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Airborne fine particulate matter (PM

International students face many impediments under the COVID-19 pandemic. The objectives of this study are to assess the association between the perceptions of international students and the lockdown policy for COVID-19. In 2021, three different levels of lockdown policy were enforced, including level I from January to April, level III from May to July, and level II from August to December. We conducted three surveys for international graduate students using a validated questionnaire during the different lockdown levels. We collected 185, 119, and 83 valid questionnaires in level I, II, and III, respectively. There were linear trends in the correlations of lockdown policy with the knowledge (p = 0.052), attitudes (p = 0.002), and practices (p < 0.001) of COVID-19. In brief, the stricter the lockdown policy, the better the students adhered to sufficient knowledge, positive attitudes, and healthy practices. Furthermore, there were significant linear correlations of lockdown policy with the transportation, school study, leisure, family life, and diet behavior. In conclusion, lockdown policy had important impacts on the knowledge, attitudes, practices, and daily lives of international students. The findings indicated that the lockdown system and its corresponding measures appear to affect perceptions in a positive way.

There are few apparent studies regarding the association between fine particulate matter (PM2.5) air pollution and development of depression. Data obtained from epidemiological studies are inconsistent and controversial. The aim of this case-crossover study was to examine the association between short-term exposure to PM2.5 alone and in combination with other pollutants and frequency of hospitalizations for depression from 2009 to 2013 in Taipei, Taiwan. In the single pollutant model without adjustment for other pollutants, 17% and 4% increase in admissions attributed to depression correlated with interquartile range (IQR) rise in PM2.5 levels was noted on warm and cool days, respectively. Data were also analyzed using two-pollutant models and it was found that on warm days, the association continued to be significant after including one of the following pollutants: sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) or carbon monoxide (CO). On cool days, the significance was lost. In conclusion, the relationship between ambient outdoor PM2.5 exposure and rates of hospitalization for depression appeared to be temperature dependent in Taipei. Further research is needed to verify these observations as well as to distinguish the relative contributions of PM2.5 and temperature to development for hospital admissions for depression.

Background Aerosol administration is increasingly being used as a therapeutic intervention for mechanically ventilated preterm infants. However, the effects of inhalation therapy on retinopathy of prematurity (ROP) have not yet been explored. Methods A retrospective cohort study was conducted in a tertiary level neonatal intensive care unit (NICU) from 2011 to 2013. All preterm infants with a gestational age (GA) of 24~29 weeks receiving invasive intubation for more than 1 week in the NICU were included. Infants with severe congenital anomalies were excluded. ROP was defined as stage II or greater according to medical records by ophthalmologists. A multivariate logistic regression model was used to estimate the risk of ROP in relation to inhalation therapy after adjusting for confounders. Results In total, 205 infants were enrolled in this study, including 154 with inhalation therapy and 51 without inhalation therapy. Univariate analyses showed an association of inhalation with the following characteristics: sex (p = 0.047), GA (p = 0.029), sepsis (p = 0.047), bronchopulmonary dysplasia (BPD) (p

Background: Parents may consider interrupting breastfeeding to manage neonatal jaundice (NJ). Our aims were to determine correlations of breastfeeding with NJ by examining infants' manifestations i...

Epidemiologic studies reported an association between exposure to ambient air pollutants and increased mortality rate attributed to suicide and suicide attempts. The investigation sought to determine whether there is an association between short-term ambient ozone (O3) level exposure and daily hospital admissions for depression in Taipei from 2009 to 2013 using a time-stratified case-crossover design. In our single-pollutant model (with no adjustment for other pollutants), the % increase in daily hospital admissions for depression was 12% on warm days and 30% on cool days, per interquartile range (IQR) rise in O3 levels, respectively. Ozone levels were significantly correlated with daily number of depression admissions both on warm and cool days. In our two-pollutant models, O3 levels remained significant after adjusting for other air pollutants, including particulate matter (PM10, PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) both on warm and cool days. Although O3 levels tended to be higher on warm days, admissions for depression were higher on cool days, suggesting that the relationship between O3 concentrations and depression may be affected by temperature. Further study is needed to better understand these findings.

This study investigated the temperature-specific risks of adverse neonatal outcomes in Taiwan. Over 2 million births between 2001 and 2010 were correlated with the daily mean outdoor temperatures at birth. A log-binomial model was used to estimate the risk of adverse neonatal outcomes in relation to ambient temperature at birth after adjusting for possible confounders. There was a significant correlation of temperature extremes with stillbirth, preterm birth, and low birth weight. Maternal exposure to temperature extremes carried greater risks of stillbirth (23.4°C), preterm birth (19.5°C and25.4°C), and low birth weight (15.5°C and23.4°C) than did temperatures of 21.5°C∼23.4°C. In conclusion, infants born to women exposed to temperature extremes possess greater risks for stillbirth, preterm birth, and low birth weight. The data suggest optimal temperatures to minimize overall adverse neonatal outcomes are 21.5°C∼23.4°C.

Oral rotavirus vaccine (RV) administration in conjunction with other injectable vaccines has been used worldwide. However, whether the sequence of RV administration is associated with the reduction of injection-induced pain remains unclear. In this randomized controlled trial, we enrolled 6–12-wk-old healthy infants. The pain response of the infants was scored on the basis of their crying, irritability, facial expression, gagging and distress. A multivariate logistic regression model was used to compare the pain response after adjustment for possible confounders. We enrolled 352 infants, of whom 176 infants received RV before injection (experimental group) and 176 infants received an RV after injection (comparison group). Sex, number of injections, main caregiver, feeding type, and RV type did not differ significantly between the 2 groups. Multivariate regression analyses showed that, at 30 s after the intervention, the episode of gagging was more frequent in the comparison group than in the experimental group (p = 0.004). At 180 s after the intervention, the infants cried more often in the comparison group (p < 0.001). Furthermore, the infants in the experimental group more often relaxed (p < 0.001), rested quietly (p = 0.001), and were smiling (p = 0.001) than did those in the comparison group. Our results indicate that compared with oral RV administration after injection, oral RV administration before injection is more effective in reducing injection-induced pain in 2-mo-old infants. The findings can provide a clinical strategy for relieving pain from vaccination in young infants.

Background. Infant holding position may reduce vaccination pain. However, the optimal position for young infants remains controversial. Objectives. To compare the effectiveness of holding infants in the supine position and the effectiveness of holding infants in upright position for relieving acute pain from vaccine injection. Methods. This prospective cohort study enrolled 6–12-week-old healthy infants. We examined infant pain responses by evaluating the following three categories: (1) crying, (2) irritability, and (3) facial expression. Results. In total, 282 infants were enrolled, with 103 and 179 held in the supine and upright positions, respectively. At 30 s after vaccination, the infants in the supine position showed a larger decrease in crying (p<0.001), irritability (p=0.002), and pained facial expression (p=0.001) than did those in the upright position. However, there was no significant difference in pain response between two groups at 180 s after intervention. Conclusion. In 2-month-old infants, the supine position may reduce acute pain more effectively than does the upright position. Our findings provide a clinical strategy for relieving vaccination pain in young infants.

Background: We developed a training course of fetal monitoring using high-fidelity simulation for obstetric nurses. Method: All participants were assessed by two standardized written tests for knowledge and interpretation of fetal heart rate tracing before and after the training. In addition, a self-estimated questionnaire survey was performed twice—after the training and 6 months later. Results: The knowledge and interpretation of fetal heart rate tracing significantly improved in the simulation group. Compared with the lecture group, the perceived improvements of knowledge and interpretation of fetal heart rate tracing in the simulation group were significantly better following the training and 6 months later. Conclusion: High-fidelity simulation courses are useful in improving the knowledge and interpretation of fetal heart rate tracings for obstetric nurses. They are more effective to improve both short- and long-term management in fetal heart rate monitoring. [ J Contin Educ Nurs . 2019;50(12):557–562.]

Several studies suggested short-term exposure to air pollution might be associated with suicide mortality, although results have been inconsistent and vary depending upon the type of air contaminants. While seasonal variation associated with suicide was reported to occur and that in the spring and early summer there are peaks in ozone (O3) distribution, the relationship between these two parameters is not known. The aim of this study was to examine the potential association between O3 levels and daily mortality rate related to suicide in Taipei for the period 2004-2008 using a time-stratified case-crossover analysis. In our single pollutant model without adjustment for other pollutants, the risk of suicide increased by 11% on warm days and 15% on cool days for each interquartile range (IQR) rise in O3 concentration, respectively. The relationship was positive but did not reach significance. In our two-pollutant models, O3 remained non-significant on warm days after inclusion of one of any other ambient air contaminants into the model. However, on cool days, a significant association was found between O3 levels and enhanced risk of mortality due to suicide after nitrogen dioxide (NO2) or carbon monoxide (CO) were included. The overall positive but not significant findings of elevated risk of mortality frequently attributed to suicide on days with higher O3 levels suggest that outdoor exposures to this gaseous contaminant may contribute to increases in daily mortality rate related to suicide.

Background Infants in a neonatal intensive care unit (NICU) have a higher incidence of bloodstream infections (BSIs) than any other pediatric or adult population. The predisposing factors have not been comprehensively evaluated in this population in Taiwan. Methods A retrospective matched case-control study was conducted in the NICUs of a teaching hospital in Taiwan. The case patients were identified from a staff-maintained electronic database containing the records of BSIs from July 2003 to June 2006. The case patients and the control patients (who did not develop BSI during their NICU stay) were 1:1 matched by birth weight, gestational age, gender, Apgar score, and date of birth. Results A total of 164 infants with culture-proven BSI were identified. Of these, 74 (45.1%) infants were female. The mean gestational age and birth weight were 30.7 ± 0.7 weeks and 1512 ± 804 g, respectively. The common etiologic pathogens included coagulase-negative staphylococci (28.7%), Staphylococcus aureus (16.5%), and Klebsiella pneumoniae (14.6%). Candida spp. accounted for 11 (6.7%) episodes. Two independent factors associated with BSIs in the neonates, as identified by multivariate analysis using conditional logistic regression, were the use of parenteral nutrition (matched odds ratio [mOR], 6.07; 95% confidence interval [CI], 1.14–32.32; p = 0.034) and intraventricular hemorrhage (mOR, 2.68; 95% CI, 1.20–5.99; p = 0.017). Conclusion Parenteral nutrition was a significant and independent risk of late-onset neonatal sepsis. This risk should be considered when implementing early parenteral nutrition in NICUs.

Prolonged jaundice is a commonly evaluated condition. The aim of this study was to assess the risk factors of jaundice in healthy infants at one month of age. This prospective cohort study enrolled 509 healthy infants from 2013 to 2018. Those with gestational age (GA) less than 35 weeks, birth weight less than 2000 grams, and illness were not enrolled. Jaundice was defined as a transcutaneous bilirubin value ≥5 mg/dL at 25–45 days of age. Umbilical cord blood samples were obtained to examine seven common gene variants. The incidence of prolonged jaundice was 32.2%. Prolonged jaundice was more common in infants with exclusive breastfeeding (p 4 times/d (p

Many studies examined the short-term effects of air pollution on frequency of daily mortality over the past two decades. However, information on the relationship between exposure to levels of coarse particles (PM(2.5-10)) and daily mortality rate is relatively sparse due to limited availability of monitoring data and findings are inconsistent. This study was undertaken to determine whether an association exists between PM(2.5-10) levels and rate of daily mortality in Kaohsiung, Taiwan, a large industrial city with a tropical climate. Daily mortality rate, air pollution parameters, and weather data for Kaohsiung were obtained for the period 2006-2008. The relative risk (RR) of daily mortality occurrence was estimated using a time-stratified case-crossover approach, controlling for (1) weather variables, (2) day of the week, (3) seasonality, and (4) long-term time trends. For the single-pollutant model without adjustment for other pollutants, PM(2.5-10) exposure levels showed significant correlation with total mortality rate both on warm and cool days, with an interquartile range increase associated with a 14% (95% CI = 5-23%) and 12% (95% CI = 5-20%) rise in number of total deaths, respectively. In two-pollutant models, PM(2.5-10) exerted significant influence on total mortality frequency after inclusion of sulfur dioxide (SO(2)) on warm days. On cool days, PM(2.5-10) induced significant elevation in total mortality rate when SO(2) or ozone (O(3)) was added in the regression model. There was no apparent indication of an association between PM(2.5-10) exposure and deaths attributed to respiratory and circulatory diseases. This study provided evidence of correlation between short-term exposure to PM(2.5-10) and increased risk of death for all causes.

This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (25°C), with a 10-μg/m(3) elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2-4%) rise in IHD admissions, 5% (95% CI = 4-6%) increase in stroke admissions, 3% (95% CI = 1-6%) elevation in CHF admissions, and 3% (95% CI = 0-6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-μg/m(3) increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-μg/m(3) rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD.

This study was undertaken to determine whether there was an association between air pollutant levels and daily clinic visits for headache in Taipei, Taiwan. Daily clinic visits for headache and ambient air pollution data for Taipei were obtained for the period from 2006–2011. The odds ratio of clinic visits for headache was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single pollutant models, on warm days (&gt, 23 °C) statistically significant positive associations were found for increased rate of headache occurrence and levels of particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). On cool days (&lt, 23 °C), all pollutants were significantly associated with increased headache visits except SO2. For the two-pollutant models, PM10, O3 and NO2 were significant for higher rate of headache visits in combination with each of the other four pollutants on cool days. On warm days, CO remained statistically significant in all two-pollutant models. This study provides evidence that higher levels of ambient air pollutants increase the risk of clinic visits for headache.

Previous studies suggested an elevated risk of non-Hodgkin's lymphoma (NHL) among farmers. To date, no apparent study examined the association between farming and NHL in Asian countries. The aim of this study was to investigate whether farmers in Taiwan exhibited an increased risk of mortality attributed to NHL. To this end, a mortality odds ratio (MOR) study was conducted to estimate the relative risk of mortality attributed to NHL for farmers in Taiwan. Data on the decedents enrolled in this investigation were derived from the death certificate database for the period 1997-2009. The study group comprised individuals who died from NHL and who were 50 years or older. The control group consisted of subjects who died from all other causes, excluding cancers, in the corresponding age group. Multiple logistic regression analysis was performed to compute the MOR, with adjustments for gender, age at death, year of death, marital status, and urbanizational levels. Among 32,456 deceased farmers, 205 died due to NHL. Farmers were found to have a nonsignificantly higher MOR than nonfarmers. This risk estimate is similar to estimates in previous meta-analyses. The MOR for NHL was higher among farmers who died 65 years or older than among those who died at younger ages. The findings indicate that farming in Taiwan may increase the risk of death attributed to NHL. Exposure to pesticides might be an influential factor contributing to high risk of mortality attributed to NHL among farmers and therefore needs to be further investigated.

This study was undertaken to determine whether there was a correlation between ambient ozone (O3) levels and number of hospital admissions for myocardial infarction (MI) in Taipei, Taiwan. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period from 2006 to 2010. The relative risk (RR) of hospital admissions for MI was estimated using a time-stratified case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased RR for a number of MI admissions was significantly associated with higher O3 levels both on warm days (>23°C) and on cool days (

G6PD-deficient adults are reported to be susceptible to severe infection, and decreased cytokine responses have been postulated as the underlying mechanism. However, investigating the association of G6PD deficiency and cytokine responses during infancy is lacking. The current study aims to determine whether cytokine responses of tumor necrosis factor ()-α, interleukins (IL)-6, and IL-10 are impaired in the G6PD-deficient infants. Upon agreements with informed consents, peripheral blood mononuclear cells (PBMCs) of enrolled infants were collected twice at 1 month and 1 year of age. PBMCs were then stimulated with toll-like receptor (TLR) agonists-including PAM3csk4 for TLR1-2, poly (I:C) for TLR3, and lipopolysaccharide for TLR4-to analyze the expression of TNF-α, IL-6, and IL-10. Males (P = .004) and phototherapy during neonatal period (P = .008) were more common among G6PD-deficient infants than G6PD-normal subjects. After the stimulation of TLR agonists, there was no significant difference in the expression of TNF-α, IL-6, and IL-10 between PBMCs of G6PD-deficient and -normal infants at both 1 month and 1 year of age. In conclusion, the clinical characteristics of G6PD-deficient infants are different from those of G6PD-normal subjects. The data suggest that the innate immune responses to TLR agonists in G6PD-deficient infants are not different from those of G6PD-normal infants.

BACKGROUND: Evidence-based practice (EBP) has been proposed as a core competence to improve healthcare quality. The profile of EBP among respiratory therapists (RTs) has not been explored. We investigated how RTs in Taiwan perceive the implementation of EBP. METHODS: We surveyed RTs in Taiwan9s regional hospitals during a 4-month period in 2011. RESULTS: A majority of RTs were aware of EBP (88.0%). Although most RTs held a favorable impression of EBP, their knowledge of and skill in EBP implementation were deficient. Only half of the RTs had implemented EBP. Insufficient convenient kits (59.1%), deficient designated personnel (50.0%), and lack of time (45.5%) were major barriers to implementing EBP. RTs rated MEDLINE as the most commonly used evidence-based retrieval database, followed by UpToDate, the Cochrane Library, MD Consult, ProQuest, CINAHL, DynaMed, and Micromedex. Multivariate regression analyses demonstrated sufficient skill in EBP and use of online databases as favorable factors for implementing EBP. In contrast, barriers of time constraint and insufficient knowledge were unfavorable factors for the implementation of EBP. CONCLUSIONS: EBP is not widespread among RTs in Taiwan. We have identified important factors in the implementation of EBP. The data provide valuable evidence for plotting strategies for disseminating EBP implementation.

Questionnaire in English. (PDF 223Â kb)

This study investigated the perceptions of short-term assignments of medical services among participating health care professionals dispatched from Taiwan to underdeveloped areas. Structured questionnaires were mailed to four groups of professionals (physicians, pharmacists, nurses, and public health personnel) who had participated in any of 88 medical missions dispatched to 24 allied nations. A total of 278 returns were valid for analysis. Among them, 222 respondents reported that they had participated in just one overseas medical mission (79.9%). The majority of physicians, pharmacists, and nurses listed humanitarianism as their foremost incentive for participation. In contrast, public health personnel most frequently reported that they had been assigned to the mission abroad. Pharmacists, nurses, and public health personnel most commonly stated that their top goal was health care; but physicians said that aiding Taiwan’s diplomatic relations was their main motive. While all groups generally recognized language proficiency and cultural awareness as important for conducting successful short-term medical aid missions (STMMs), many members of groups did not rate their own capabilities in those area as sufficient, especially pharmacists ( p < .001). Orientation for participants and training for local health workers were seen as relatively insufficient. In conclusion, there are considerable differences in the thoughts about STMMs across four key groups of heath personnel. The findings can help inform efforts to integrate evidence into the deployment of STMMs.

Online databases have been increasingly used as a key resource in the search for health information. The current study aims to compare the use patterns of online databases between physicians and nurses. A structured questionnaire was mailed to physicians and nurses of randomly selected regional hospitals in Taiwan. Valid questionnaires with complete answers were collected from 544 physicians and 1,573 nurses from November 2008 to February 2009. In general, physicians made more use of online databases than nurses (p 0.001). They more often accessed English-language online databases (p 0.001), including MEDLINE, MD Consult, UpToDate, Cochrane Library and ProQuest. On the other hand, nurses accessed Chinese-language online databases more frequently than physicians (p 0.001). Using a multivariate logistic regression model to adjust the personal characteristics, we found that nurses more often accessed Chinese-language online databases than physicians. Physicians used online databases to locate health information the most for clinical practice (76.6%), followed by instruction preparation (63.3%), and research (57.0%). Nevertheless, nurses used such databases more often for class assignments (66.4%) and clinical practice (55.8%). In conclusion, the behavior and motivation of access to online databases varied between physicians and nurses. Our findings provide evidence in the strategies to enhance the accessing of online databases.

The aim of this study is to identify clinical, etiologic, and laboratory factors that potentiate adverse outcome of hyperbilirubinemia among term and late preterm neonates in logistic regression analysis. A retrospective cohort of infants with total serum bilirubin (TSB) ≥ 20 mg/dL from 1995 to 2007 was surveyed. Eighteen infants had adverse outcome. Controls were 270 infants without sequelae. Risks were significantly higher in infants with six etiologies causing hyperbilirubinemia: sepsis (odds ratio [OR] = 161.7, 95% confidence interval [CI] = 11.7 to 2242.8), gastrointestinal obstruction (OR = 39.2, 95% CI = 2.7 to 567.3), Rh incompatibility (OR = 31.0, 95% CI = 5.1 to 188.9), hereditary spherocytosis (OR = 19.6, 95% CI = 1.6 to 235.5), ABO incompatibility (OR = 5.1, 95% CI = 1.3 to 19.7), and glucose-6-phosphate dehydrogenase deficiency (OR = 4.7, 95% CI = 1.3 to 16.7). Infants with acute bilirubin encephalopathy were more likely to have adverse outcome than subjects without acute bilirubin encephalopathy (OR = 281.7, 95% CI = 25.8 to 3076.7). Adverse outcome was more common in infants with a positive direct Coombs test (OR = 4.5, 95% CI = 1.3 to 15.4). Infants with hemoglobin < 10 g/dL tended to have adverse outcome more often than those with hemoglobin ≥ 13 g/dL (OR = 11.8, 95% CI = 3.3 to 42.9). Infants with TSB of 35 mg/dL or more (OR = 472.5, 95% CI = 47.8 to 4668.8) and of 30 to 34.9 mg/dL (OR = 9.5, 95% CI = 1.6 to 57.9) carry greater risks as compared with those with TSB of 20 to 24.9 mg/dL. In conclusion, this study quantitatively verified the potential risks for adverse outcome of neonatal hyperbilirubinemia.

OBJECTIVE To compare the efficacy and safety of exchange transfusion (ET) via three different catheterization methods: femoral vein (FV); umbilical vein (UV); and umbilical artery/vein (UA/V). DESIGN A retrospective cohort of neonates who underwent ET for hyperbilirubinemia between 1996 and 2007 was surveyed. Subjects with gestational age < 33 wks were excluded. SETTING Neonatal intensive care units in a tertiary referral hospital. PATIENTS A total of 109 neonates with 128 ET procedures (33 via FV, 35 via UV, and 60 via UA/V routes) were analyzed. MEASUREMENTS AND MAIN RESULTS There was no significant difference in the decline of total serum bilirubin between each group. When compared with the UA/V group, the transfusion rate was slower in the FV and UV groups (p < .001). Adverse events with clinical significance were more common in ET via the UA/V route than ET via the FV and UV routes (p < .05; odds ratio, 2.4; 95% confidence interval, 1.2-5.0). Neonates with ET via the UA/V route tended to have more asymptomatic laboratory aberrances (p < .01; odds ratio, 2.5; 95% confidence interval, 1.3-4.6). There were no significant differences in the transfusion rate (p = .498) and adverse events (p = .822) between the FV and UV groups. CONCLUSIONS ET through the FV route is an effective and secure method for the treatment of neonatal hyperbilirubinemia when the UV route is unavailable. Physicians should be cautious when using UA/V catheterization for ET.

Rationale To disseminate evidence-based practice (EBP) among hospital-based health professionals, since 2007 the National Health Research Institutes (NHRI) of Taiwan has run a complex outreach program that includes information resource support and promotional campaigns. Objectives The aim is to evaluate the impact of this outreach program on the diffusion of EBP. Setting Sixty-one regional hospitals in Taiwan. Design A cross-sectional, pre- and post-survey of a nationally representative sample of physicians and nurses was carried out in 2007 and 2009 to examine views related to EBP including changes in beliefs, attitudes, knowledge, skills, perceived barriers and behaviors. Results Physicians and nurses in the 2009 survey tended to have more knowledge and skill of EBP than their counterparts in the 2007 survey. They were less likely, however, to believe that EBP can improve patient care quality and to support the implementation of EBP. The prevalence of perceived barriers to EBP declined during the 2-year study period. In addition, physicians and nurses were more likely to access the online evidence retrieval databases according to the 2009 survey when compared with responses to the 2007 survey. Conclusions The knowledge of, skill in, and behavior regarding EBP have improved among physicians and nurses of regional hospitals in Taiwan after a promotion period of 2 years and they perceive fewer barriers to EBP. These data suggest that the multifaceted nationwide promotion program of the type conducted by NHRI succeeded in diffusion and implementation of EBP among professionals.

Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance.A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007.Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians.There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians and nurses.

Physicians have to deal with a broad range of medical problems in clinical practice, thus making the timely acquisition of relevant information is a critical skill for physicians to improve care quality. The current national study investigates how physicians search for medical information and analyses how they use online medical databases. A structured questionnaire survey was conducted, with 457 valid returns collected. Internet-based resources (Web portals, online databases, and electronic journals) were more often accessed by physicians to look for medical information than personal or paper ones. Almost universally, physicians have accessed online databases. MEDLINE was the most frequently accessed database. Furthermore, physicians under 50 years old tended to access online databases more often than their elder colleagues (OR = 5.27, 95% CI = 1.96-14.14 for age35; OR = 4.68, 95% CI = 2.07-10.60 for ages 35-50). In addition, physicians with faculty position were more often accessing online databases (OR = 3.32; 95% CI = 1.75-6.30). Other factors - including clinical experience, administrative position, gender, academic degree, and professional specialty - carried no significant differences. These data may assist in determining how to promote the use of online evidence-based medical information for clinical services.

Our purpose was to investigate the gene expression of endothelin-1 (ET-1) and endothelial nitric oxide synthase (eNOS) in human umbilical vein endothelial cells (HUVECs) under various concentrations and time periods of exogenous nitric oxide (NO) gas exposure. Cultured HUVECs were exposed to 0, 20, and 80 ppm NO for 0, 24, and 48 h. With NO exposure for 24 h, ET-1 peptide levels decreased in both the 20 and 80 ppm groups. Thereafter at 48 h, ET-1 peptide levels persistently decreased in the 20 ppm group, but significantly increased in the 80 ppm group. Furthermore, there was a significant decrease in the expression levels of eNOS protein and mRNA in the 80 ppm 48 h group. The data suggest a timeand dose-dependent effect of NO gas exposure on the gene expression of ET-1 and eNOS in HUVECs. A high concentration and long period of NO exposure induces an inhibition of eNOS and enhancement of ET-1, which could lead to vasoconstriction. These findings may have clinical implications in NO therapy regarding the optimal dose and time period.

Background An extensive assessment investigating the association between sex differences and neonatal outcomes is lacking. In the current study, we estimated the correlation of gender with adverse birth outcomes in a large cohort population. Methods National population-based data containing maternal and neonatal information in 2001 to 2010 were derived from the Health Promotion Administration, Taiwan. Singletons without high-risk pregnancy were further analyzed for the sex ratio of live births in relation to neonatal outcomes—including preterm birth, birth weight, neonatal death, delivery mode, and congenital anomaly. A multivariate logistic regression model was used to adjust for possible confounders. Results In total, 2,123,100 births were valid for the analysis. Overall, the sex ratio at birth (male/female) was 1.096. Compared to multiple births, the sex ratio was significantly higher with singleton births (p

Background An increasing number of short-term medical missions (STMMs) are being dispatched to provide humanitarian healthcare; however, extensive investigations on how recipient patients perceive STMMs are lacking. The current study evaluated the perceptions of patients toward medical services provided by a Taiwanese STMM in a resource-poor area of Swaziland. Methods A structured questionnaire survey was completed by patients who had received medical services from the medical mission of Taipei Medical University in Swaziland in July 2014. Results In total, 349 questionnaires were valid for the analysis. More respondents were female than male (69.6 % vs 30.4 %). The most common chief complaint was musculoskeletal problems (45.8 %), followed by respiratory symptoms (35.0 %). Most of the patients stated that their overall experience with the medical services was excellent (91.4 %). Universal patients would like to see the service provided in the future (99.7 %). Nearly 90 % of the patients were aware of how to take care of the medical problem they were diagnosed with. A majority of the patients comprehended what their medical providers said. Only a few patients did not understand what physicians said (5.2 %). Conclusion Medical services provided by the STMM were helpful in resolving patients’ problems. The data have crucial implications for evaluating overseas mobile medical aid from the viewpoint of patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1186-4) contains supplementary material, which is available to authorized users.

Background: Directors of nursing (DONs) have an important influence in the dissemination of evidence-based practice (EBP) in hospital settings. The current study examined how the knowledge, skills, and behaviors of DONs changed when EBP was implemented during a 5-year, nationwide promotional campaign providing EBP-related information resources and promotional activities in regional hospitals in Taiwan. Method: Cross-sectional questionnaire surveys for a nationwide representative sample of DONs were conducted in 2007, 2009, and 2011 to examine views related to EBP, including changes in beliefs, attitudes, knowledge, skills, behaviors, and barriers. Results: This study enrolled 267 DONs in 2007, 257 in 2009, and 287 in 2011. During the study period, DONs' EBP knowledge and skills increased, but their beliefs and attitudes did not significantly change. Furthermore, the use of Internet-based resources, including web portals, electronic textbooks, electronic journals, and evidence-based online databases, increased. Most barriers significantly declined after the intervention. Conclusion: DONs' knowledge, skills, and behaviors regarding EBP increased after the multifaceted intervention. The data suggest this outreach program is useful in disseminating EBP implementation to DONs. J Contin Educ Nurs. 2016;47(4):181–188.

Questionnaire in English and Swazi language. (PDF 107 kb)

Background Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. Methods A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. Results Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. Linking Evidence to Action The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation.

Heme oxygenase (HO), the rate-limiting enzyme in bilirubin production, has been identified from the late 1960s. This enzyme has been shown to have many other roles in recent years. The inducible form is regulated by oxidative stress, inflammation, and heavy metals, among others, and is cytoprotective in many instance. Nonetheless, there are instances when HO-1 can be deleterious due to the release of iron from the reaction. Another important by-product, carbon monoxide, is a vasodilator and a neurotransmitter and has been implicated in signal transduction pathways. More recently, nonenzymatic, signaling roles of HO have been suggested. This may serve to regulate the endogenous activity of this enzyme when cellular heme levels are low.

Somatic cell gene transfer is a potentially useful strategy to alter lung function. However, achieving efficient transfer to the alveolar epithelium, especially in smaller animals, has not been demonstrated. In this study, the rat heme oxygenase-1 (HO-1) gene was delivered to the lungs of neonatal mice via transpulmonary injection. A bidirectional promoter construct coexpressing both HO-1 and a luciferase reporter gene was used so that in vivo gene expression patterns could be monitored in real time. HO-1 expression levels were also modulated with doxycycline and assessed in vivo with bioluminescent light transmitted through the tissues from the coregulated luciferase reporter. As a model of oxidative stress and HO-1-mediated protection, groups of animals were exposed to hyperoxia. After gene transfer, elevated levels of HO-1 were detected predominantly in alveolar type II cells by immunocytochemistry. With overexpression of HO-1, increased oxidative injury was observed. Furthermore, this model demonstrated a cell-specific effect of lung HO-1 overexpression in oxidative stress. Specific control of expression for therapeutic genes is possible in vivo. The transpulmonary approach may prove useful in targeting gene expression to cells of the alveolar epithelium or to circumscribed areas of the lung.

Background Implementation of evidence-based practice (EBP) is regarded as core competence to improve healthcare quality. In the current study, we investigated the EBP of six groups of professionals: physicians, nurses, pharmacists, physical therapists, technicians, and other allied healthcare personnel. Methods A structured questionnaire survey of regional hospitals throughout Taiwan was conducted by post in 2011. Questionnaires were mailed to all healthcare workers of 11 randomly selected hospitals. Linear and logistic regression models were used to examine predictors for implementing EBP. Results In total, 6,160 returned questionnaires, including 645 from physicians, 4,206 from nurses, 430 from pharmacists, 179 from physical therapists, 537 from technicians, and 163 from other allied healthcare professionals, were valid for the analysis. Physicians and pharmacists were more aware of EBP than were the other professional groups (p Conclusions This study depicts various levels of EBP implementation among medical, nursing, pharmacological, and allied healthcare personnel. There were significant differences in their implementation of EBP. We observed that certain factors were associated with EBP implementation, including personal backgrounds and perceptions toward EBP. The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals.

Background Competition and education are intimately related and can be combined in many ways. The role of competition in medical education of evidence-based medicine (EBM) has not been investigated. In order to enhance the dissemination and implementation of EBM in Taiwan, EBM competitions have been established among healthcare professionals. This study was to evaluate the impact of competition in EBM learning. Methods The EBM competition used PICO (patient, intervention, comparison, and outcome) queries to examine participants’ skills in framing an answerable question, literature search, critical appraisal and clinical application among interdisciplinary teams. A structured questionnaire survey was conducted to investigate EBM among participants in the years of 2009 and 2011. Participants completed a baseline questionnaire survey at three months prior to the competition and finished the same questionnaire right after the competition. Results Valid questionnaires were collected from 358 participants, included 162 physicians, 71 nurses, 101 pharmacists, and 24 other allied healthcare professionals. There were significant increases in participants’ knowledge of and skills in EBM (p p p p p p = 0.001), CINAHL (p = 0.001), and MicroMedex (p = 0.024). Conclusions The current study demonstrates a method that successfully enhanced the knowledge of, skills in, and behavior of EBM. The data suggest competition using PICO queries may serve as an effective way to facilitate the learning of EBM.

Dietitians can obtain nutrition-related information from a variety of sources. The current study was to investigate how registered dietitians look for nutritional information and perceive evidence-based nutrition (EBN). A postal questionnaire survey was conducted, with 67 valid returns collected. The most common informational sources were Web portals, followed by continuing education, colleague consultation, textbooks, online databases, electronic journals, printed journals, and electronic textbooks. Among the 11 commonly used online databases, dietitians preferred to access MEDLINE and three databases in Chinese. Sixty-two dietitians (92.5%) were aware of EBN. Although they had a favorable impression of EBN, their knowledge of and skills in EBN were relatively lacking. The most common barrier to the implementation of EBN was a lack of library resources in Chinese (58.1%), followed by deficient skill in critical appraisal (54.8%), insufficient convenient kits (53.2%), and time constraints (50.0%). In conclusion, most registered dietitians search for information through non-EBN resources. Language is an important element relevant to the implementation of EBN. These findings may help the refining of strategies to promote the accessing of evidence-based information.

Background Since the beginning of 2007, the National Health Research Institutes has been promoting the dissemination of evidence-based medicine (EBM). The current study examined longitudinal trends of behaviors in how hospital-based physicians and nurses have searched for medical information during the spread of EBM. Methods Cross-sectional postal questionnaire surveys were conducted in nationally representative regional hospitals of Taiwan thrice in 2007, 2009, and 2011. Demographic data were gathered concerning gender, age, working experience, teaching appointment, academic degree, and administrative position. Linear and logistic regression models were used to examine predictors and changes over time. Results Data from physicians and nurses were collected in 2007 (n = 1156), 2009 (n = 2975), and 2011 (n = 3999). There were significant increases in the use of four Internet-based resources – Web portals, online databases, electronic journals, and electronic books – across the three survey years among physicians and nurses (p Conclusions Physicians and nurses used a variety of sources to look for medical information. There was a steady increase in use of Internet-based resources during the diffusion period of EBM. The findings highlight the importance of the Internet as a prominent source of medical information for main healthcare professionals.