome group had an 18.38-fold increased risk of epilepsy than the control group [hazard ratio=18.38, 95% confidence interval (CI)=8.26-40.92; P<0.001]. Even after adjusting for the comorbidities, the risk of epilepsy in the Tourette syndrome group with comorbidities remained high (hazard ratio=16.27, 95% CI=6.26-18.46; P<0.001), indicating that the increased risk was not associated with comorbidities. This population-based retrospective cohort study provides the first and strong evidence that Tourette syndrome is associated with a higher risk of epilepsy. A close follow-up of children with Tourette syndrome for the development of epilepsy is warranted. [ABSTRACT FROM AUTHOR]

Background: Investigating the factors related to suicide is crucial for suicide prevention. Psychiatric disorders, gender, socioeconomic status, and catastrophic illnesses are associated with increased risk of suicide. Most studies have typically focused on the separate influences of physiological or psychological factors on suicide-related behaviors, and have rarely used national data records to examine and compare the effects of major physical illnesses, psychiatric disorders, and socioeconomic status on the risk of suicide-related behaviors. Objectives: To identify the characteristics of people who exhibited suicide-related behaviors and the multiple factors associated with repeated suicide-related behaviors and deaths by suicide by examining national data records. Design: This is a cohort study of Taiwan’s national data records of hospitalized patients with suicide-related behaviors from January 1, 1997, to December 31, 2010. Participants: The study population included all people in Taiwan who were hospitalized with a code indicating suicide or self-inflicted injury (E950–E959) according to the International Classification of Disease, Ninth Revision, Clinical Modification. Results: Self-poisoning was the most common method of self-inflicted injury among hospitalized patients with suicide-related behaviors who used a single method. Those who were female, had been hospitalized for suicide-related behaviors at a younger age, had a low income, had a psychiatric disorder (i.e., personality disorder, major depressive disorder, bipolar disorder, schizophrenia, alcohol-related disorder, or adjustment disorder), had a catastrophic illness, or had been hospitalized for suicide-related behaviors that involved two methods of self-inflicted injury had a higher risk of hospitalization for repeated suicide-related behaviors. Those who were male, had been hospitalized for suicide-related behaviors at an older age, had low income, had schizophrenia, showed repeated suicide-related behaviors, had a catastrophic illness, or had adopted a single lethal method had an increased risk of death by suicide. Conclusions: High-risk factors should be considered when devising suicide-prevention strategies. [ABSTRACT FROM AUTHOR]

Background: We conducted a study using a case-crossover design to clarify the risk of acute effects of zolpidem and benzodiazepine on all-sites of fractures in the elderly. Design of study: Case-crossover design. Methods and Materials: Elderly enrollees (n = 6010) in Taiwan’s National Health Insurance Research Database with zolpidem or benzodiazepine use were analyzed for the risk of developing fractures. Results: After adjusting for medications such as antipsychotics, antidepressants, and diuretics, or comorbidities such as hypertension, osteoarthritis, osteoporosis, rheumatoid arthritis and depression, neither zolpidem nor benzodiazepine was found to be associated with increased risk in all-sites fractures. Subjects without depression were found to have an increased risk of fractures. Diazepam is the only benzodiazepine with increased risk of fractures after adjusting for medications and comorbidities. Hip and spine were particular sites for increased fracture risk, but following adjustment for comorbidities, the associations were found to be insignificant. Conclusion: Neither zolpidem nor benzodiazepine was associated with increased risk of all-site fractures in this case cross-over study after adjusting for medications or comorbidities in elderly individuals with insomnia. Clinicians should balance the benefits and risks for prescribing zolpidem or benzodiazepine in the elderly accordingly. [ABSTRACT FROM AUTHOR]

Electroencephalogram (EEG) signals, as it can express the human brain’s activities and reflect awareness, have been widely used in many research and medical equipment to build a noninvasive monitoring index to the depth of anesthesia (DOA). Bispectral (BIS) index monitor is one of the famous and important indicators for anesthesiologists primarily using EEG signals when assessing the DOA. In this study, an attempt is made to build a new indicator using EEG signals to provide a more valuable reference to the DOA for clinical researchers. The EEG signals are collected from patients under anesthetic surgery which are filtered using multivariate empirical mode decomposition (MEMD) method and analyzed using sample entropy (SampEn) analysis. The calculated signals from SampEn are utilized to train an artificial neural network (ANN) model through using expert assessment of consciousness level (EACL) which is assessed by experienced anesthesiologists as the target to train, validate, and test the ANN. The results that are achieved using the proposed system are compared to BIS index. The proposed system results show that it is not only having similar characteristic to BIS index but also more close to experienced anesthesiologists which illustrates the consciousness level and reflects the DOA successfully. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore varied forms of psychological distress and to determine the mediating influence of psychological distress on functional outcomes in stroke patients. Background Previous studies attest to the influence of depression on poststroke functional recovery. While there is evidence for neuropathological deficits that occur after stroke to be associated with psychological distress, few studies have explored the effect of various types of psychological distress on functional recovery. Design A cross-sectional study was used. Methods Data were collected from 178 first-time stroke patients. Study variables included demographic and disease characteristics (stroke location and stroke syndrome classification), psychological distress (the Chinese language version of the Emotional and Social Dysfunction Questionnaire) and functional outcome (Barthel index). Regression and mediation models were used to evaluate the effect of psychological distress on functional outcome. Results Results revealed that stroke patients experience various forms of mild psychological distress, including anger, helplessness, emotional dyscontrol, indifference, inertia and euphoria, after stroke. Regression and mediation analyses further confirmed that various forms of psychological distress significantly mediated the effect of severe stroke syndromes on functional dependence. Conclusion The various forms of psychological distress after stroke might play a mediating role in functional recovery and explain how stroke severity affects functional dependence. Relevance to clinical practice By understanding the nature of various forms of psychological distress, healthcare professionals should adopt appropriate assessment instruments and design effective interventions to help improve mental and physical function of stroke patients. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the relative validity and reproducibility of the quantitative FFQ used in the Tzu Chi Health Study (TCHS).DesignThe reproducibility was evaluated by comparing the baseline FFQ with the 2-year follow-up FFQ. The validity was evaluated by comparing the baseline FFQ with 3 d dietary records and biomarkers (serum folate and vitamin B12). Median comparison, cross-classification and Spearman correlation with and without energy adjustment and deattenuation for day-to-day variation were assessed.SettingTCHS is a prospective cohort containing a high proportion of true vegetarians and part-time vegetarians (regularly consuming a vegetarian diet without completely avoiding meat).SubjectSubsets of 103, seventy-eight and 1528 TCHS participants were included in the reproducibility, dietary record-validity and biomarker-validity studies, respectively.ResultsCorrelations assessing the reproducibility for repeat administrations of the FFQ were in the range of 0·46–0·65 for macronutrients and 0·35–0·67 for micronutrients; the average same quartile agreement was 40%. The correlation between FFQ and biomarkers was 0·41 for both vitamin B12 and folate. Moderate to good correlations between the baseline FFQ and dietary records were found for energy, protein, carbohydrate, saturated and monounsaturated fat, fibre, vitamin C, vitamin A, K, Ca, Mg, P, Fe and Zn (average crude correlation: 0·47 (range: 0·37–0·66); average energy-adjusted correlation: 0·43 (range: 0·38–0·55); average energy-adjusted deattenuated correlation: 0·50 (range: 0·44–0·66)) with same quartile agreement rate of 39% (range: 35–45%), while misclassification to the extreme quartile was rare (average: 4% (range: 0–6%)).ConclusionsThe FFQ is a reliable and valid tool to rank relative intake of major nutrients for TCHS participants. [ABSTRACT FROM PUBLISHER]

Purpose: The Short Form version of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) was designed to measure patients' subjective experience of enjoyment and satisfaction. However, it had not yet been validated for Chinese societies. This paper reports on the validation of the Chinese version of the Q-LES-Q-SF among primary care patients in Taiwan. Methods: The study included adult patients in primary care clinics. The participants completed the Q-LES-Q-SF, the Patient Health Questionnaire, and the Short Form Health Survey. After that, the trained researchers interviewed the patients using the mood module of the Schedules for Clinical Assessment in Neuropsychiatry and the 17-item Hamilton Rating Scale for Depression. A subsample of participants was reassessed with Q-LES-Q-SF within a 2-week interval. Results: A total of 1,482 patients completed the Q-LES-Q-SF. The content validity was good, with no significant floor/ceiling effect. The internal consistency of the Q-LES-Q-SF proved to be substantial as well as the test-retest reliability. The factor structure was examined by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA yielded a 2-factor structure, which was confirmed by a CFA with acceptable fit indices. Known-group validity of the Q-LES-Q-SF was satisfactory in distinguishing patients with and without depression, according to hierarchical regression analyses. Evidence of concurrent validity was provided for the Q-LES-Q-SF, and its two subscales identified significant correlations with other measures. Conclusion: The Chinese Q-LES-Q-SF was shown to have adequate validity and reliability. It may be a useful tool to measure patients' quality of life in Chinese societies. [ABSTRACT FROM AUTHOR]

Purpose To examine the prevalence of headache or migraine complaints and the use of dietary supplements, and to determine their correlation according to sex. Methods This population-based cross-sectional study used data from a 2005 National Health Interview Survey of 15,414 participants (age 18-65 years) in Taiwan. Prevalence of headache or migraine complaints was accessed by a single question on their occurrence during the previous 3 months. Dietary supplement use was evaluated by another single question. Data were stratified by sex and analyzed using independent t-test, chi-square test, and multivariate logistic regression. Results The prevalence of headache or migraine complaints was 17.2% in males and 32.4% in females. The percentage of women taking supplements was 31.8%, which was much higher than the 15.5% of men. In male supplement users, use of isoflavones had a significantly higher odds ratio ( OR) of headache or migraine complaint compared with those of male without use of isoflavones (adjusted OR = 3.86, 95% confidence interval [ CI] = 1.68-8.85). In females, vitamin B complex, vitamin C, and green algae supplement use had higher likelihoods of headache or migraine complaint in comparison to those of female without use of supplements (adjusted OR = 1.28, 1.21, and 1.43; 95% CI = 1.05-1.57, 1.03-1.42, and 1.07-1.90, respectively). Conclusions This population-based study confirmed sex-specific associations between headache or migraine complaints and the use of dietary supplements, warranting further investigation of the underlying causes. [ABSTRACT FROM AUTHOR]