Gender Self-Identification: Opinions About Transgender Women from a National Online Survey in Taiwan.

Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population's attitudes toward gender self-identification. A self-report survey, entitled "Opinions of Gender Self-Identification," collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women's safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p < .01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents.

Impact of class cancellations on parents' and children' adaptation following an outbreak of the Omicron variant during the COVID-19 pandemic in Taiwan in April 2022.

OBJECTIVE: To explore the impact on Taiwanese parents and children following an outbreak of the Omicron variant during the COVID-19 pandemic. METHODS: Data were collected following class cancellations mandated by the Ministry of Education due to an outbreak of the Omicron variant of COVID-19 in April 2022. A national parent organization developed self-report survey questionnaire, "Impact of the Pandemic-related School Closures/Class Cancellations" (IPRSCCC), assessed parents' perceived impact of school cancellations on their child/children' and on their adaptation. The online survey was available between May 4 and May 9, 2022, in 20 districts throughout Taiwan. RESULTS: A total of 2126 parents representing 2592 children responded. Total scores on the IPRSCCC were significantly higher for parents of children whose classes were cancelled (n = 891) compared with parents whose children continued in-person classes (n = 1053). Parents perceived the class cancellations of the child/children disrupted daily routine, learning loss and impacted academic motivation. They also reported emotional stress and no time for rest, which were associated with parental burnout. However for these parents, there were no significant differences in scores between parents living in low and high socioeconomic areas. Only the subscale score for disrupted daily routine was significantly higher for fathers, and emotional stress was significantly higher for parents with two, or ≥ 3 children. When academic impacts were examined using national examination scores for 12th grade students, the percent of students with scores of ≤ 6 in English, Chinese, and mathematics was higher in 2022 than in 2020. CONCLUSIONS: Higher IPRSCCC scores for parents of children whose classes were cancelled provides additional evidence of the impact of disruptions of in-person classes due to the COVID-19 pandemic. Examination scores confirmed class cancellations impacted academic performance.

Prevalence and Comorbidity of Gender Dysphoria in Taiwan, 2010-2019.

Gender dysphoria (GD) is a condition in which a person exhibits marked incongruence between their expressed or experienced gender and their sex assigned at birth. The last survey of individuals with GD in Taiwan was conducted approximately 10 years ago. In this study, we investigated the prevalence of GD in Taiwan within the last 10 years as well as comorbidities. A retrospective medical record review was performed for all patients in the database of the Health and Welfare Data Science Center covered by National Health Insurance in Taiwan from January 2010 until December 2019. The study population of persons with GD was defined as individuals who had been diagnosed with transsexualism (transgender or transsexual) or gender identity disorders. Our review found case numbers and prevalence of GD in 2019 were about twice that of patients in 2010 for both assigned males and assigned females at birth. Case numbers for 2010 versus 2019 were 440 versus 867 for assigned males at birth, and 189 versus 386 for assigned females at birth. The 1-year prevalence for 2010 versus 2019 was 3.8/100,000 versus 7.4/100,000 for assigned males at birth, and 1.6/100,000 versus 3.2/100,000 for assigned females at birth. Comorbidities of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and psychosis were more likely in children with GD younger than 12 years of age; comorbid depression was more likely in adolescents and adults with GD. Improvements in social and mental health support should be provided to help address these comorbidities of ADHD, ASD, and depression among individuals with GD.

Legalization of marijuana or not? Opinions from over 38,000 residents in Taiwan.

BACKGROUND: Marijuana is legal in many Western countries and Thailand. In Taiwan, Marijuana remains a category-2 narcotic; however, some legislative candidates recently advocated legalization of medical marijuana. This study surveyed a large sample of Taiwanese to gain a better understanding of the public's knowledge and attitudes towards legalizing marijuana. METHODS: This cross-sectional mixed-methods study included demographic data and responses to a survey questionnaire, "Knowledge and Attitudes of Legalizing Marijuana" (KALM). The survey included 15 statements about four categories: public health, social impact, medical applications of THC (Δ9-tetrahydrocannabinol), and legal and tax consequences; and two yes/no questions about medical use and legalization of marijuana. Knowledge was scored as disagree = 0, no knowledge = 2, or agree = 4; attitude was scored from 0 = very unimportant to 4 = very important. Responses to an open-ended question asking for additional comments/concerns were analysed with content analysis. The survey was conducted from February 15 to March 1, 2023. RESULTS: Data were analysed from 38,502 respondents, aged 15 to > 56 years. Most were female (67.1%) and parents (76.4%). Scores were higher for respondents who were parents, religious, ≥ 36 years of age, had a high-income status, no history of substance abuse, knowledge of medical marijuana, and did not support legalization of marijuana. Medical personnel had greater knowledge of marijuana, but their attitude indicated they viewed legalization as less important. In the open-ended question, many respondents requested more information about marijuana be provided to the public before considering legalization. CONCLUSIONS: Taiwanese respondents considered legalization of marijuana a significant concern, especially as it relates to impacts on public health.

Stressors experienced by children with autism spectrum disorder in Taiwan: Perspectives of children and their parents.

Autism spectrum disorder has only recently been recognized as a developmental disability in Taiwan. We conducted an exploratory qualitative descriptive study with children (n = 14, mean age = 13.57 years) and their parents to understand stressors experienced by children with autism spectrum disorder in Taiwan. An analysis of face-to-face interviews revealed that children with autism spectrum disorder experienced stressors of daily living, which included environmental stimuli, academic and behavioral expectations, deviations in routine, behavioral expectations, and emotional control, and stressors of socializing, which included bullying, communication, personal interactions, conflict resolution, and difficulty understanding others' emotions. Stressors resulted from the core symptoms and characteristic behaviors of autism spectrum disorders, and also Taiwanese cultural expectations. Our findings could help develop individualized educational plans and culturally-sensitive behavioral interventions. Facilitation of these interventions could be used by nurses and health-care professionals to help facilitate problem solving and communication skills, which could reduce the stress for children with autism spectrum disorder in Taiwan.

Coping strategies of Taiwanese children with autism spectrum disorders.

AIMS AND OBJECTIVES: To explore and describe the coping experiences of children with autism spectrum disorders in Taiwan. BACKGROUND: Children with autism spectrum disorders are faced with daily social and living challenges, which can cause stress. Chinese culture emphasises discipline and obedience, which may influence coping strategies of children with autism spectrum disorders in Taiwan. DESIGN: This qualitative study employed an exploratory descriptive design. METHOD: Data were collected from in-depth, face-to-face structured interviews. Interviews explored coping strategies of Taiwanese school-aged children (aged 6-19) with autism spectrum disorders. Children (N = 17) and their caregivers were recruited by purposive sampling. Transcribed interview data were thematically analysed using the procedure of Miles and Huberman. RESULT: Five themes emerged from the analysis of the data, which described the coping strategies of the children: (1) problem-solving, (2) acting-out, (3) avoidance, (4) seeking help and (5) self-regulation. These themes included multiple coping strategies, which employed the concepts of engagement and disengagement. CONCLUSIONS: The children with autism spectrum disorder used many strategies to cope with the stresses resulting from behaviours and symptoms associated with the disorder. Most of the Taiwanese children use both problem-solving and emotional-focused coping strategies. RELEVANCE TO CLINICAL PRACTICE: Understanding coping strategies of children with autism spectrum disorder could help caregivers (parents, teachers) and medical professionals develop interventions to reduce these challenges, which could alleviate stress and improve social functioning for these children.

Exploring Coping Strategies of Parents of Children With Autism Spectrum Disorder in Taiwan: A Qualitative Study.

BACKGROUND: Children with autism spectrum disorder (ASD) experience impairments in their social interactions, language communication, and stereotypical patterns of behavior. Parents of children with ASD experience higher levels of stress and more depression and anxiety than parents of children with other disabilities or typically developing children. Parents of children with disabilities develop coping strategies to counteract the stresses associated with raising a child with special needs. Understanding coping strategies to help counteract the stresses associated with parenting a child with ASD may enhance well-being in parents of children with ASD, improve the quality of care provided to these children, and foster better parent-child relationships. PURPOSE: The purpose of this study was to explore the coping strategies used by parents in Taiwan parenting a child with ASD. METHODS: In this descriptive qualitative study, thematic analysis was conducted on data collected during face-to-face interviews. Fourteen parents of children with ASD were recruited using purposive sampling. Researchers employed a teamwork approach for data analysis to increase the dependability and consistency of the transcribed interviews. Team members discussed coding and identified the themes collaboratively. RESULTS: Taiwanese parents of children with ASD coped with the psychological impacts of parenting by employing problem-focused and emotion-focused strategies. Problem-focused strategies included communication, support, and management, whereas emotion-focused strategies included acceptance and adaptation. Findings showed that both coping strategies were useful in addressing specific situations and circumstances. Social and clinical support improved parents' mental health and children's external behaviors. CONCLUSIONS/IMPLICATION FOR PRACTICE: Healthcare providers should evaluate how parents are coping with the stresses related to raising a child with ASD and consider the cultural factors that might influence how they accept and adapt to parenting children with ASD. Understanding these variables may be used to tailor strategies appropriate to reducing stress and improving the well-being of parents and their children. Support and resource referrals should be considered, including parent support groups, books, web-based services, and recommendations for professional consultations with social workers or therapists.

Impact of Taiwan's 2021 COVID-19 lockdown on the symptom severity and quality of life of patients with narcolepsy.

COVID-19 lockdowns can influence the sleep quality and daytime condition of patients with narcolepsy. Using data from our cohort study, we investigated changes in the quality of life and the symptom severity of patients with narcolepsy during Taiwan's 2021 lockdown and investigated differences by narcolepsy subtype, sex, and age. Patients with type 1 and type 2 narcolepsy (NT1 and NT2, respectively) aged 6-40 years were retrospectively recruited from our narcolepsy cohort study. These patients were regularly evaluated using the Short Form 36 Health Survey questionnaire (SF-36), the Epworth Sleepiness Scale (ESS), the visual analog scale (VAS) for hypersomnolence, the VAS for cataplexy and sleep diary. We compared the differences between the lockdown and the prelockdown periods by narcolepsy subtype, sex, and age. We used a paired t test analysis to compare differences in the SF-36, ESS, VAS scores and data of sleep diary between the prelockdown and lockdown periods (p1), and an independent t test analysis was used to compare the changes in different subgroups between the prelockdown and lockdown periods (p2). A total of 120 patients with narcolepsy were recruited (mean age 24.22 ± 6.87 years; 58% male); 80 of the patients had NT1 (mean age 25.25 ± 6.79 years; 60% male) and 40 had NT2 (mean age 22.16 ± 6.64, 53% male). During the lockdown period, the ESS score of total patients was decreased (p = 0.039) and body mass index was increased (p = 0.02). The NT1 group decreased significantly (p1 = 0.017), especially in men (p1 = 0.016) and adults (p1 = 0.04); scores for the VT domain of the SF-36 increased significantly in male and adult patients with NT2 (p1 = 0.048 and 0.012). Additionally, male patients with NT2 exhibited significantly decreased scores in the physical and emotional role functioning domains (p1 = 0.028, 0.024). The children and adolescents with NT1 had significantly decreased scores in the general health domain of the SF-36, but no significant change was noted in that of adults (p1 = 0.027, p2 = 0.012). We observed both negative and positive impacts of Taiwan's 2021 lockdown on patients with narcolepsy. A more flexible but structured daily routine with adequate sleep time should be considered for this population during lockdown and nonlockdown periods.

Integration of a service-learning component into a course on nursing care for children with developmental disorders: A mixed-methods study.

BACKGROUND: Service-learning provides nursing students with hands-on experience in a real-world setting. Students learn how to care for others and manage their emotions. AIM: This study examined the effectiveness of integrating service-learning into a nursing course on nursing care for children with developmental disorders. DESIGN: This was a mixed-methods study with two pretest-posttest quantitative analyses and a qualitative component. METHODS: Nursing students (N = 74) enrolled in a semester-long course in nursing care for children with developmental disorders participated in the study. Data were collected between February 2017 and June 2021. The service-learning part of the course assigned teams of two to three students to provide nursing care for a child (ages 5-19 years) diagnosed with a developmental disorder. At the conclusion of the course, students presented a short video with reflections of their experiences. Pretest versus post-test scores compared mid-term and final exam scores regarding knowledge of children with developmental disorders and scores on a 9-item self-report instrument on service-learning skills. Self-reflections from the video presentation provided qualitative data about the impact on students' awareness of the caregiving needs of children with developmental disorders. RESULTS: The mean final exam scores were significantly higher compared with midterm scores (96.12, (SD = 4.63) vs 94.82 (SD = 12.08); F = 6.81, p < .001), indicating knowledge of developmental disabilities had increased. Pretest vs posttest scores for service-learning skills indicated confidence had significantly increased (p < .001). Students' video reports indicated sensitivity to the challenges and needs of these children had increased. CONCLUSIONS: Service-learning exposed nursing students to the challenges and rewards of caring for children with developmental disorders. Knowledge, as well as confidence, increased. Nurse educators could easily integrate service-learning into courses required as part of the curriculum for pediatric nursing students.

Survey Responses of School Closures During the COVID-19 Outbreak in Taiwan.

Background: Taiwan faced a surge of COVID-19 infections in May 2021. Because new cases were quickly increasing, parents called for school closures. A national parent group used an online survey to collect opinions about upcoming school closings planned by the Ministry of Education. This study evaluated the results of the survey for all respondents and investigated the level of viral transmission following school closures among students in Taiwan. Methods: An online survey titled "Survey of Opinions of School Closures during the Current COVID-19 Outbreak" (SOSC-COVID-19) was designed by the national parent association and then distributed to members of the community throughout Taiwan via local parent groups from May 17 to 18, 2021. The survey included an open-ended respondents' opinions about school closures. Differences among regions and socioeconomic scores (SES) were analyzed with chi-square tests. Results: A total of 8,703 completed survey forms data were analyzed. Nearly all respondents (7,973, 91.6%) approved of school closures; there were no differences of opinions inside and outside municipalities or by regional SES scores. Only 8.4% of respondents were opposed to any type of school closure, believing parents should decide whether their child attended school, which also did not vary with region or SES score. Qualitative feedback from parent and teacher responders indicated students' health and economic impacts were additional concerns that influenced their choice of whether the government or parents should decide about school closures. On the afternoon of May 18, 2021, the government of Taiwan closed all schools. Although a spike in new cases of COVID-19 occurred among students 10 days after school closures, over the next 40 days new cases declined, falling to zero by July 5th. Conclusions: Despite the inability of nationwide school closures to completely halt transmission of the virus within families during the COVID-19 outbreak, school closures helped to impede transmission between students.

An Effective Life-Sex-Emotions Course for Taiwanese Adolescents on Health Perceptions: A Cohort Study.

Aim: Adolescence is a time of transition from childhood to adulthood, when young people go through a number of vital physical and psychological developments. It is surprising yet unfortunate that the number of teenage suicide deaths and teenage infections of gonorrhea have increased over the years, becoming serious public health concerns in Taiwan. The aim of this study was to investigate the effect of an education course on teenagers' understanding of adolescence and their attitudes toward life, sex, gender equality, and mental health. Material and Methods: Participants were comprised of Taiwanese students in Grades 5 to 9 who completed a Life-Sex-Emotions course, titled "Sailing through Adolescence." The effect of the course was measured using pre- and post-test scores on the Perception Index of Life-Sex-Emotions Education (PILSEE) instrument. Qualitative data included subjective responses to questions before and after the course. Data were collected between September 2017 and June 2020. Results: A total of 10,506 completed questionnaires were collected. The mean PILSEE pretest scores for each subscale ranged from 8.71 to 13.37 (SD = 1.499-1.99); posttest subscale scores ranged from 9.30 to 13.95 (SD range = 1.490-2.288). The mean overall pretest score was 86.86 (SD = 10.83); the mean posttest score was 92.62 (SD = 10.30). The paired t-test demonstrated that post-test scores were significantly higher than pretest scores (t = 55.46; p < 0.01). Qualitative feedback indicated that the course improved students' self-esteem, their understanding adolescence, and awareness of influences of the media. Conclusion: Our findings indicate that an educational course about life, sex, and emotions during adolescence can be an effective intervention to help teenagers understand the impact of adolescence on attitudes toward life, sex, mental health, and gender equality.

Knowledge of attention-deficit hyperactivity disorder among the general public, parents, and primary school teachers.

ABSTRACT: We compared the knowledge of attention-deficit hyperactivity disorder (ADHD) among the general public, parents of children with ADHD, and primary school teachers and identified factors associated with ADHD knowledge in each group, separately.Secondary data analysis was made on the pre-lecture data from those (122 from the general public, 64 parents of children with ADHD, and 515 primary school teachers) attending education lectures by the Department of Public Health, New Taipei City Government, Taiwan, 2014.ADHD onset age was least known in these 3 groups. Knowledge of ADHD was significantly better among teachers (test score, 75.3%) than among parents (65.5%) and the general public (59.2%). Among the general public, the test score significantly decreased with age and was worst in those who did not know their friends or relatives with ADHD. Among parents, service workers, and retired/unemployed knew significantly less about ADHD than housewife did. Among teachers, men knew significantly less than women; those who taught children with ADHD knew significantly more than those who did not.Primary school teachers knew more about ADHD than parents and the general public. Factors associated with ADHD knowledge varied among the 3 groups.

Colon Tissues Classification and Localization in Whole Slide Images Using Deep Learning.

Colorectal cancer is one of the leading causes of cancer-related death worldwide. The early diagnosis of colon cancer not only reduces mortality but also reduces the burden related to the treatment strategies such as chemotherapy and/or radiotherapy. However, when the microscopic examination of the suspected colon tissue sample is carried out, it becomes a tedious and time-consuming job for the pathologists to find the abnormality in the tissue. In addition, there may be interobserver variability that might lead to conflict in the final diagnosis. As a result, there is a crucial need of developing an intelligent automated method that can learn from the patterns themselves and assist the pathologist in making a faster, accurate, and consistent decision for determining the normal and abnormal region in the colorectal tissues. Moreover, the intelligent method should be able to localize the abnormal region in the whole slide image (WSI), which will make it easier for the pathologists to focus on only the region of interest making the task of tissue examination faster and lesser time-consuming. As a result, artificial intelligence (AI)-based classification and localization models are proposed for determining and localizing the abnormal regions in WSI. The proposed models achieved F-score of 0.97, area under curve (AUC) 0.97 with pretrained Inception-v3 model, and F-score of 0.99 and AUC 0.99 with customized Inception-ResNet-v2 Type 5 (IR-v2 Type 5) model.

Establishment of the reliability and validity of the Stress Index for Children or Adolescents with Tourette Syndrome (SICATS).

AIMS: The aim of this study was to evaluate the validity and reliability of the stress index for 10-18-years-old children or adolescents with Tourette syndrome. BACKGROUND: Tourette syndrome is a chronic tic disorder, which occurs in childhood. Children with Tourette syndrome exhibit sudden and unexpected voices or movements that may have influence on their daily activities and cause interaction barriers for children with Tourette syndrome. Therefore, a self-report stress index is necessary for children with Tourette syndrome to quickly measure the stress they have. DESIGN AND METHODS: Eight experts rated appropriateness, comprehensiveness and relevance of the questionnaire to establish content validity. A total of 116 paediatric patients filled out the stress index for 10-18-years-old children or adolescents with Tourette syndrome to evaluate its construct validity using exploratory factor analysis and internal consistency. Data from 90 pairs of paediatric patients and their caregivers were used to evaluate the inter-rater reliability. RESULT: The criterion validity index ranged from 80-98%. One item was deleted because of a small item-to-total correlation. Therefore, 26 items made up the final stress index for 10-18-years-old children or adolescents with Tourette syndrome. In exploratory factor analysis, four factors (unfairly treated, psychological, symptom control and future concern) were achieved and accounted for 52.3% of the total variance. Cronbach's alphas of the stress index for 10-18-years-old children or adolescents with Tourette syndrome were 0.89. The inter-rater reliability of stress Index for 10-18-years-old children or adolescents with Tourette syndrome (Pearson correlation coefficient between patients and their caregivers) was 0.56. CONCLUSION: The stress Index for 10-18-years-old children or adolescents with Tourette syndrome is a self-administered tool to assess the stress of children or adolescents with Tourette syndrome. Validity (content and construct) and reliability (internal consistency and inter-rater reliability) of our Stress Index for 10-18-years-old Children or Adolescents with Tourette syndrome was acceptable. RELEVANCE TO CLINICAL PRACTICE: The Stress Index for Children or Adolescents with Tourette Syndrome appears to be an ideal instrument for evaluating the stress for children with Tourette syndrome in clinical setting and finding the direction in designing an appropriate intervention programme. We welcome other researchers to use stress index for 10-18-years-old children or adolescents with Tourette syndrome so that their findings can be compared using the same measurement.

Comparison of the effectiveness of teaching strategies for a pediatric pain management program for undergraduate nursing students: A quantitative evaluation using an objective structured clinical examination.

Pain is a common experience for hospitalized children; however, nursing students are often not adequately trained in pediatric pain management. Innovative teaching strategies, such as e-learning, have been employed for instructing students, however success of these platforms has not been quantitatively measured. This study compared students' knowledge and skill performance following a researcher-designed pain management program administered with three teaching strategies: traditional face-to-face, e-learning, or blended learning. Undergraduate nursing students in Taiwan (N = 296) randomly assigned to one of the teaching strategies participated. Knowledge of pain management, and pain management skills were quantified. A subjective assessment of attitudes towards learning found no significant difference between groups. Knowledge of pediatric pain management did not differ significantly between groups (p = 0.36). A 15-item objective structured clinical examination (OSCE) measured the competency of pain management skills; scores were not significantly different, regardless of teaching strategy (p = 0.70). Traditional face-to-face teaching was as effective as both innovative strategies. Evaluating students' skills following a pain management program with an OSCE provided a quantitative assessment of competency. Innovative strategies for teaching pediatric pain management could be a cost-effective way to provide flexible learning opportunities for nursing students who are distant from educational institutions.

[Recognition and management of Tourette syndrome].

Tourette syndrome (TS) is a chronic tic disorder that occurs in childhood. Children with TS may have multiple tic incidents during a day, even many times per minute. Such sudden, rapid and short utterings or movements may influence sufferers' ability to perform daily activities and present barriers to normal interaction with others. Anger, depression and low self-esteem are commonly seen in many children with TS. Awareness of TS is not great in Taiwan, and so many pediatric patients fail to obtain an early diagnosis and / or are mistreated or punished due to disorder-related behaviors. Such results in elevated physical, psychological and social stresses for sufferers. In this paper, we briefly introduce TS symptoms, diagnosis, classification, prognosis, co-morbidity, related psycho-social stresses, and common treatments. In order to facilitate the effective management of TS, we provide suggestion for patient families and schools as well as recommendations on how to interact effectively with others. We hope this article is helpful for healthcare workers, patients, families and schools to improve the recognition and management of TS.

How Taiwanese parents of children with autism spectrum disorder experience the process of obtaining a diagnosis: A descriptive phenomenological analysis.

An autism spectrum disorder can result in considerable stress and confusion for parents as they attempt to understand their child's problems and obtain a diagnosis. Few studies have explored the parental experience in the context of Chinese culture. The purpose of this study was to understand the experiences of parents in Taiwan of children diagnosed with autism spectrum disorder. In total, 15 parents, 1 father and 14 mothers, were recruited by purposive sampling. This qualitative study used semi-structured interviews and descriptive phenomenological analysis. The findings indicated that parents of children diagnosed with autism spectrum disorder underwent five coping experiences during the diagnostic process: (1) uncertainty and difficulty understanding their child's behaviour, which occurred during the pre-diagnosis phase; (2) obligation to obtain professional services; (3) anxious searching for a second opinion, which occurred during the diagnosis phase; (4) acceptance and fortitude and (5) further adjustment during the post-diagnosis phase. Our findings add to our understanding of how parents experience the diagnostic process, which could improve medical professionals' counselling and support for parents at the stage of obtaining a diagnosis for their children.

The quality of life for cancer children (QOLCC) in Taiwan (part I): reliability and construct validity by confirmatory factor analysis.

Part 1, the current paper describes the development and testing of a quality-of-life (QOL) assessment specifically designed for Taiwanese pediatric cancer patients (7-18 years) and their parents/caregivers. The assessment instrument was established based on a qualitative study, then refined using recognized item-analysis methods and pilot tested on a group of 25 patients. The final assessment instrument included three versions of the same instrument, a patient self-report (QOLCC-7-12, for children aged 7-12 years; QOLCC-ADO for adolescent aged 13-18 years) and a parent proxy-report (QOLCC-PAR). The final seven-subscale tool has a total of 34 items and was tested among 106 young cancer patients and 106 their parents. Psychometric properties of the measure were tested using item analysis, Cronbach's alpha, and a confirmatory factor analysis. Results suggest acceptable reliability and goodness of fit of this seven-scale measure. In order to test the factor validity of QOLCC, an independent group of 42 children with cancer participated. The results of confirmatory factor analysis shows the goodness of fit in QOLCC.

The quality of life for cancer children (QOLCC) for Taiwanese children with cancer (part II): feasibility, cross-informants variance and clinical validity.

The quality of life in childhood cancer (QOLCC) is a research instrument that has been developed to assess the quality of life for children and adolescents who suffer from cancer in Taiwan. The current paper is the second of a two-part series of research reports. Part I is reported in this journal (Yeh et al., 2003). Part II describes the range of measurement, concordance of cross-informants reports, and clinical validity of Taiwanese pediatric cancer children (7-12 years) and adolescents (13-18 years) and their parents/caregivers. Due to the cognitive ability of children and adolescents, data were analyzed for children and adolescent separately. The validity of cross-referenced information between parent and child forms was subsequently examined using Pearson product correlation. The feasibility (percentage of missing values per item) and range of measurement [percentage of minimum (floor effect) and maximum (ceiling effect) possible scores] was calculated for the five QOLCC and the total scale score. The findings of medium to high correlation of the patient/parent responses strongly imply that relevant information might be obtainable through parents when children are unable or unwilling to complete the assessment instrument. Feasibility for the QOLCC was very good.