Factors affecting early feeding performance in preterm infants below 32 weeks gestation.

OBJECTIVE: To identify the influence of various physiological and behavioral factors on feeding performance of preterm infants in the transition to full oral feeding. METHODS: We retrospectively reviewed data from a feeding assessment conducted on 24 preterm infants born at 25-31 weeks without severe brain complications. RESULTS: Prolonged oxygen use and low current weight are two adverse factors for feeding efficiency (volume of milk ingested orally per minute in the initial 5 min of feeding) and proficiency (percentage of prescribed volume ingested orally over the entire feeding). Young post-menstrual age, low baseline oxygen saturation and high feeding efficiency were risk factors for oxygen desaturation during the initial feeding. CONCLUSION: Proper feeding strategies are needed for preterm infants with those disadvantageous factors to improve their early feeding performance.

Psychometric validation of the S-QoL Chinese (Taiwan) version for patients with schizophrenia.

We translated the S-QoL into the Chinese (Taiwan) language and evaluated the score distributions of the translated S-QoL in terms of ceiling/floor effect, internal consistency, test-retest reliability, and convergent and discriminant validity. To ensure conceptual and semantic equivalence of the S-QoL, the researchers performed both forward translation and back translation, consulted professionals, and completed a pilot trial on college students. Forty-one patients with schizophrenia were recruited. No significant ceiling/floor effects (<20%) were found in subscales of the translated S-QoL. The internal consistency reliabilities were acceptable to good for the whole scale and 7 of the subscales (Cronbach's alpha = 0.71-0.93), but not for the sentimental life subscale (Cronbach's alpha = 0.44). The test-retest reliabilities were moderate to high (ICC = 0.64-87, P < 0.001 to <0.0001). The convergent validities were supported by satisfactory correlations among subscales measuring related constructs of the translated S-QoL and those of the SQLS-R4, WHOQoL-BREF, and RESE (r = 0.36-0.82, P < 0.05 to <0.01). Discriminant validity was demonstrated between groups with different numbers of episodes and hospitalization. The S-QoL Chinese (Taiwan) version was found to have good psychometrics and is suggested as a feasible choice of disease-specific measure for capturing HRQoL in patients with schizophrenia.

Impairment of stance control in children with sensory modulation disorder.

OBJECTIVE: To compare stance control between children with sensory modulation disorder (SMD) and typically developing children in various visual and somatosensory conditions. METHOD: Thirty-one children participated in this study, including 17 children with SMD and 14 matched typically developing children. The Sensory Profile was used to screen for sensory modulation problems, which were further confirmed by measures of electrodermal response and the Evaluation of Sensory Processing. Stance parameters for an assessment of postural stability were obtained with a dual-axis accelerometer on the lumbar area. RESULTS: The children with SMD presented atypical sensory responses in terms of both electrophysiological and behavioral measures. The results for stance showed a greater body sway in the SMD group than in the control group (p < .05). However, the group difference was not always significant under the conditions of reliable somatosensory input and sway-referenced vision. CONCLUSION: Our findings first confirmed impaired stance control in children with SMD.

Validation of a Taiwanese Version of the Burn-Specific Health Scale-Brief.

The purposes of this study were to translate the brief version of the Burn-Specific Health Scale (BSHS-B) into traditional Chinese (Taiwanese) and to evaluate its psychometric properties to measure quality of life of burn patients in Taiwan. The BSHS-B-Taiwanese was translated and reviewed by an expert committee. Patients were invited to participate in this study while they visited the outpatient burn clinic. One hundred and eight burn patients participated in this study by filling out the BSHS-B-Taiwanese and SF-36 Taiwanese version. Forty-one of 108 patients completed a retest on the BSHS-B-Taiwanese. A ceiling effect was found for psychosocial functioning and all domains of the BSHS-B-Taiwanese. Internal consistency shown by Cronbach's alpha was all above 0.70 except for the interpersonal relationships domain. Of these, Cronbach's alpha ≥0.9 was found in the work, heat sensitivity, and body image domains. Test-retest reliabilities ranged from 0.74 to 0.93 except for the simple activity domain. As for the criterion validity, most of the BSHS-B-Taiwanese version was shown to have fair to moderate correlations with the SF-36-Taiwanese in corresponding domains. The discriminant validity of the BSHS-B-Taiwanese was demonstrated by significant score differences in several domains between subgroups of different severity regarding length of hospital stay and TBSA. Our finding suggests that the BSHS-Taiwanese is generally reliable and valid. A shorter version of BSHS-B-Taiwanese together with a generic instrument, such as SF-36, can be used to measure the quality of life of burn patients in Taiwan.

Video-computer quantitative evaluation of thumb function using workspace of the thumb.

This study develops the basis for video-computer quantitative evaluation method for measuring degree of thumb impairment. The system evaluates the three-dimensional space (workspace) within which the thumb-tip moves and computes its surface area. This study is intended to be the basis of a subsequent study which will compute the percentage of actual use compared to the "ideal" value for the given thumb length. Based on this quantitative measurement, the movement function of the impaired thumb can be identified objectively. Repeatability testing confirms that the video motion analysis system is a reliable tool for measuring the workspace of thumb-tip motion. It is also shown experimentally that there is a linear correlation between the surface area of thumb-tip motion workspace and the square of the thumb length. Accordingly, this method may be used to evaluate the functional abnormalities and deformities of the thumb.

Physician practices in the diagnosis of carpal tunnel syndrome at a medical center in southern Taiwan.

Carpal tunnel syndrome (CTS) is the most common neurologic entrapment disorder diagnosed in the upper limb. Nevertheless, there is still debate about the most reliable test that should be performed to diagnose CTS. Much of the argument has been drawn from the opinions of individuals or groups with varying degrees of expertise in the field; little has been based on actual data. The purpose of this study was to investigate the diagnostic patterns of CTS in an academic medical setting in southern Taiwan. The charts of 1,050 patients with a diagnosis of CTS over a 1-year period (2001-2002) were retrospectively reviewed. Data on 622 patients with new-onset CTS were included in the analysis. On the patient's initial visit, physicians made a diagnosis of CTS in 34.9% of cases solely on the basis of the history of symptoms without resort to provocative tests, while 8.7% of cases were diagnosed on the basis of symptom characteristics alone in spite of negative provocative tests. A CTS diagnosis was given according to symptoms and positive provocative tests in 55% of cases. Apart from these, CTS diagnosis remained unchanged in 27.3% of cases without electrodiagnostic signs of CTS during follow-up visits. An average of 1.6 diagnostic maneuvers were conducted for CTS patients, with nerve conduction velocity (NCV) studies (516 cases) being the most frequently performed, followed by Tinel's sign (350 cases) and Phalen's test (102 cases). Our findings imply that physicians are inclined to base their diagnosis on clinical history and physical examination for patients with suspected CTS. Clear guidelines regarding the indications for referral for NCV studies should be established in response to the increased concerns about the cost effectiveness of diagnostic tests.

Factors related to return to work and job modification after a hand burn.

Occupational therapy aims to help patients resume their occupations. Therefore, we must know their work status after our intervention. We collected demographic and burn-related data from patient charts and analyzed it to determine the work status of former patients with burned hands and what influenced their returning to work. From 284 former patients with burns, we screened 159 with burned hands, 108 of whom were interviewed through the telephone about their work status. We used logistic regression analysis to analyze factors for having work, returning to work, the length of time required to return to work, and job modifications. We found that 1) having preburn employment increased the likelihood of having postburn employment; 2) being the primary wage earner in a family increased the likelihood of having work and of a return to work postburn; 3) a longer stay in the hospital, and burn injuries on both hands and trunk increased the time required to return to work; and 4) being older and having a smaller percentage of total body burn area decreased the likelihood of returning to a job modified because of a burn injury. Returning to work was affected not only by burn-related factors but also by general demographic and employment factors. We urge occupational therapy departments to include a return-to-work program in their routine services to improve the chances of patients with hand burns to return to work. We strongly recommend that a multicenter prospective study of hand-burn injuries should be performed.

Effectiveness of web space pressure inserts for postburn dorsal slant.

Postburn web space scar, if not appropriately treated, can result in the progressive loss of the web space or the increase in angle of the dorsal slant of the web space or both, which will not only lead to cosmetic and hygiene problems, but also to functional limitations. The purpose of this study was to determine the effectiveness of web space pressure inserts for postburn dorsal slants. An individualized custom-made web space pressure insert was fitted into each web space. Inserts were worn underneath the pressure glove to create additional pressure on each web space and to inhibit distal migration of the scar to avoid the increase in the angle of the dorsal slant of the web space. Twenty-four survivors with 36 burned hands, who had been treated in the burn clinic of National Cheng Kung University Hospital, were recruited for this study. When skin wounds were closed, the participants received custom-made web space pressure inserts. The dorsal slant of each web space was measured by a conventional goniometer every time the participants visited the burn clinic. The initial and final measurements were used to compare the change in the angle of the dorsal slant of the web space. Paired t-tests were computed to determine the effectiveness of pressure inserts. The final dorsal slant angle of each web space was also compared with the unburned value by independent t-test. After 234.6 +/- 177.0 days of intervention, the mean dorsal slants of 36 dorsal burn hands' four web spaces were all significantly reduced (P < .001). The most important finding was that the angle of the first dorsal slant could be improved to normal. A custom-made web space pressure insert could be used to improve postburn dorsal slant.

Handle size as a task constraint in spoon-use movement in patients with Parkinson's disease.

OBJECTIVE: To examine the effect of spoon-handle size on kinematic performance in people with Parkinson's disease. DESIGN: A counterbalanced repeated-measures design. SETTING: A motor control laboratory in a university setting. SUBJECTS: Eighteen individuals with Parkinson's disease and 18 age-matched controls. EXPERIMENTAL CONDITIONS: Each participant was instructed to scoop water (simulated soup) using spoons with three different-sized handles. MAIN MEASURES: Kinematic variables (movement time, peak velocity and number of movement units) of arm movement, size of hand aperture and number of fingers to grasp the spoon. RESULTS: The movement of the participants with Parkinson's disease was faster (shorter movement time) and smoother (fewer movement units) when they used spoons with a small- or medium-sized handle than when using a spoon with a large-sized handle. In contrast, the healthy controls showed no significant differences in movement kinematics between handle sizes. Moreover, the participants with Parkinson's disease had a significantly smaller hand aperture and used more fingers to hold the spoons than the controls did. CONCLUSIONS: These results suggest that, for people with Parkinson's disease, a small-to-medium-sized handle is more suitable than a large-sized built-up handle.

Validation of the Chinese version of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) in Taiwanese patients with schizophrenia.

We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). One hundred Taiwanese individuals with schizophrenia were recruited. The internal consistency reliability was satisfactory for both the psychosocial and vitality domains (Cronbach's alpha = 0.92, 0.84). The test-retest reliability was also high (psychosocial: ICC = 0.84, vitality: ICC = 0.84) for those individuals whose psychological conditions remained stable between the two-week interval. However, the responsiveness coefficient for those with considerable changes in psychological conditions ranged from very small to moderate, suggesting either low responsiveness for the vitality domain or a complex relationship between the change of psychological conditions and quality of life, and the need to estimate responsiveness more conclusively in a future intervention study. The convergent validity was supported by moderate-to-large correlations between domains measuring related constructs of the SQLS-R4 and SF-36 (r = -0.65 to -0.67). Overall, the results of this study provide preliminary evidence for the reliability and validity of the SQLS-R4 used in Taiwanese individuals with schizophrenia. This study provides a common ground for international researchers to understand quality of life in Taiwanese patients with schizophrenia.

Reliability and validity testing of a Chinese-translated version of the 39-item Parkinson's Disease Questionnaire (PDQ-39).

The trend toward international cooperation in research projects emphasizes the need to translate existing validated tools into local languages. The purpose of this study was to test the reliability and validity of a Chinese-translated version of the 39-item Parkinson's Disease Questionnaire (PDQ-39). Seventy-three Taiwanese individuals with Parkinson's disease were consecutively recruited. The internal consistency reliability was satisfactory for all domains (Cronbach's alpha = 0.80-0.96), except for the social support, cognition, and bodily discomfort domains (alpha = 0.58-0.63). The convergent validity was also supported by strong correlations between domains measuring related constructs of the PDQ-39 and Unified Parkinson's Disease Rating Scale (r = 0.81-0.86), and between those of the PDQ-39 and SF-36 (r = -0.70--0.93). Except for the bodily discomfort domain, all domains of the PDQ-39 significantly discriminated patients at different stages, as indicated by the Hoehn and Yahr scale. Overall, the results of this study are consistent with the reports of the PDQ-39 in other countries (e.g., UK, Spain, US, and Greece), which suggests that the PDQ-39 is appropriate for use among Taiwanese individuals with PD. This study lays the foundation for future combinations and comparisons of data cross-nationally.