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Summary: Background: Uric acid (UA) and homeostatic model assessment of insulin resistance (HOMA‐IR) are endogenous biomarkers implicated in metabolic disorders and dysfunction. Objectives: To investigate the structural associations between sugar‐sweetened beverage intake (SSB), UA, HOMA‐IR and adolescent latent MetS construct (MetsC) representing paediatric metabolic syndrome (MetS). Methods: A population‐based representative adolescent cohort (n = 1454) was evaluated for risk profiles of MetS. Structural equation modelling was performed to identify multifactor structural associations between study parameters and evaluate mediating effects. Results: Adolescents had a single‐factor latent construct representing MetS. Increased SSB intake was associated with higher UA and HOMA‐IR levels, and the two biomarkers were positively associated with the MetsC score. UA and HOMA‐IR exerted three mediating effects on the association between fructose‐rich tea beverage (FTB) intake of >500 mL/day and MetsC: adjusted standardized coefficient and mediating effect (%), FTB → UA → MetsC: 0.071, 23.1%; FTB → HOMA‐IR → MetsC: 0.034, 11.0%; FTB → UA → HOMA‐IR → MetsC: 0.010, 3.1%. The UA‐associated pathways accounted for 31.1% of the overall mediation on the association between bottled sugar‐containing beverage intake and MetsC. After accounting for the UA‐ and HOMA‐IR‐derived detrimental effects, the fructose‐rich tea beverage intake of >500 mL/day had a tea‐related beneficial effect on MetsC, with an adjusted standardized coefficient of −0.103. Conclusions: UA and HOMA‐IR individually and jointly mediate the adverse effects of high fructose‐rich SSB intake on the mechanisms underlying paediatric MetS. Fructose‐free tea‐based beverages may have a beneficial effect on latent MetS structure in adolescents. [ABSTRACT FROM AUTHOR]

Our aim was to develop a machine learning-based predictor for early mortality and severe intraventricular hemorrhage (IVH) in very-low birth weight (VLBW) preterm infants in Taiwan. We collected retrospective data from VLBW infants, dividing them into two cohorts: one for model development and internal validation (Cohort 1, 2016–2021), and another for external validation (Cohort 2, 2022). Primary outcomes included early mortality, severe IVH, and early poor outcomes (a combination of both). Data preprocessing involved 23 variables, with the top four predictors identified as gestational age, birth body weight, 5-min Apgar score, and endotracheal tube ventilation. Six machine learning algorithms were employed. Among 7471 infants analyzed, the selected predictors consistently performed well across all outcomes. Logistic regression and neural network models showed the highest predictive performance (AUC 0.81–0.90 in both internal and external validation) and were well-calibrated, confirmed by calibration plots and the lowest two mean Brier scores (0.0685 and 0.0691). We developed a robust machine learning-based outcome predictor using only four accessible variables, offering valuable prognostic information for parents and aiding healthcare providers in decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Chronic physical disease (CPD) makes life filled with many negative events in adolescents, but not all adolescents experiencing negative life events proceed to develop emotional distress, only those with low emotional distress tolerance (EDT). A valid and reliable scale to measure EDT in CPD adolescents is important for caring for their emotional distress. Therefore, the purpose of this study is to translate the 15‐item English version Distress Tolerance Scale (DTS) into a Chinese version and then validate the scale for measuring EDT of adolescents with CPD. Methods: The 15‐item English version DTS was translated into a Chinese version using the translation guidelines for cross‐cultural research. Two cohorts of adolescents with CPD were recruited from four hospitals in southern Taiwan, with the first cohort including 124 adolescents with CPD employed to conduct exploratory factor analysis, corrected item‐total correlation and reliability testing, while the second cohort, consisting of 238 adolescents with CPD, was utilized to examine confirmatory factor analysis and concurrent validity. Results: The two‐factor nine‐item Chinese version DTS for Adolescents with CPD (C‐DTS‐A) was developed. Lower scores of the C‐DTS‐A were significantly associated with higher diabetes distress, poorer self‐management, and worse glycaemic control; their correlation coefficients sequentially were −.40,.17 and −.23. Cronbach's α and the test–retest reliability of the two‐factor C‐DTS‐A ranged from.81 to.87 and from.79 to.89, respectively. Conclusion: The two‐factor nine‐item C‐DTS‐A with good cross‐cultural translation quality was a reliable and valid scale to assess EDT for adolescents with CPD. [ABSTRACT FROM AUTHOR]

Background/purpose: The in-hospital length of stay (LOS) among very-low-birth-weight (VLBW, BW < 1500 g) infants is an index for care quality and affects medical resource allocation. We aimed to analyze the LOS among VLBW infants in Taiwan, and to develop and compare the performance of different LOS prediction models using machine learning (ML) techniques.Methods: This retrospective study illustrated LOS data from VLBW infants born between 2016 and 2018 registered in the Taiwan Neonatal Network. Among infants discharged alive, continuous variables (LOS or postmenstrual age, PMA) and categorical variables (late and non-late discharge group) were used as outcome variables to build prediction models. We used 21 early neonatal variables and six algorithms. The performance was compared using the coefficient of determination (R2) for continuous variables and area under the curve (AUC) for categorical variables.Results: A total of 3519 VLBW infants were included to illustrate the profile of LOS. We found 59% of mortalities occurred within the first 7 days after birth. The median of LOS among surviving and deceased infants was 62 days and 5 days. For the ML prediction models, 2940 infants were enrolled. Prediction of LOS or PMA had R2 values less than 0.6. Among the prediction models for prolonged LOS, the logistic regression (ROC: 0.724) and random forest (ROC: 0.712) approach had better performance.Conclusion: We provide a benchmark of LOS among VLBW infants in each gestational age group in Taiwan. ML technique can improve the accuracy of the prediction model of prolonged LOS of VLBW. [ABSTRACT FROM AUTHOR]

Aim: To examine the effects of using different teaching sequences on knowledge acquisition, knowledge retention, self‐directed learning and teamwork in a nursing administration project. Background: Compared to other professional courses, nursing administration is relatively difficult, and it is important for nursing administration students to spend long hours working in hospitals. As such, better teaching strategies utilizing proper sequencing may yield better learning outcomes for students. Methods: A longitudinal quasi‐experimental design was used. A total of 129 students were assigned to two groups with which different teaching sequences were used. The investigated learning outcomes were knowledge acquisition, knowledge retention, self‐directed learning and teamwork. Generalized estimating equations were used to measure the learning outcomes. Results: There was no significant difference between the two teaching sequences in terms of learning effects. One teaching strategy, problem‐based learning (PBL), yielded effective student learning outcomes. Conclusion: PBL increased the students' self‐directed learning and teamwork. This strategy can be applied to side‐by‐side co‐teaching and post‐graduate year training programmes. Implications for Nursing Management: The results from this study may help hospitals retain nurses and find potential nursing leaders. Instructors and nurse managers should discuss learning goals with students in advance to enhance the students' learning outcomes. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore the lived experiences of patients afflicted with spinal muscular atrophy. Background Existing research studies on spinal muscular atrophy address the physical and psychological effects and complications of the disease; they also provide suggestions for how to improve the current management of this disease. However, information is limited on the disease process and the lived experience of spinal muscular atrophy patients. Design A phenomenological approach was conducted. Methods Through 18 in-depth interviews recorded by a pen voice recorder, this study collected data obtained from a purposive sample of nine patients from the, 'Taiwan spinal muscular atrophy Families,' between November 2010-August 2011. The audio recordings were transcribed verbatim and data were analysed using Colaizzi's steps. Findings Four themes and eight subthemes were identified: a loss of control (loss of muscular strength and independence), breaking limitations (assistive device use and mobility design), transcending limitations (independence/autonomy and social development) and living with hope (cherishing life and self-control). The results showed that the lived experiences of the spinal muscular atrophy patients involved living with illness, transcending the self and pursuing the meaning of life. Facing a life-threatening illness, these patients made self-adjustments in their lifestyles and exerted themselves to positively cope with hardships and maintain dignity and self-control. Conclusion These findings could serve as evidence-based practice resources for healthcare professionals in helping individuals and their family members gain an in-depth understanding of spinal muscular atrophy's progression and life course and assist individuals in improving self-integrity to with hope. [ABSTRACT FROM AUTHOR]

• A new cementless binder is developed from CFA, ggbs and DG. • Innovative cementless mixtures can be used as a binder for pervious concrete. • Reasonable amount of DG content can effectively improve the strength. • Main hydration reactants of cementless binders are C-S-H and AFt crystals. • Cementless pervious concrete has a compressive strength of 12 MPa. In this study, alkali-free activator-type ternary cementless binders were developed using ground granulated blast-furnace slag (GGBS), co-fired fly ash (CFA), and desulfurization gypsum (DG). The properties of cementless binders were verified and used to investigate the feasibility of application to pervious concrete. The results indicated that including CFA in cementless binders increased the initial and final setting times. The addition of DG shortened the setting time and the addition exceeded 7 wt% resulting in a rapid setting, which did not meet the ASTM C150 specification. A binary cementless binder with a CFA-GGBS mix achieved a maximum compressive strength up to 54% of the cement group, and the optimum mixture was 70% GGBS with 30% CFA. DG increased the SO 3 content of the binder and promoted the production of ettringite (AFt), resulting in an effective increase in compressive strength up to 92% of the cement group. The optimum proportion of cementless binders to meet the setting times was 70% GGBS, 25% CFFA, and 5% FGDG, resulting in maximum compressive strength up to 79% of the cement group. During the hardening period of the cementless pastes, the generation of AFt affected the internal pore structures of the C-S-H colloids, resulting in higher capillary pores. DG also accelerated the production of AFt, causing an increase in capillary pores. In addition, the maximum compressive strength of cementless pervious concrete developed in this study reached 12 MPa, and the permeability coefficient was up to 0.156 cm/s. It can meet the requirements of the general pervious pavement specification in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Constitutional changes in pregnant women differ from those in the general adult population. Purpose: The purpose of this study was to establish and test the reliability and validity of the "Traditional Chinese Medical Yang-Xu Constitutional Questionnaire (TCMYCQ)" on pregnant women. Methods: We used a cross-sectional questionnaire survey and collected data from a convenience sample of 426 pregnant women who received prenatal examinations at obstetrics and gynecology clinics in southern Taiwan. Construct validity was assessed using item analysis and principle component analysis. Results: Results showed a total explained variance of 58.25% and internal consistency reliability (Cronbach's a) of .86 for the TCMYCQ in our sample population. The five factors extracted were "yang-qi deficiency in chest", "yang-qi deficiency in head", "yang-qi deficiency in four limbs", "yang-qi deficiency in abdominal cavity", and "yang-qi deficiency on body surface". The Cronbach's a ranged from .53 - .84 for the five factors; the intraclass correlation coefficient for test-retest reliability was .90. The correlation coefficients between the 5 factors and the total scale were .77, .82, .73, .69, and .54, respectively, representing significant correlations (p < .0001) that indicate good TCMYCQ convergent validity. Correlation coefficients among the 5 factors ranged from .20 - .53. Because correlation coefficients between the 5 factors and the total scale were all higher than those among the 5 factors, good divergent validity was indicated for this questionnaire. Conclusion: This questionnaire is not only appropriate as an assessment and reference indicator of traditional Chinese medical constitution during pregnancy and reference to help pregnant women adjust their constitution, but also offers evidence-based data for nurses to provide healthcare guidance. [ABSTRACT FROM AUTHOR]

The vigorous promotion of reuse and recycling activities in Taiwan has solved a number of problems associated with the treatment of industrial waste. Considerable advances have been made in the conversion of waste materials into usable resources, thereby reducing the space required for waste storage and helping to conserve natural resources. This study examined the use of non-alkali activators to create bonded materials. Our aims were to evaluate the feasibility of using ground-granulated blast-furnace slag (S) and circulating fluidized bed co-fired fly ash (F) as non-cement binding materials and determine the optimal mix proportions (including embedded fibers) with the aim of achieving high dimensional stability and good mechanical properties. Under a fixed water/binder ratio of 0.55, we combined S and F to replace 100% of the cement at S:F ratios of 4:6, 5:5, 6:4. Polypropylene fibers (L/d = 375) were also included in the mix at 0.1%, 0.2% and 0.5% of the volume of all bonded materials. Samples were characterized in terms of flowability, compressive strength, tensile strength, water absorption, shrinkage, x-ray diffraction (XRD) and scanning electron microscope (SEM) analysis. Specimens made with an S:F ratio of 6:4 achieved compressive strength of roughly 30 MPa (at 28 days), which is the 80% the strength of conventional cement-based materials (control specimens). The inclusion of 0.2% fibers in the mix further increased compressive strength to 35 MPa and enhanced composite properties. [ABSTRACT FROM AUTHOR]

Background: We conducted a study of the clinical manifestations and outcomes of empyema thoracis caused by Candida spp. in hospitalized patients. Methods: We identified patients who from January 2010 to June 2012 had signs of inflammation, such as fever and leukocytosis, and concomitant positive cultures of Candida spp. from specimens of pleural fluid. We reviewed retrospectively the medical records of all such patients. Results: Eight of the patients in whom we identified fever and leukocytosis with concomitant positive pleural fluid cultures of Candida spp. were found to have Candida empyema thoracis. Candida albicans was the most common species causing empyema (n=4), followed by C. glabrata (n=3) and C. tropicalis (n=1). Among the eight patients with Candida empyema thoracis, malignant disease was the most common underlying disease. Seven of the eight patients' episodes of Candida empyema thoracis (87.5%) were classified as health care-associated infections. One patient had a mixed infection with Candida spp. and Pseudomonas aeruginosa. None of the patients had concomitant candidemia. Fluconazole was the antifungal agent used most commonly in treating the patients, and all of the patients had drainage of pleural effusions, including tube thoracostomy in five patients and drainage through a pigtail catheter in three patients. One patient underwent video-assisted thoracic surgery for the management of empyema thoracis, and the patients' overall in-hospital mortality was 62.5%. Conclusion: Although Candida empyema thoracis is encountered rarely, it can develop in immunocompromised patients and can be associated with a high mortality rate. [ABSTRACT FROM AUTHOR]

Abstract Background Nursing staff spend long periods in high-risk working environments. Objective The purpose of this study was to compare the hospitalization risk between nursing staff and the general population. Design This study adopted a retrospective observational design. Setting Data from the Taiwan National Health Insurance Research Database from 2011 to 2013 were analyzed. Method The standardized hospitalization ratio model was used to analyze the relative risk of hospitalization for various diseases between nursing staff and the general population. Results A total of 33,267 numbers of nursing staff in Taiwan were hospitalized, an overall crude hospitalization rate of 21.5%. After controlling for gender, calendar year, and age of nursing staff, the standardized hospitalization ratio of female nursing staff was significantly higher compared to the general population for infectious and parasitic diseases (SHR = 121.05, 95% CI = 112.66–129.89), diseases of the respiratory system (SHR = 105.12, 95% CI = 100.60–109.80), complications of pregnancy, childbirth, and the puerperium (SHR = 102.59, 95% CI = 100.85–104.35), and diseases of the skin and subcutaneous tissue (SHR = 109.71, 95% CI = 101.10–118.86). Conclusions Nursing staff have a significantly higher hospitalization risk compared to the general population for infectious and parasitic diseases, diseases of the respiratory system, complications of pregnancy, childbirth, and puerperium, and diseases of the skin and subcutaneous tissue. This may be associated with the job characteristics and environment of nursing staff. [ABSTRACT FROM AUTHOR]

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

Background: Early palliative care (EPC) benefits some cancers, but its clinical outcomes differ depending on patients' racial and ethnic disparities, and customs. To determine whether EPC improves symptoms, emotional distress, and quality of life among Taiwanese patients with early or advanced-stage head and neck cancer (HNC)., Methods: Based on participants' pathological stages, they were categorized as having early and advanced-stage HNC. Those willing and unwilling to undergo EPC were assigned to the EPC and standard groups, respectively. Their daily cancer-related symptoms were assessed using the Distress Thermometer (DT) and MD Anderson Symptom Inventory (MDASI), whose scores' concurrent validity was evaluated using the European Organization for Research and Treatment of Core Quality of Life (EORTC-QLQ-C30) and Head and Neck 35 (EORTC-QLQ-H&N35) questionnaires., Results: Patients (n = 93) diagnosed with HNC at Taiwan's Chia-Yi Christian Hospital from November 2020 to October 2022 were recruited. The patients voluntarily split into two groups: EPC groups and standard groups (23 and 11 in early-stage; 46 and 13 in advanced-stage, respectively). DT assessment showed significant emotional distress improvements for all patients with HNC who received EPC. The EORTC-QLQ-C30 questionnaire indicated that, compared to standard interventions, EPC groups significantly improved the quality of life and some symptoms for both early and advanced-stage HNC patients. However, the EORTC-QLQ-H&N35 questionnaire found no significant difference between the two groups. Furthermore, advanced-stage patients' anticancer treatment completion rates with EPC and standard interventions were 95.35% and 75%, respectively., Conclusion: EPC improves symptoms, emotional distress, quality of life, and treatment completion rates in Taiwanese patients with early or advanced-stage HNC. Nonetheless, further extensive clinical studies are required for validation., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2024, the Chinese Medical Association.)

Background: This study was conducted to compare the number of cases of non-airborne/droplet-transmitted notifiable infectious disease (NID) before and after COVID-19 pandemic., Methods: This study used an open database - National Notifiable Diseases Surveillance System to collect the epidemiological data of NIDs. Ten fecal-oral-, six vector-borne-, four direct-contact, and four sexually-transmitted NIDs between pandemic period (defined as from January 2020 to December 2021) and the pre-pandemic period (defined as the period from January 2018 to December 2019) were included for the analysis., Results: Overall, the annual case number of these 24 non-airborne/droplet-transmitted NIDs was 19,186, 19,101, 19,567, and 19,863 in 2018, 2019, 2020 and 2021, respectively. The overall case number in the pandemic period was higher than those in pre-pandemic period (39,430 vs 38,287) and the monthly case number was significantly higher in pandemic period than pre-pandemic period (1643 vs 1595, p < 0.05). However, the lower case number in the pandemic period than those in pre-pandemic period was observed in overall ten fecal-oral-transmitted NIDs (1278 vs 1775), six vector-borne-NIDs (922 vs 2210), and four direct-contact transmitted NIDs (196 vs 344). In contrast, the case number of sexually-transmitted NIDs in the pandemic period was higher than those in pre-pandemic period (37,034 vs 33,958), particularly for gonorrhea (14,463 vs 8732)., Conclusions: Most of the fecal-oral-, vector-borne, and direct-contact transmitted NIDs had declined during pandemic in Taiwan. In contrast, gonorrhea had large increase, and other NPIs were needed., Competing Interests: Declaration of Competing Interest No conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Insulin resistance (IR) is a pathophysiological construct that derives a series of metabolic disturbances that promote cardiometabolic dysfunction. This study evaluated mediating and modifying effects of homeostatic model assessment-based IR (HOMA-IR) on the association between sugar-sweetened beverage (SSB) consumption and a constellation of adolescent cardiometabolic abnormalities., Methods: Comprehensive data on sociodemographics, diet, physical activity, and anthropometric and biochemical parameters for 1454 adolescents were obtained from a large-scale representative study for adolescent metabolic syndrome (MetS) conducted in Taiwan. The original (HOMA1-IR) and updated nonlinear (HOMA2-IR) HOMA-IR indicators were used as IR biomarkers. Principal component (PC) analysis was employed to create reduced groups of variables and risk scores for retained PCs., Results: Higher SSB intake was associated with higher levels of HOMA1-IR and HOMA2-IR, and the two IR biomarkers were positively correlated with metabolic dysfunction clustering. Compared with SSB nondrinkers, adolescents who consumed >500 mL/day of hand-shaken high-fructose corn syrup beverages (HHB) had a 0.22 increase in the number of abnormal MetS components, and HOMA-IR mediation explained 33.9-37.9% of the effect. IR biomarkers accounted for 26.5-31.0% of the relationship between >500 mL/day of SSB consumption and bodyweight-enhanced PC scores. The effects of HOMA-IR indicators on all bodyweight-related factors were consistently intensified among >350 mL/day HHB drinkers (all P interaction  < 0.05)., Conclusions: Fructose-rich SSB intake correlates with a constellation of cardiometabolic abnormalities in adolescents, and this association may be partly mediated by HOMA-IR levels. The adverse effects of HOMA-IR on bodyweight-associated cardiometabolic risk factors depend on the type of SSB consumption, with enhanced risks observed in the intake of high amounts of HFCS-containing SSBs.

A simple, robust, and characterized adiposity indicator may be appropriate to be used as a risk screening tool for identifying metabolic syndrome (MetS) in adolescents. This study used dual adolescent populations to develop and validate efficient adiposity indicators from 12 characterized candidates for identifying MetS that may occur during the transition from adolescence to young adulthood. Data from the adolescent Nutrition and Health Survey in Taiwan ( n = 1920, 12-18 years) and the multilevel Risk Profiles for adolescent MetS study ( n = 2727, 12-16 years) were respectively used as training and validation datasets. The diagnostic criteria defined by the International Diabetes Federation for adolescents (IDF-adoMetS) and the Joint Interim Statement for adults (JIS-AdMetS) were employed to evaluate MetS. In the training dataset, principal component analysis converted 12 interrelated obesity indices into bodyfat-, lipid-, and body-shape-enhanced groups, with the first two characteristic-groups having a higher discriminatory capability in identifying IDF-adoMetS and JIS-AdMetS. In the validation dataset, abdominal volume index (AVI) among girls and waist circumference (WC) among boys were respectively validated to have a higher Youden's index (0.740-0.816 and 0.798-0.884) in identifying the two MetS. Every 7.4 and 4.3 positive tests of AVI (cutoff = 13.96) had an accurate IDF-adoMetS and JIS-AdMetS, respectively, and every 32.4 total tests of WC (cutoff = 90.5 cm) had a correct identification for the two MetS. This study stresses the discriminatory capability of bodyfat- and lipid-enhanced adiposity indicators for identifying MetS. AVI and WC were, respectively, supported as a risk screening tool for identifying female and male MetS as adolescents transition to adulthood.

Objectives: Work is often a barrier for women to continue breastfeeding after they have given birth. Breastfeeding support is an important part of workplace health promotion. We investigated the implementation of breastfeeding promotion and gender equality polices in workplaces with the Taiwan Badge of Accredited Healthy Workplace., Methods: Our samples consisted of 1648 corporations with the badge of Accredited Healthy Workplace issued by the Bureau of Health Promotion from 2007 to 2008. Concomitantly, 2000 corporations without accreditation were randomly selected from the National Business Directory as the control group. Data were collected from self-administered questionnaires. Logistic regression was used to examine the association with breast-feeding promotion and other variables in Taiwanese workplaces., Results: Members of accredited group of 1089/1648 (66.1%) and the control group of 526/2000 (26.3%) responded to the questionnaire. The accredited companies had more mother-friendly settings, including breastfeeding policies and documents, appropriate breastmilk preserving equipment and settings in the workplace. In the accredited group, breastfeeding rate of mothers returning to work after giving birth was 64.3% in 2008 (1 year after giving birth) and 60.4% in 2009 (1 year after giving birth), while the rate of the control group was 59.1% in 2008 and 51% in 2009., Conclusion: Accredited corporations are better at breastfeeding support than those of the control group. This might be related to the company size, location, and the implementation of tobacco control and/or occupational health promotion policies, which may increase awareness of healthy workplaces and influence maternal protection positively., (© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: "Perceptions of challenges and barriers related to the transition to a new handover informatics system," "Perceptions of benefits and strategies to the transition to a new handover informatics system," and "Suggestions for successful implementation of a new handover informatics system." Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system.

Clustering of metabolic syndrome (MetS) risk components in childhood has been linked to a higher risk of diabetes and cardiovascular diseases in adulthood. By using data from the 2010⁻2011 Nutrition and Health Survey in Taiwan, this study investigated epidemic patterns and correlates for the clustering of MetS risk components. A total of 1920 adolescents aged 12⁻18 years were included in this study. The MetS diagnostic criteria defined by the Taiwan Pediatric Association (TPA) and International Diabetes Federation (IDF) for adolescents and the criteria defined by the Joint Interim Statement for adults (JIS-Adult) were used to evaluate MetS and its abnormal components. The prevalence of TPA-, IDF-, and JIS-Adult-defined MetS was 4.1%, 3.0%, and 4.0%, with 22.1%, 19.3%, and 17.7%⁻18.1% of adolescents having high fasting glucose, low high-density lipoprotein cholesterol, and central obesity, respectively. A 0.4-to-0.5-fold decreased risk of having ≥2 MetS abnormal components was detected among adolescents who consumed ≥1 serving/week of dairy products and fresh fruits. Boys who consumed ≥7 drinks/week of soda and girls who consumed ≥7 drinks/week of tea had a 4.6- and 5.2-fold risk of MetS, respectively. In conclusion, our findings revealed significant dimensions of adolescent MetS, including detecting population-specific prevalent patterns for MetS risk components and their clustering, and emphasized on health promotion activities that reduce sugar-sweetened beverage intake.

Purpose of the Research: The Revised Children's Manifest Anxiety Scale, second edition (RCMAS-2) is widely used internationally to assess anxiety. However, there is little data regarding its validity for pediatric cancer patients. This study evaluated the psychometric properties of the RCMAS-2 in pediatric cancer patients., Methods and Sample: This cross-sectional study included 370 pediatric cancer patients (aged 6-19 years) that were recruited from three medical centers between August 2008 and March 2011 in Taiwan. Reliability was evaluated by internal consistency. Confirmatory factor analysis was performed to examine the factor structure. Construct validity was examined by known-groups analyses., Key Results: The internal consistency of the full scale was good (α = 0.90) but the scores of Physiological Anxiety subscale was low (α = 0.65). Using known-groups validity, significant differences in anxiety were observed between genders and between patients that were on and off treatment. The hypothesized three-factor model did not adequately fit (χ(2)/d.f = 2.4; p < 0.01, GFI = 0.80, CFI = 0.71, RMSEA = 0.06, SRMR = 0.01)., Conclusions: The RCMAS-2 demonstrated reliability and validity for use with pediatric cancer patients aged 6 and 19 years. Further structure evaluation of the RCMAS-2 in pediatric oncology population is needed, and the scores of the Physiological Anxiety subscale should be interpreted with caution., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: This study investigated the clinical characteristics of patients with septic arthritis caused by Staphylococcus aureus and tried to identify the risk factors for methicillin-resistant S. aureus (MRSA) arthritis., Methods: Between January 2008 and December 2011, patients with septic arthritis caused by S. aureus were identified from the computerized databases of a regional hospital and a medical center in southern Taiwan. The medical records of these patients were retrospectively reviewed., Results: A total of 93 patients with S. aureus arthritis were identified, and MRSA arthritis was found in 38 (40.9%) cases. The mean age of the patients was 58 years, and 86 (92.5%) episodes were classified as community-acquired infections. Diabetes mellitus (n = 41, 44.1%) was the most common underlying disease, followed by chronic kidney disease and liver cirrhosis. Patients with MRSA arthritis were more frequently elderly and found in the setting of healthcare-associated infection than patients with methicillin-susceptible S. aureus (MSSA) infections. No other significant differences in clinical manifestations and outcomes were noted between these two groups of patients. Overall, the in-hospital mortality rate was 5.4%, and diabetes mellitus was the only risk factor for mortality., Conclusions: MRSA is emerging in the setting of community-acquired septic arthritis. MRSA septic arthritis is more likely to develop in the elderly and in healthcare-associated infections than MSSA septic arthritis.

Background: This study was conducted to investigate the bacteriology and associated patterns of antibiotic resistance Fournier gangrene., Methods: Patients with Fournier's gangrene from 2008 to 2012 were identified from the computerized database in a medical center in southern Taiwan. The medical records of all patients with Fournier's gangrene were reviewed retrospectively., Results: There were 61 microorganisms, including 60 bacteria and one Candida spp, isolated from clinical wound specimens from 32 patients. The most common isolates obtained were Streptococcus spp. (n=12), Peptoniphilus spp. (n=8), Staphylococcus aureus (n=7), Escherichia coli (n=7), and Klebsiella pneumoniae (n=7). Among 21 strains of gram-negative bacilli, five (23.8%) were resistant to fluoroquinolones, and three isolates were resistant to ceftriaxone. Two E. coli strains produced extended-spectrum beta-lactamase. Four of the seven S. aureus isolates were methicillin-resistant. Among 15 anaerobic isolates, nine (60%) were resistant to penicillin, and eight (53.3%) were resistant to clindamycin. Four (26.7%) isolates were resistant to metronidazole. The only independent risk factor associated with mortality was inappropriate initial antibiotic treatment (p=0.021)., Conclusion: Antibiotic-resistant bacteria are emerging in the clinical setting of Fournier gangrene. Clinicians should use broad-spectrum antibiotics initially to cover possible antibiotic-resistant bacteria.

Background: The metabolic effect of fructose in sugar-sweetened beverages (SSB) has been linked to de novo lipogenesis and uric acid (UA) production., Objectives: This study investigated the biological effects of SSB consumption on serum lipid profiles and retinol-binding protein 4 (RBP4) among Taiwanese adolescents., Methods: We evaluated the anthropometric parameters and biochemical outcomes of 200 representative adolescents (98 boys and 102 girls) who were randomly selected from a large-scale cross-sectional study. Data were analyzed using multiple regression models adjusted for covariates., Results: Increased SSB consumption was associated with increased waist and hip circumferences, body mass index (BMI) values and serum UA, triglyceride (TG) and RBP4 levels. Adolescents who consumed >500 ml/day of beverages half-to-heavily sweetened with high-fructose corn syrup (HFCS) exhibited TG and RBP4 levels 22.7 mg/dl and 13.92 ng/ml higher than non-drinkers, respectively. HFCS drinkers with hyperuricemia had higher TG levels than HFCS drinkers with normal UA levels (98.6 vs. 81.6 mg/dl). The intake of HFCS-rich SSBs and high value of BMI (≥24) interactively reinforced RBP4 levels among overweight/obese adolescents. Circulating RBP4 levels were significantly correlated with weight-related outcomes and TG and UA concentration among HFCS drinkers (r = 0.253 to 0.404), but not among non-drinkers., Conclusions: High-quantity HFCS-rich beverage consumption is associated with higher TG and RBP4 levels. Hyperuricemia is likely to intensify the influence of HFCS-rich SSB intake on elevated TG levels, and in overweight and obese adolescents, high BMI may modify the action of fructose on higher circulating levels of RBP4.

Objective: This study was conducted to investigate the clinical characteristics of patients with Aeromonas peritonitis, particularly secondary peritonitis., Methods: Patients with Aeromonas peritonitis treated between July 2004 and December 2011 were identified from the computerized database of a regional hospital in southern Taiwan. The medical records of these patients were retrospectively reviewed., Results: A total of 50 patients with Aeromonas peritonitis were identified. Nine cases were classified as spontaneous bacterial peritonitis, and 41 cases were classified as secondary peritonitis. The most common etiology of secondary peritonitis was acute appendicitis (n=26), followed by small bowel perforation (n=7) and colon perforation (n=6). The patients with spontaneous bacterial peritonitis were more likely to be immunocompromised (p=0.0013) and more frequently had an initial presentation of shock (p=0.0129), an abnormal liver function (p<0.05) and concomitant bacteremia (p=0.0024) than the patients with secondary peritonitis. Although the patients with secondary peritonitis had higher levels of inflammatory parameters, including leukocytes and C-reactive protein, and more frequent polymicrobial infections, their survival outcome rates, such as in-hospital mortality, were significantly lower (p=0.0007). The overall in-hospital mortality rate was 20%, and initial shock was the only independent prognostic factor for mortality (p=0.012)., Conclusion: The clinical characteristics, including outcomes, of patients with spontaneous and secondary Aeromonas peritonitis differ. In-hospital mortality is significantly associated with the initial presentation of shock.

Purpose: Gluten sensitivity (GS) is related to the pathogenesis of sporadic or hereditary ataxia., Methods: Total of 194 healthy controls and patients with either hereditary ataxia (n=207) or sporadic ataxia (n=361) were tested for the circulating gluten-related autoantibodies which serve as biomarkers to interpret the existence of GS., Results: The incidences of GS in each population were 1% in normal subjects, 2% in hereditary ataxia patients and 9% in sporadic ataxia patients. High serum level of anti-gliadin IgG/IgA and t-transglutaminase IgA were disclosed at the sporadic ataxia patients compared with normal subjects. However, the anti-gliadin IgG is more specific to the disease of sporadic ataxia., Conclusion: Relatively higher incidence of GS was found in the population of sporadic ataxia patients but not in either normal subjects or hereditary ataxia patients in Taiwan. Anti-gliadin IgG still is a very powerful indicator to implicate the immune-related sporadic ataxia and we conclude that GS-related sporadic ataxia exists in Taiwan with linkage to autoimmune events.

Background: Second-hand Smoke (SHS) exposure is a significant public health problem that may be responsible for serious health hazards for child. This study aimed to examine the exposure status of SHS and the factors associated with SHS avoidance behavior among the mothers of pre-school children., Methods: A cross-sectional study was used to obtain a sample of the mothers of pre-school children (n = 1,020) in 30 registered kindergartens in eastern Taiwan. Overall, 919 (a response rate of 90%) completed the questionnaires. Regression models were used to identify factors with respect to the avoidance behavior of SHS., Results: The prevalence of exposure to SHS was 70% and 50% for the mothers and their children, respectively. After adjusting for other variables, mothers who were current smokers (β = -0.260, p < 0.001), had spouses who smoked (β = -0.060, p < 0.05), SHS exposure (β = -0.138, p < 0.001), and/or children with exposure to SHS (β = -0.084, p < 0.05) were found to be less likely to avoid SHS, whereas mothers with a high knowledge score about SHS (β = 0.082, p < 0.01), positive attitudes (β = 0.274, p < 0.001) and a high self-efficacy level in regard to the avoidance of SHS (β = 0.397, p < 0.001) were observed to be more likely to avoid SHS. Regression analyses confirmed that the significantly factors associated with the avoidance behavior of SHS were self-efficacy, being a current smoker, and the attitude toward the avoidance of SHS to be that of 55.5% of the total variance explained (p < 0.001)., Conclusions: The high prevalence rate of exposure to SHS for mothers and their children suggests that a well-designed future intervention program should be implemented in regard to pre-school children's mothers in order to prevent these mothers and their children from SHS exposure hazards, more particularly, to strengthen the knowledge base, to enhance self-efficacy and to foster a more positive attitude toward the avoidance of SHS in the mothers.