The Development of a Comprehensive Dimensions Scale for Assessing Clinical Teachers' Occupational Well-Being.

Objective: In Taiwanese clinical and healthcare environments, there is a dearth of appropriate and effective tools to evaluate clinical teachers' occupational well-being. Therefore, this study aimed to develop a culturally adapted scale, a Taiwanese version of the Clinical Teachers' Occupational Well-Being Dimensions Scale (CTOWDS), to accurately measure the occupational well-being of clinical teachers in Taiwan. Methods: Following a comprehensive literature review and expert panel discussions, the study developed the CTOWDS and conducted exploratory factor analysis (EFA) with 346 participants using SPSS to identify its underlying dimensional structure and psychometric properties. Confirmatory factor analysis (CFA) was then performed with 255 participants using AMOS to validate the EFA results. The study also assessed internal consistency, convergent and discriminant validities, and goodness-of-fit indexes to ensure that the scale was valid and reliable in the Taiwanese cultural setting. Results: The EFA refined the scale from 51 to 29 items across five dimensions: personal qualities (11 items), academic research and career development pressure (6 items), teaching experience (4 items), learning experience (4 items), and teaching and communication pressure (4 items). These five dimensions explained 65.279% of the total variance. The CFA confirmed the five dimensions and 29 items, with good convergent and discriminant validities, goodness-of-fit indexes, and Cronbach's alpha values exceeding 0.70. Conclusion: The findings affirm the utility of the developed CTOWDS as a reliable and culturally relevant instrument for assessing the occupational well-being of clinical teachers.

A Scale Development for Visual Literacy on Health Students and Professionals.

Objective: Viewing that there is a lack of valid and reliable measures to assess visual literacy in clinical and healthcare settings, this study aimed to develop a visual literacy scale to assess health students' and professionals' visual literacy, by which teachers can further help them sharpen their visual literacy skills and sensitivity to let them reach effective communication in clinical and healthcare settings. Methods: The scale was constructed according to Slavec and Drnovsek's three-phase scale development process: theoretical significance and existence of the scale construct, representative data collection and appropriate data collection methods, and statistical analysis of data collection and statistical evidence of the scale construct. To investigate the psychometrical properties, the researchers first performed a pilot study on randomly selected 464 health students and professionals, using exploratory factor analysis (EFA) with SPSS to derive the hidden factor structure, and then on randomly selected 303 participants, using confirmatory factor analysis (CFA) with AMOS to validate the derived factor structure. Internal consistency, convergent validities, discriminant validities, and goodness-of-fit indices were also examined in the study. Results: After going through the EFA, 30 items in three factors were identified: "allegorical meaning" (12 items), "explicit meaning" (10 items), and "symbolic meaning" (8 items). The three factors explained 73.191 of the total variance. The CFA generated the same three factors and 22 items: "allegorical meaning" (12 items), "explicit meaning" (4 items), and "symbolic meaning" (6 items). The three factors accounted for 75.022% of variance. Both the EFA and CFA models demonstrated satisfactory goodness-of-fit and good convergent and discriminant validities. Regarding the reliabilities, the Cronbach's alpha values in the EFA and CFA models were all above 0.90. Conclusion: The findings have demonstrated that the VLS-HSP can be a formal instrument to measure visual literacy on health students and professionals.

Narrative medicine and humanities for health professions education: an experimental study.

BACKGROUND: Narrative medicine can serve as a tool to empathize with human beings' predicament and suffering. The research intended to examine whether the use of narrative medicine to form an empathetic connection could bring any positive impacts on health professions students. METHODS: A two-group quasi-experimental design was adopted to examine whether the intervention of narrative medicine to form an empathetic connection could demonstrate differences between the experimental group (35 students) and the control group (32 students) with regard to professional identity, self-reflection, emotional catharsis, and reflective writing competency. These 67 participants were health professions students in a medical university (mean age = 20.02; SD = 0.23), with varied majors in health disciplines. The 16-week intervention was the use of narrative medicine to form an empathetic connection with those suffering, via the three stages of narrative medicine: attention → representation → affiliation. The quantitative instruments included a professional identity scale (PIS-HSP), a reflective thinking scale (RTS-HSP), and an emotional catharsis scale (ECS-IN), as well as an analytic reflective writing scoring rubric (ARWSR-HSP). To triangulate the quantitative results, the study also used the student interviews. The SPSS software was used to analyze the data. RESULTS: The quantitative results demonstrated that the narrative medicine-based intervention could bring positive effects on the health professions students. After going through the intervention, the students in the experimental group had stronger professional identity, a higher reflective thinking level, more emotional catharsis, and greater improvement in reflective writing competency than those not receiving the intervention, though some subscales not reaching statistical significance. CONCLUSION: This research results proved that the use of narrative medicine to form an empathetic connection could bring positive impacts on health professions students regarding professional identity, self-reflection, emotional catharsis, and self-reflective writing competency.

The use of social cognitive learning for humanistic professional role modelling: impacts on awareness of humanistic professionalism, caring behaviour, and transitional anxiety.

BACKGROUND: Although medical literature has highlighted the importance of role modelling, hardly any reveals how humanistic qualities and role modelling should be taught. This study aimed to determine whether the use of Bandura's social cognitive learning for humanistic professional role modelling could elicit any positive effect on medical university students' awareness of humanistic professionalism, caring behaviours, and school-to-work transitional anxiety. METHODS: We conducted a 16-week quasi-experimental study to examine whether the intervention could elicit any differences between the experimental group (BanduraSCLT - HPRM - Literature-and-Film Study; N = 34) and the control group (non-BanduraSCLT - HPRM - Literature-and-Film Study; N = 33), comprising of medical university students from the central part of Taiwan. The quantitative instruments included the Humanistic Professional Awareness Scale (HPAS-HSP), Caring Behaviour Scale (CBS-HSP) and School-to-Work Transitional Anxiety Scale (StWTA-HS). One-way MANOVA (multivariate analysis of variance) and one-way MANCOVA (multivariate analysis of covariance) were used for statistical analysis. RESULTS: The results revealed that students who received Bandura's social cognitive learning for humanistic professional role modelling had significantly stronger humanistic professional awareness in terms of 'personal integrity and accountability', 'sensitivity to others' and 'professional competence'. They also had more effective caring behaviour in terms of 'support and attentiveness', 'professional knowledge and skills', 'gratifying needs and responsiveness' and 'confidentiality and trust'. In addition, they had less school-to-work transitional anxiety in terms of 'inexperience in professional knowledge and skills', 'fear of death', 'fear of being infected' and 'interpersonal interactions.' CONCLUSION: The findings suggest that using Bandura's social cognitive learning for humanistic professional role modelling can have a positive impact on awareness of humanistic professionalism, caring behaviour and school-to-work transitional anxiety. Hence, it can be an effective teaching tool for medical education.

Social cognitive learning for humanistic professional role modelling is an effective teaching tool for increasing medical and health sciences students' awareness of humanistic professionalism.Social cognitive learning for humanistic professional role modelling is associated with more effective caring behaviours.Social cognitive learning for humanistic professional role modelling can decrease the students' school-to-work transitional anxiety.

The Study of Learning Computer Programming for Students with Medical Fields of Specification-An Analysis via Structural Equation Modeling.

In this study, the authors constructed structural equation models in order to determine the relationship between students' learning attitudes and their computational thinking perspectives and programming empowerment. The purpose is to understand students' perceived competence to use computational thinking effectively, along with their computer programming learning attitude regarding the C++ programming language for one semester (2 hours per week, 36 total learning hours). A total of 495 students specializing in the medical field participated in the study. Structural equation models were constructed according to three adapted scales: the computer programming learning attitude scale, the computational thinking perspectives scale, and the programming empowerment scale. The computer programming learning attitude scale is based on three factors: willingness, negativity, and necessity. The computational thinking perspectives scale also considers three factors: the ability to express, the ability to connect, and the ability to question. The programming empowerment scale is composed of four factors: meaningfulness, impact, creative self-efficacy, and programming self-efficacy. The results showed that a positive learning attitude will positively affect computational thinking perspectives and programming empowerment. However, when students have a negativity attitude, feeling that they are being forced to learn the C++ programming language, their computational thinking perspectives and programming empowerment will be negatively affected. In order to promote students' learning attitude, various teaching strategies, teaching curriculum design, and pedagogy design could be further explored.

Development and psychometric testing of a scale measuring caring behaviors for healthcare students and providers.

This study intended to develop and assess the psychometric properties of a caring behavior scale on healthcare students and providers (CBS-HSP) in a Taiwanese population. After a literature review was conducted and an expert panel was consulted for item generation, 104 items for the CBS-HSP scale were derived on a nine-point Likert scale, with 9 indicating 'extremely important' and 1 indicating 'extremely unimportant.' A pilot study was then conducted with seven hundred forty-eight healthcare students and providers in Taiwan for further data analysis. The statistic software used in the study was SPSS for the exploratory factor analysis (EFA) and AMOS for the confirmatory factor analysis (CFA). Also, to examine the psychometric properties of the scale, internal consistency, convergent validities, discriminant validities, and model fit indices were calculated in the study. The EFA results derived 31 items in four factors, with 65.742% of the total variance explained: 'support and attentiveness' (11 items; 48.714% of the variance explained), 'professional knowledge and skills' (8 items; 8.226% of the variance explained), 'gratifying needs and responsiveness' (7 items; 5.236% of the variance explained), and 'confidentiality and trust' (5 items; 3.566% of the variance explained). The Cronbach's alphas for the four subscales and the overall scale ranged from 0.894 to 0.964. The CFA results yielded the same 31 items, with the same four factors. The CFA results demonstrated good to excellent model fit in the χ2/df ratio (1.242), GFI (0.988), CFI (0.988), TFI (0.985), and RMSEA (0.031). The Cronbach's alphas ranged between 0.866 and 0.971; the composite alphas ranged between 0.854 and 0.964. The convergent and discriminant validities also proved the stability of the CBS-HSP scale. The research results indicated that the developed CBS-HSP appeared to be a reliable instrument to measure healthcare students' and providers' caring behaviors.

Reducing Waste in Healthcare through Occupational Safety and Health Measures: A Study of Manufacturing Industries in Taiwan.

Occupational accidents and diseases cause the loss of valuable workers and lead to high healthcare expenses. Because occupational accidents and diseases are ascribed to inadequate working conditions and work environments, they can be prevented through a well-established occupational safety and health management system, which can ensure workers' health and reduce the expense of healthcare. The study investigated the shortage of work-related occupational safety and health (OSH) measures in medium-sized manufacturing industries. This study mainly focused on qualitative interviews with 15 labor inspectors and 25 business executives from OSH participating to investigate the problems of occupational safety and health in the manufacturing industries in Taiwan. The results of a qualitative study show that the most important problems with OSH management are employers' negligence and workers' insufficient knowledge about OSH management. The research results revealed the following eighteen significant shortcomings of OSH management: employers care mostly about production profit and do not care much for OSH; OSH data collection and OSH planning are not suitable for the workplace; many managers of OSH affairs are not qualified, in terms of their professional or academic backgrounds; and the repair of workplaces' roofs often results in falling accidents, especially before or after a typhoon, because of workers' failure to use safety belts and/or to follow OSH guidelines. In order to address the shortcomings and bottlenecks, the study also presented recommendations for how to implement and revise the OSH Act and how to research and enhance OSH management. The results of this study will not only supply the Ministry of Labor (Taiwan) with data to plan the strategy of OSH management but also will allow employers and workers to improve OSH management in the workplace in order to prevent the occurrence of occupational accidents.

Development and Validation of a Scale Measuring Humanistic Professional Awareness for Healthcare Students and Providers.

OBJECTIVE: This study aimed to develop an appropriate scale accessing healthcare students' and providers' humanistic professional awareness (HPAS-HSP). METHODS: Following a literature review, stakeholder interviews, and panel discussions for item generation, 65 items for the HPAS-HSP scale were created based on a nine-point Likert scale, with 9 indicating "strongly agree" and 1 indicating "strongly disagree." A pilot study using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), with seven hundred twenty-five medical care students and providers in Taiwan as the total sample number of the study, was administered to examine the practicability of the HPAS-HSP scale. The statistics software SPSS and AMOS 24.0 were used to examine the psychometric properties of the scale, including internal consistency, convergent validities, discriminant validities, and exploratory and confirmatory factor analysis. RESULTS: The EFA resulted in 21 items in three factors, with 66.221% of the total variance explained: "personal integrity and accountability" (9 items; 51.763% of the variance explained), "sensitivity to others" (6 items; 8.667% of the variance explained), and "medical professional competence" (6 items; 5.791% of the variance explained). The Cronbach's alphas for the three subscales and the entire questionnaire ranged from 0.892 to 0.949. The CFA results yielded 20 items, with the same three factors, and demonstrated good model fit in the χ 2/df ratio (1.130; p = 0.140), CFI (0.998), TFI (0.998), and RMSEA (0.013). The composite alphas ranged between 0.900 and 0.969. Convergent and discriminant validity also confirmed the stability and consistency of the scale. CONCLUSION: The statistical results demonstrated that the HPAS-HSP scale can be a measure to assess healthcare students' and providers' humanistic professional awareness.

Development of a Scale Measuring Emotional Catharsis through Illness Narratives.

OBJECTIVE: This study intended to construct a scale measuring the catharsis effect on medical professionals or students through illness narratives (ECS-IN). METHODS: After a systematic literature review and panel discussion, the researchers conducted a pilot study with a sample of seven hundred and eighty-two randomly selected healthcare students and providers in Taiwan to examine psychometric properties using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for item derivation and factor extraction. The researchers also tested the validities and reliabilities of the ECS-IN scale to confirm its feasibility. RESULTS: the EFA yielded 29 items and three factors: "emotional identification as self-healing" (12 items; 55.500% of variance explained), "emotional release for compensation" (10 items; 7.465% of variance explained), and "emotional adjustment for intellectual growth" (7 items; 4.839% of variance explained). The CFA yielded an 18-item, three-factor model with satisfactory fit to the data, where the χ2/df ratio = 1.090, Tucker-Lewis index (TLI) = 0.996, comparative fit index (CFI) = 0.997, and root mean square of approximation (RMSEA) = 0.020. The convergent validity and discriminant validities also demonstrated the feasibility of the ECS-IN scale. For the first version of the ECS-IN scale (29 items), the Cronbach's alphas for the three factors and the overall scale were in the range between 0.912 and 0.971; for the reduced version of the scale (18 items), the Cronbach's alphas and composite reliabilities were in the range of 0.888-0.946 and 0.890-0.968. CONCLUSION: The findings proved that the ECS-IN could be a reliable and valid instrument to assess participants' emotional catharsis through illness narratives.

Deontological or Utilitarian? An Eternal Ethical Dilemma in Outbreak.

Both deontological ethics and utilitarian ethics are important theories that affect decision making in medical and health care. However, it has been challenging to reach a balance between these two ethical theories. When there is a conflict between these two ethical principles in the medical context, the conflict must be addressed in order to reach an appropriate solution for patients and others involved. To demonstrate decisions made in terms of deontological ethics and utilitarian ethics, the study will use the film Outbreak as example to further understand these two ethics in relation to epidemiology and public health. The paper will also analyze film scenarios to examine how deontological ethics and utilitarian ethics are involved and strike a balance with different pearspectives to reach an appropriate public health solution. To reach more just solutions, it is essential to determine how to make wise decisions by balancing deontological ethics and utilitarian ethics. However, the decision-making process is complicated because any solution must consider not only medical ethics but also political, environmental, and military issues. In order to reach an appropriate public health decision, those involved should be inclined toward empathy and contemplate things from different ethical perspectives to deal with ethical/moral dilemmas and create greater beneficence and justice for patients and humanity at large.

Development and Validation of a Chinese Version of a School-to-Work Transition Anxiety Scale for Healthcare Students.

OBJECTIVE: The aim of this paper was to develop an appropriate scale measuring healthcare students' anxiety during the transition from school to work. METHODS: After an extensive literature review and panel discussion to prove the face validity and content validity, the initial item pool was reduced to 52 items. In a pilot study, a sample of four hundred and twenty-four healthcare students participated, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. Psychometric properties-construct validity, convergent validity, discriminant validity, goodness of fit, and reliabilities-were also analyzed. RESULTS: After the use of EFA, the 52 items were reduced to 31 items in four factors, with 66.70% of the total variance explained. The Cronbach's alpha values ranged between 0.91 and 0.93. The study also used CFA to validate the EFA model, and the results demonstrated that with the same thirty-one items in a 7-point Likert scale, the model was a better fit in four factors: "inexperience in professional knowledge and skills" (nine items; factor loadings: 0.642-0.867; 43.72% of the variance explained), "fear of death" (eight items; factor loadings: 0.745-0.831; 9.94% of the variance explained), "fear of being infected" (eight items; factor loadings: 0.678-0.866; 7.86% of the variance explained), and "interpersonal interactions" (six items; factor loadings: 0.704-0.913; 5.18% of the variance explained). The CFA model demonstrated a good model fit in the χ2/df ratio (1.17; p = 0.016), CFI (0.99), TFI (0.99), and RMSEA (0.02). The composite reliabilities ranged from 0.89 to 0.92, confirming the StWTA-HS scale's stability and internal consistency. The convergent validity and discriminant validity were also confirmed. The StWTA-HS scale has been proven to be a stable scale to measure healthcare students' school-to-work transition anxiety.

Integrating the Gender Perspective into Literature Studies to Enhance Medical University Students' Gender Awareness and Critical Thinking.

OBJECTIVE: This study attempted to integrate the gender perspective into literature studies to allow medical university students to examine internalized gender prescriptions and investigate whether the integration of the gender perspective into literature studies would create any difference among students in gender awareness and critical thinking. METHODS: This study used fifteen-week quasi-experimental research to verify the feasibility of using the gender perspective in literature studies to arouse medical university students' gender awareness and critical thinking. Before and after the intervention, a gender awareness test and a critical thinking disposition test were carried out by both the experimental group (41 students) and control group (41 students). RESULTS: The findings show that regarding gender awareness, with the integration of the gender perspective into literature studies, medical university students had significantly higher post-test scores for "public gender consciousness" and "private gender consciousness." In regard to critical thinking, they also had significantly better post-test scores in "systematicity and analyticity," "maturity and skepticism," and "inquisitiveness and conversance." CONCLUSION: This study demonstrated that the integration of the gender perspective into literature studies could result in positive learning outcomes among medical university students in terms of gender awareness and critical thinking.

Development and Validation of a Chinese Version of a Professional Identity Scale for Healthcare Students and Professionals.

This study was intended to develop a comprehensive and psychometrically adequate professional identity scale for healthcare students and professionals based on Taiwanese cultural contexts. In order to elicit a more consistent result of the psychometric indices of the newly developed scale, the study adopted a combination of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the consistency of the scale factors. In a pilot study of 562 randomly selected healthcare students and professionals, the EFA yielded a 33-item four-factor model with the terms "professional commitment & devotion" (16 items; 47.33% of variance), "emotional identification & belongingness" (7 items; 9.72% of variance), "professional goals & values" (5 items; 8.17% of variance), and "self-fulfillment & retention tendency" (5 items; 3.38% of variance). The CFA yielded an 18-item four-factor model with good or even excellent fit to the data, where the χ2/df ratio = 1.138, Tucker Lewis index (TLI) = 0.997, comparative fit index (CFI) = 0.997, and root mean square of approximation (RMSEA) = 0.016. The convergent validity and discriminant validities were also conducted to test the feasibility of the Professional Identity Scale for Healthcare Students and Professionals (PIS-HSP) scale. For the EFA model, the Cronbach's alphas for the four factors and the overall scale ranged from 0.84 to 0.96; for the CFA model, the Cronbach's alphas and composite reliabilities were, respectively, in the ranges of 0.78-0.93 and 0.78-0.97, demonstrating satisfactory reliabilities. The results proved that the developed PIS-HSP can be a reliable measurement tool to assess professional identity for healthcare students and professionals.

Toward an Integrative Nursing Curriculum: Combining Team-Based and Problem-Based Learning with Emergency-Care Scenario Simulation.

OBJECTIVE: The study intended to combine team-oriented, problem-based learning (PBL) with emergency-care simulation to investigate whether an integrative intervention could positively impact the core nursing competencies and teacher performance of nursing students. METHODS: The study belonged to the domain of action research, which aimed to address the weaknesses of traditional teacher-led, lecture-based learning. An 18-week, single-case experimental design, in which 58 senior nursing students at a medical university in central Taiwan participated, was conducted to test the possible benefits of the intervention. The measures included the Scale of Core Nursing Competencies and the Teacher Performance Evaluation Scale. RESULTS: The research results showed that nursing students who received integrative training that combined team-based PBL with emergency-care scenario simulation had stronger mastery over core nursing competencies. At the same time, they also evaluated both the "Emergency Care" course for which the curriculum was used and the teachers' performance in that course more highly. CONCLUSIONS: The findings suggest that an integrative curriculum combining team-based PBL with scenario simulation is worth pursuing. Compared with traditional teacher-led, lecture-based teaching, this curriculum may be more effective in helping nursing students develop core competencies in their field.

Storytelling in Medical Education: Narrative Medicine as a Resource for Interdisciplinary Collaboration.

Objective: The study intended to use narrative medicine study for interdisciplinary collaboration to let medical and healthcare students have a chance to interact with one another and listen to patients' stories to enhance students' reflective thinking, communication, empathy, and narrative medicine writing skills. Methods: A fifteen-week quasi-experimental design was used to examine the learning outcomes of the intervention. Two groups of students were randomly assigned as the experimental group (33 students) and the control group (32 students). Before and after the intervention, both groups had to fill in a Reflective Thinking Scale for Healthcare Students and Providers (RTS-HSP), Patient-Healthcare Provider Communication Scale (P-HCS), Empathy Scale in Patient Care (ES-PC), and Analytic Narrative Medicine Writing Scoring Rubric (ANMWSR). Results: The findings showed that on the reflective thinking scale, experimental group students had significantly higher reflective thinking posttest scores in "reflective skepticism," "empathetic reflection," and "critical open-mindedness," but not in "self-examination." As for patient-healthcare provider communication, they had significantly higher posttest scores in all "perception of trust and receptivity," "patient-centered information giving," "rapport building," and "facilitation of patient involvement" factors. As for empathy, they had significant higher posttest scores in "behavioral empathy" and "affective empathy," but not in "intelligent empathy." In narrative medical writing skills, they had significant higher posttest scores in the "attention → representation → affiliation," "depth of reflection," "focus and context structure," and "ideas and elaboration" sections, but not in the "language and conventions" section. Conclusion: The findings suggest that narrative medicine is worth recommending for interdisciplinary collaboration for healthcare education.

The Application of GSCM in Eliminating Healthcare Waste: Hospital EDC as an Example.

Eliminating unnecessary healthcare waste in hospitals and providing better healthcare quality are the core issues of green supply chain management (GSCM). Hence, this study used a hospital's emergency department crowding (EDC) problem to illustrate how to establish an emergency medicine service (EMS) simulation system to obtain a robust parameters setting for solving hospitals' EDC and waste problems, thereby increasing healthcare quality. Inappropriate resource allocation results in more serious EDC; more serious EDC results in increasing operating costs. Therefore, in the healthcare system, waste includes inappropriate costs and inappropriate resource allocation. The EMS of a medical center in central Taiwan was the object of the study. In this study, the dynamic Taguchi method was used to set the signal factor, noise factor, and control factors to simulate the EMS system to obtain the optimal parameters setting. The performance was set to Emergency Department Work Index (EDWINC) and system time (waiting time and service time) per patient. The signal factor was set to the number of physicians; the noise factor was set to patient arrival rate; the control factors included persuading Triage 4 and Triage 5 outpatients, checkup process, bed occupation rate in the emergency department (ED), and medical checkup sequence for Triage 4 and Triage 5 patients. This study makes two significant contributions. First, the study introduces the GSCM concept to the healthcare setting to bring green innovation to hospitals. Hospital administrators may hence design better GSCM activities to facilitate healthcare processes to provide better healthcare outcomes. Second, the study applied the dynamic Taguchi method to the EMS and neural network (NN) to construct a computational model revealing the cause (factors) and effect (performances) relationship. In addition, the genetic algorithm (GA), a solution method, was used to obtain the optimal parameters setting of the EDC in Taiwan. Hence, after obtaining the solutions, the unnecessary waste in EDC-inappropriate costs and inappropriate resource allocation-is reduced.

The Impact of the Hazard Correlation between Risk Factors and Diabetes.

This study examined the occurrence of diabetes and sustainable risk factors in residents aged 30 and above of a community in Taoyuan County, Taiwan. The main purpose of this research was to explore the correlations between related variables and the occurrence of diabetes. The demographic variables, health exam variables, healthy behavior variables, and environmental variables had obvious impacts on the risk of diabetes. As age increased, the risk of developing the disease also increased; higher educational levels lowered risk, while unemployment raised it. Also, analysis of the health exam variables showed that abnormal BMIs, waist-hip ratios, and body fat percentages had significant impacts on individuals' risk of diabetes. Moreover, it was found that smoking affected the risk of having diabetes: smokers, particularly male smokers, had a relatively higher risk of developing the disease. Lastly, the results showed that exposure to second-hand smoke did not have a significant effect on the diabetes proportion in the male population. However, a significantly higher proportion of females who had been exposed to second-hand smoke had diabetes.

The application of heterogeneous cluster grouping to reflective writing for medical humanities literature study to enhance students' empathy, critical thinking, and reflective writing.

BACKGROUND: To facilitate interdisciplinary collaboration and to make connections between patients' diseases and their social/cultural contexts, the study examined whether the use of heterogeneous cluster grouping in reflective writing for medical humanities literature acquisition could have positive effects on medical university students in terms of empathy, critical thinking, and reflective writing. METHODS: A 15-week quasi-experimental design was conducted to investigate the learning outcomes. After conducting cluster algorithms, heterogeneous learning clusters (experimental group; n = 43) and non-heterogeneous learning clusters (control group; n = 43) were derived for a medical humanities literature study. Before and after the intervention, an Empathy Scale in Patient Care (ES-PC), a critical thinking disposition assessment (CTDA-R), and a reflective writing test were administered to both groups. RESULTS: The findings showed that on the empathy scale, significant differences in the "behavioral empathy," "affective empathy," and overall sections existed between the post-test mean scores of the experimental group and those of the control group, but such differences did not exist in "intelligent empathy." Regarding critical thinking, there were significant differences in "systematicity and analyticity," "skepticism and well-informed," "maturity and skepticism," and overall sections. As for reflective writing, significant differences existed in "ideas," "voice and point of view," "critical thinking and representation," "depth of reflection on personal growth," and overall sections, but not in "focus and context structure" and "language and conventions." CONCLUSION: This study outlined an alternative for using heterogeneous cluster grouping in reflective writing about medical humanities literature to facilitate interdisciplinary cooperation to provide more humanizing medical care.

Hazard Prevention Regarding Occupational Accidents Involving Blue-Collar Foreign Workers: A Perspective of Taiwanese Manpower Agencies.

Since 1989, blue-collar foreign workers have been permitted to work in Taiwanese industries. Most blue-collar foreign workers apply for jobs in Taiwan through blue-collar foreign workers' agencies. Because blue-collar foreign workers are not familiar with the language and culture in Taiwan, in occupational accident education and hazard prevention, the agencies play an important role in the coordination and translation between employees and blue-collar foreign workers. The purpose of this study is to establish the agencies' role in the occupational accidents education and hazard prevention for blue-collar foreign workers in Taiwan. This study uses a qualitative method-grounded theory-to collect, code, and analyze the data in order to understand the agencies' role in occupational accident education and hazard prevention for blue-collar foreign workers in Taiwan. The results show that the duty of agencies in occupational accident education and hazard prevention includes selecting appropriate blue-collar foreign workers, communicating between employees and blue-collar foreign workers, collecting occupational safety and health information, assisting in the training of occupational safety and health, and helping blue-collar foreign workers adapt to their lives in Taiwan. Finally, this study suggests seven important points and discusses the implementation process necessary to improve governmental policies. The government and employees should pay attention to the education/training of occupational safety and health for blue-collar foreign workers to eliminate unsafe behavior in order to protect the lives of blue-collar foreign workers.

The Relationship of Vocabulary Learning Strategies and Self-Efficacy with Medical English and Terminology.

This study examined the relationship between the use of vocabulary learning strategies and self-efficacy in medical English learning, and whether after an initial six-week course to master the basics of medical terminology, those with higher use of vocabulary learning strategies and those with a higher degree of self-efficacy would have significant score improvements in the medical English proficiency. Second-year medical students (N = 115; M age = 19.6, SD = 0.5; 82 men, 33 women) participated in the study. A one-group pretest-posttest design was used. Measures included medical English tests, the English Vocabulary Learning Strategies Survey (EVLSS), and the English Learning Self-Efficacy Scale (ELSES). Results showed that there was no significant correlation between vocabulary learning strategies and English learning self-efficacy. In addition, as a whole, vocabulary learning strategies and self-efficacy significantly predicted students' score improvements in medical English proficiency.