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Abstract Background In recent years, smart devices have become an integral part of daily life. However, longitudinal studies, particularly those regarding the relationship between toddlers’ smart device usage and behavioral outcomes, are limited. Understanding the impact of parent–child interactions on this relationship is crucial for enhancing toddlers’ developmental outcomes. Accordingly, this study examined the influence of early screen time and media content exposure on toddlers’ behaviors, as well as the positive effects of mother–child interactions on this influence. Methods We used relevant data related to 277 children born between November 2016 and July 2020 and who were part of an ongoing prospective follow-up study conducted across five hospitals in Taipei City, Taiwan. We analyzed (1) data from maternal reports regarding children’s behavior by using the Child Behavior Checklist (for ages 11/2–5 years), (2) assessments of mother–child interactions by using the Brigance Parent–Child Interactions Scale, and (3) self-reported parental data covering the first 3 postpartum years. Statistical analyses involved group-based trajectory modeling and multiple linear regression. Results A considerable increase in screen time between the ages of 1 and 3 years was associated with less favorable behavioral outcomes at age 3. These outcomes included somatic complaints [adjusted beta coefficient (aβ) = 2.17, 95% confidence interval (CI) = 0.39–3.95, p-value = 0.01], withdrawal (aβ = 2.42, 95% CI = 0.15–4.69, p-value = 0.04), and aggressive behavior (aβ = 6.53, 95% CI = 0.25–12.81, p-value = 0.04). This association was particularly evident among children with lower levels of mother–child interaction. Nevertheless, positive mother–child interactions mitigated most of the adverse effects. Additionally, increased exposure to games and cartoons was associated with poorer behavioral outcomes in all children except for those experiencing positive mother–child interactions. Conclusion Early mother–child interactions play a crucial role in mitigating the risk of behavioral problems in toddlers who spend prolonged periods looking at screens and who are frequently exposed to game and cartoon content.

Abstract Preterm delivery of low-birth weight infants is considered a leading cause of morbidity and mortality among neonates. Various studies have reported a positive correlation between periodontal disease (PD) and premature birth (PB) and yet no population-based study has assessed the impact of PD severity and treatments on premature birth. This cohort study used Taiwan’s national medical records (1999–2012, included 1,757,774 pregnant women) to investigate the association between PD severity and PB. Women with PD during the 2-year period prior for giving birth were more likely to have PB (11.38%) than those without PD (10.56%; p

Abstract Background Down syndrome is a common chromosomal abnormality and prenatal screening can inform parents of the risk of their baby having Down syndrome. Little research has examined how decisions regarding both Down syndrome screening as well as diagnosis are made among women who are currently pregnant and how their decisions are influenced by their social contexts, specifically family and social media, using mixed methods. The study was to test the validity and reliability of a scale that measures pregnant women’s attitudes and decision-making concerning prenatal Down syndrome screening and diagnosis in urban areas of Taiwan. Methods We developed an item pool based on a literature review and in-depth interviews with 30 pregnant women recruited at two district hospitals in urban areas. The item pool was reviewed by a panel of experts and then administered to 300 women who had been pregnant for less than 24 weeks and had not received the Down syndrome screening tests. We used item analysis and exploratory factor analysis to validate the scale and test its reliability. Results The initial item pool had 54 items. After the expert review, three items were deleted. After the item analysis, 16 additional items were deleted. Exploratory factor analysis of the remaining items revealed four factors labeled – “Attitudes towards Down syndrome and Screening Tests,” “Important others’ Attitudes towards Down Syndrome,” “Influence of Important Others on Decision-Making,” and “Influence of Social Media on Decision-Making” – and 16 of the remaining items had satisfactory loadings on those factors, explaining 72.0% of the total variance. The Cronbach’s α values of the dimensions ranged between 0.75 and 0.90, demonstrating satisfactory internal reliability. Conclusions The scale has satisfactory validity and reliability, and can be used to understand pregnant women’s attitudes and decision-making regarding Down syndrome screening and diagnosis, and to help design tailored consultations for pregnant women in clinical settings.

Objective: The objective of this study is to evaluate the learning experience effect of online problem-based learning (PBL) and case-based learning (CBL) in teaching disaster nursing. Methods: According to the characteristics of online PBL and CBL, the revised curriculum experience questionnaire (CEQ) was used to evaluate the teaching quality. Cronbach's coefficient and the reliability of the split-half reliability questionnaire were calculated. The exploratory factor analysis of 26 items was carried out by principal component analysis and maximum variance rotation method. Kaiser-Meyer-Olkin (KMO) and Bartlett's tests were used to test the validity of the questionnaire. The comparison between groups was performed by one-way analysis of variance. Results: A total of 191 questionnaires were issued and 183 copies were recovered, with a recovery rate of 95.8%. The Cronbach's alpha coefficient of CEQ is 0.929, and the Cronbach's alpha coefficient of each dimension is between 0.713 and 0.924. After factor analysis, the KMO value was 0.817. The 26 items finally returned to 6 principal components, and all factor load values were above 0.7, indicating good factor analysis effect. This study found that students who learned disaster nursing had an ideal online learning experience, and the average value of CEQ was 3.74 ± 0.42. In particular, male students, senior students or medical students had a higher curriculum experience score. In addition, compared with the national recruitment, the international students have higher curriculum experience score on the dimension of Appropriate Assessment Scale, indicating that the international students are more inclined to use online PBL and CBL. Conclusions: Using the revised CEQ is an innovative approach to evaluate the effect of online PBL and CBL in teaching disaster nursing, which can improve students' experience and curriculum quality.

Abstract Background Although maternal mental illnesses have been found to influence child health and development, little is known about the impact of maternal positive well-being on child health and development. Therefore, this longitudinal study investigated the effects of prenatal subjective well-being on birth outcomes and child development by considering the potential modifier effect of parity. Methods Pregnant women in early stages of pregnancy were recruited at five selected hospitals in Taipei, Taiwan, during their prenatal appointments since 2011. Self-reported evaluations were conducted at seven time points up to 2 years postpartum. Linear regression and generalized estimating equation models were used for examination. Results Higher prenatal eudaimonic well-being was associated with longer gestational length (adjusted beta [aβ] = 0.36, 95% confidence interval [CI] = 0.03, 0.68) and higher birth weight (aβ = 124.71, 95% CI = 35.75, 213.66). Higher positive and negative affect were associated with longer gestational length (aβ = 0.38, 95% CI = 0.06, 0.70) and smaller birth weight (aβ = −93.51, 95% CI = −178.35, −8.67), respectively. For child’s outcomes, we found an association between higher prenatal eudaimonic well-being and decreased risks of suspected developmental delay, particularly for children of multiparous mothers (adjusted odds ratio = 0.18, 95% CI = 0.05, 0.70). Higher levels of prenatal depression and anxiety were significantly associated with increased risks of suspected developmental delay for children of primiparous mothers. Conclusions Positive prenatal maternal mental health may benefit birth outcomes and child development, particularly for children of multiparous mothers. Interventions for improving prenatal mental health may be beneficial for child development.

Objective: Many women quit smoking during pregnancy resume in postpartum period and difficult to prevent. No studies had focused on their psychosocial response in Taiwan. We analyzed data from a trial of Taiwan Smoker's Helpline (TSH) to determine factors associated with smoking relapse after delivery. Materials and methods: A prospective cohort was conducted at Taipei City Hospital during Sep. 2014 and Nov. 2015 period. We collected data by self-developed questionnaire combining theory of planned behavior (TPB), Fagerstrom test for nicotine dependence (FTND) and Edinburgh Postnatal Depression Scale (EPDS) from 68 women immediately after delivery, 2 months later and followed up until 6 months. Multivariable logistic models for relapse of smoking at the end of 3rd month and 6th month were created. Results: At 6th month, 42.6% participants relapsed with odds lower among first parity (OR = 0.04, 95% CI =

Ectropis grisescens Warren is one of the most important pests of tea plants. In this study, data on the development, survival, and fecundity of E. grisescens were collected at 15, 22, and 32 °C and analyzed by using the age-stage, two-sex life table. At 15 °C, the duration of the preadult period of E. grisescens was significantly prolonged (81.06 days), with high mortality (69.0%), and the proportion of emerged female adults was extremely low (7.0%). At 32 °C, the preadult period was significantly shortened (29.12 days), with high preadult mortality (74.0%), and a low proportion of emerged female adults (15.0%). At 22 °C, with low preadult mortality (24.0%), and a high proportion of emerged female adults (26.0%). The overall effects of the shorter preadult duration, higher preadult survival rate, higher proportion of emerged female adults, higher fecundity (F = 350.88 eggs/♀), and higher net reproductive rate (R0 = 91.23 offspring/individual) at 22 °C resulted in the highest values of the intrinsic rate of increase (r = 0.1054 days–1) and finite rate of increase (λ = 1.1112 days–1). Computer simulation showed that E. grisescens populations can increase much faster at 22 °C than at 15 and 32 °C. The weighted population size and cumulative weighted insect-days provided the dynamics necessary for estimating the damage potential of E. grisescens in devising economical pest management programs. Our results demonstrate that populations of E. grisescens were able to develop at a broad range of temperatures and adapt to the high temperatures. These finding can be utilized to improve the management of E. grisescens. Graphical Abstract Age-stage, two-sex life table can reveal the survival and stage differentiation for assessment of differences between temperatures. [ABSTRACT FROM AUTHOR]

Objective: The worldwide prevalence of congenital rubella syndrome has drastically decreased after the uptake of vaccine to prevent the infection. However, outbreaks have occurred in some countries due to their own vaccination policies, and this phenomenon has not yet been investigated in Taiwan. Our study aims to fill this gap. Materials and Methods: We constructed an analytical database containing 10,824 pregnant women at the Taipei City Hospital, Taipei, Taiwan from January 2004 to July 2012. They were categorized into five birth cohorts according to the different vaccination programs in Taiwan: those born before 1971; those born between September 1971 and August 1976; between September 1976 and August 1979; between September 1979 and August 1985; and between September 1985 and August 1990. Differences of the seronegative rate and titers were compared using the Chi-square and Kruskal–Wallis tests among the five cohorts. Results: The seronegative rates for the five cohorts were 15.00%, 4.07%, 2.88%, 4.21%, and 10.98%, respectively, and were statistically significant different (p

Responsive feeding is crucial to the formation of life-long healthy eating behavior. Few studies have examined maternal responsive feeding in early infancy among a Chinese population. This prospective study describes maternal responsive feeding and factors associated with maternal responsive feeding, with emphasis on infant growth and maternal depressive symptoms, during the first 3 months postpartum in Taiwan. From 2015 to 2017, 438 pregnant women were recruited and followed at 1 and 3 months postpartum. Maternal responsive feeding at 3 months was measured on a 10-item 5-point Likert-type scale. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale with a cutoff score of 10. Infant growth was categorized into four groups based on weight-for-length Z scores from birth to 3 months: no change, increase but in the normal range, increase to overweight, and decrease to underweight. Multiple regression revealed that postpartum depressive symptoms, primipara, and decreased infant weight-for-length Z score were negatively associated with maternal responsive feeding, while exclusive breastfeeding and maternal age younger than 29 years were positively associated with maternal responsive feeding. Heath professionals should educate mothers on responsive feeding, with emphases on first-time and non-exclusive breastfeeding mothers, as well as those with depressive symptoms, advanced maternal age, and infants who are becoming underweight.

Objective: The purpose of this methodology study is to examine the relative validity of four dietary assessment methods during pregnancy and to understand the pros and cons of each method. Materials and methods: We recruited 181 healthy pregnant women with less than 20 weeks of gestation and collected information through personal and telephone interviews in Taipei, Taiwan. Dietary assessment methods including 24-hour recalls, 3-day food records, and the weekly food frequency questionnaire during the 3 trimesters and the meal-based Chinese food frequency questionnaire (CFFQ) in the 3rd trimester were used in this prospective study. Results: The percentages of energy from protein (15%), fat (31–34%), and carbohydrate (50–54%) were similar by the recall and record methods. The energy intakes from 24-hour recalls were 1924 kcal, 1980 kcal, and 2172 kcal in the 1st, 2nd, and 3rd trimesters, respectively. The weekly food frequency questionnaire resulted in significantly higher intakes of all energy nutrients, especially for protein and fat intakes (percentages and densities) for the 3 trimesters; a further adjustment for the food list is needed. The CFFQ showed comparable results with the quantitative methods in estimating dietary patterns for the entire pregnancy. The 24-hour recalls by telephone interviews provided reasonable results in the assessment of the average nutrient intakes during the trimesters. Conclusion: The combinations of 24-hour recalls for the short-term dietary changes and the CFFQ for long-term dietary patterns are suggested as appropriate dietary assessment methods during pregnancy in Taiwan.

Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4-0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1-1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4-0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6-0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0-1.8, P < .05). Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.

Objective: To assess adolescent pregnancy for demographic characteristics, obstetric morbidity, and birth outcome in Taipei City Hospitals. Materials and Methods: Registry data for 9,630 singleton births at 20 weeks or more of gestation at seven city hospitals in Taipei between January 2002 and June 2003 were studied. Mothers were divided into three groups by age: under 20 (n = 133 births; 1.4%); 20-34 (n = 8,035; 83.4%), and over 34 (n = 1,462; 15.2%). The overall registration rate was about 95%. Data were analyzed by Chi-squared, logistic regression, and ANOVA tests. Results: Education attainment in the teenage group was lower and the proportion who were single, had first parity, sought prenatal care after first trimester, and smoked were significantly higher. Obstetric complications were more common in this group in terms of antenatal anemia and precipitate labor, with adjusted odds ratios (ORs) of 2.2 (1.2-4.0) and 3.0 (1.5-6.2), but not in the frequency of prolonged labor, postpartum hemorrhage, abruptio placenta, or hypertensive disorder. However, rates were higher for stillbirth (adjusted OR, 2.8;1.0-8.2) and small for gestational age (crude OR, 1.9; 1.2-3.2), resulting in the lowest mean birth weight of infants. No significant differences were demonstrated in frequency of prematurity, Apgar score, congenital anomalies, intensive care unit admission, or neonatal death. Conclusion: Teenage maternity is associated with general characteristics of social disadvantage and suboptimal outcome. We recommend education classes, focusing on the nutritional aspects of anemia correction, smoking cessation, and adequate preparation for birth. In addition, an integrated program is required, with social workers recruited to enhance family support.

Objective: Torsion of adnexa is relatively common, but isolated torsion of the fallopian tube is rare. It should be considered in all adolescents who present with acute pelvic pain. Laparoscopy or laparotomy is often necessary to establish the diagnosis. This report focuses on a 14-year-old girl with isolated tubal torsion who presented with acute pelvic pain. Case Report: A 14-year-old adolescent was admitted to our hospital because of acute right-sided abdominal pain without vomiting and diarrhea. Pelvic ultrasound showed an adnexal mass. Conservative treatment was given but did not improve her condition. Emergent laparoscopy was performed due to persistent symptoms, which later confirmed the diagnosis of isolated torsion of the fallopian tube. Pathology showed hemosalpinx with necrosis. Conclusion: Isolated torsion of the fallopian tube is an uncommon event, especially in adolescents. It must be kept in mind whenever a young girl presents with low abdominal pain and pelvic mass on ultrasound. Prompt laparoscopic intervention may allow for early diagnosis, treatment and preservation of the tube if possible.

Hepatic cysts are found in heterogeneous disorders with different pathogeneses, of which simple hepatic cysts and polycystic liver diseases are two major types. The process of hepatic cytogenesis for these two diseases is caused by defects in remodelling of the ductal plate during biliary tract development, which is called ductal plate malformation. SOX9 is a transcription factor participating in the process of bile duct development, and thus, its dysregulation may play important roles in hepatic cystogenesis. SEC63 encodes an endoplasmic reticulum membrane protein that is mutated in human autosomal dominant polycystic liver disease. However, the transcriptional regulation of SEC63 is largely unknown. In the present study, a liver‐specific Sox9 knockout (Sox9LKO) mouse was generated to investigate the roles and underlying mechanism of SOX9 in hepatic cystogenesis. We found that hepatic cysts began to be observed in Sox9LKO mice at 6 months of age. The number and size of cysts increased with age in Sox9LKO mice. In addition, the characteristics of hepatic cytogenesis, including the activation of proliferation, absence of primary cilium, and disorder of polarity in biliary epithelial cells, were detected in the livers of Sox9LKO mice. RNAi silencing of SOX9 in human intrahepatic biliary epithelial cells (HIBEpic) resulted in increased proliferation and reduced formation of the primary cilium. Moreover, Sec63 was downregulated in primary biliary epithelial cells from Sox9LKO mice and SEC63 in HIBEpic transfected with siSOX9. Chromatin immunoprecipitation assays and luciferase reporter assays further demonstrated that SOX9 transcriptionally regulated the expression of SEC63 in biliary epithelial cells. Importantly, the overexpression of SEC63 in HIBEpic partially reversed the effects of SOX9 depletion on the formation of primary cilia and cell proliferation. These findings highlight the biological significance of SOX9 in hepatic cytogenesis and elucidate a novel molecular mechanism underlying hepatic cytogenesis. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]