Conceptualisation and Development of a values-based scale of emergency physicians' professional identities.

BACKGROUND: Physicians' values about what constitute their professional identities are integral in understanding how they ascribe meaning to their practice. However, there is no general consensus on the conceptualization and measurement of physicians' professional identities. This study developed and validated a values-based scale for measuring physicians' professional identities. METHODS: A hybrid research method was used to gather both qualitative and quantitative data. We employed literature review, semi-structured interview, Q-sorting exercise to examine the conceptualization of emergency physicians' professional identities and to initially develop a 40-item scale. A panel of five experts assessed the scale's content validity. Using 150 emergency physicians as our sample, we conducted Confirmatory Factor Analyses (CFA) to test the fit of our hypothesised four-factor model based on our preliminary findings. RESULTS: Initial CFA suggested revisions to the model. Following theoretical assumptions and modification indices, the model was revised and adjusted to a four-factor 20 item Emergency Physicians Professional Identities Value Scale (EPPIVS) with acceptable fit statistics χ2 = 389.38, df = 164, Normed χ2 = 2.374, GFI = 0.788, CFI = 0.862, RMSEA = 0.096. The Cronbach's alpha, McDonald's Omega reliability and composite reliability of the subscales ranged from α: 0.748 to 0.868, Omega: 0.759 to 0.868 and CR: 0.748 to 0.851, respectively. CONCLUSION: The results indicate that the EPPIVS is a valid and reliable scale for measuring physicians' professional identities. Further research on the sensitivity of this instrument to important changes over career progression in emergency medicine is warranted.

Effect of national curriculum reform on medical students' preparedness for practice: a prospective cohort study from undergraduate to postgraduate periods.

BACKGROUND: In recent years, a national curriculum reform was implemented in undergraduate medical education in Taiwan to reduce clinical rotation training from 3 years to 2 years. The last generation of the old curriculum and the first generation of the new curriculum both graduated in 2019. This study aimed to compare the learning outcomes of the medical students in these two curriculum groups in terms of preparedness for practice during the transition from undergraduate to postgraduate study. METHODS: This was a 3-year prospective, longitudinal, comparative cohort study between 2017 and 2020. Medical students from both the 7-year and 6-year curriculum groups received biannual questionnaire surveys starting 18 months before graduation and running until 11 months after graduation. The measurement tools were the Preparedness for Hospital Practice Questionnaire (PHPQ) and Copenhagen Burnout Inventory (CBI). Personal demographic information was also collected. Linear mixed models were used to determine the effect of curriculum change on learners' preparedness and burnout levels. RESULTS: A total of 130 medical students from the two cohorts provided 563 measurements during the study period. Compared to their counterparts following the old curriculum, the participants following the new curriculum showed a lower level of preparedness when first entering clinical rotation (p = 0.027) and just after graduating (p = 0.049), especially in the domains of clinical confidence (p = 0.021) and patient management p = 0.015). The multivariate linear mixed model revealed gradual increases in preparedness and burnout in serial measurements in both curriculum groups. Students following the new curriculum, which involved a shortened clinical rotation, showed a slightly lower overall preparedness (p = 0.035) and the same level of burnout (p = 0.692) after adjustment. The factor of year of change did not show a significant effect on either preparedness (p = 0.258) or burnout (p = 0.457). CONCLUSION: Shortened clinical rotation training for medical undergraduates is associated with a decrease in preparedness for practice during the transition from undergraduate to postgraduate study. Clinical confidence and patient management are the main domains affected.

Evaluating Clinical Educators' Competence in an East Asian Context: Who Values What?

Background: How to evaluate clinical educators is an important question in faculty development. The issue of who are best placed to evaluate their performance is also critical. However, the whos and the hows of clinical educator evaluation may differ culturally. This study aims to understand what comprises suitable evaluation criteria, alongside who is best placed to undertake the evaluation of clinical educators in medicine within an East Asian culture: specifically Taiwan. Methods: An 84-item web-based questionnaire was created based on a literature review and medical educational experts' opinions focusing on potential raters (i.e., who) and domains (i.e., what) for evaluating clinical educators. Using purposive sampling, we sent 500 questionnaires to clinical educators, residents, Post-Graduate Year Trainees (PGYs), Year-4~6/Year-7 medical students (M4~6/M7) and nurses. Results: We received 258 respondents with 52% response rate. All groups, except nurses, chose "teaching ability" as the most important domain. This contrasts with research from Western contexts that highlights role modeling, leadership and enthusiasm. The clinical educators and nurses have the same choices of the top five items in the "personal qualities" domain, but different choices in "assessment ability" and "curriculum planning" domains. The best fit rater groups for evaluating clinical educators were educators themselves and PGYs. Conclusions: There may well be specific suitable domains and populations for evaluating clinical educators' competence in East Asian culture contexts. Further research in these contexts is required to examine the reach of these findings.

Undergraduates' preparedness for practice is associated with professional identity and perception of educational environment: A validation study.

BACKGROUND: Medical schools prepare undergraduates for clinical practice. Clinical competencies build up gradually and continuously. Existing literature suggests that new graduates are often unprepared for independent practice. This study aims to validate a Chinese version of a Preparedness for Hospital Practice Questionnaire (PHPQ) in a Taiwanese undergraduate cohort. METHODS: The original eight-domain English version PHPQ was translated into Chinese and back-translated for expert panel discussion. The eight domains encompass interpersonal skills, confidence, collaboration, management, science, prevention, holistic care, and self-directed learning. Reliability and validity were checked by Cronbach's alpha and by confirmatory factor analysis (CFA), respectively. Participants were divided into higher and lower preparedness groups according to PHPQ results, and compared by age, sex, professional identity, and perception of educational environment. RESULTS: A total of 129 undergraduate medical students (55% males) participated in the study. The overall Cronbach's alpha was 0.94. Participants were found to be best prepared in the domain of disease prevention (M = 4.37, SD = 0.68) and least prepared in interpersonal skills (M = 2.68, SD = 0.77). A satisfactory goodness of fit data was yield from CFA with a CMIN/DF of 2.02. Higher levels of preparedness are associated with stronger professional identity (p < 0.001) and better perceived learning environment (p < 0.001). CONCLUSION: The Chinese version of PHPQ showed good reliability and validity. Preparedness for practice was associated with how learners feel about themselves as doctors and how well they had integrated into medical teamwork.

Levels of 15-HETE and TXB2 in exhaled breath condensates as markers for diagnosis of childhood asthma and its therapeutic outcome.

BACKGROUND: Dysregulation of eicosanoids is associated with asthma and a composite of oxylipins, including exhaled leukotriene B4 (LTB4 ), characterizes childhood asthma. While fractional exhaled nitric oxide (FeNO) has been used as the standard for monitoring steroid responsiveness, the potential utility of eicosanoids in monitoring the therapeutic outcomes remains unclear. We aimed to examine the levels of major eicosanoids representing different metabolic pathways in exhaled breath condensates (EBCs) of children with asthma during exacerbation and after treatment. METHODS: Levels of 6 exhaled eicosanoid species in asthmatic children and healthy subjects were evaluated using ELISA. RESULTS: In addition to those previously reported, including LTB4 , the levels of exhaled 15-hydroxyeicosatetraenoic acid (15-HETE), but not thromboxane B2 (TXB2 ), showed significant difference between asthmatics (N = 318) and healthy controls (N = 97), particularly the severe group showed the lowest levels of exhaled 15-HETE. Receiver operating characteristic (ROC) curve analyses revealed similar distinguishing power for the levels of 15-HETE, FEV1 (forced expiratory volume in the first second), and FeNO, while the 15-HETE/LTB4 ratio was significantly lower in subjects with asthma as compared to that of healthy controls (p < 0.0001). Analysis of asthmatics (N = 75) during exacerbation and convalescence showed significant improvement in lung function (FEV1 , p < .001), but not FeNO, concomitant with significantly increased levels of 15-HETE (p < .001) and reduced levels of TXB2 (p < .05) at convalescence, particularly for those who at the top 30% level during exacerbation. Further, decreased LTB4 and lipoxin A4 (LXA4 ) at convalescence were noted only in those at the top 30 percentile during exacerbation. CONCLUSION: The exhaled 15-HETE was found to discriminate childhood asthma while decreased levels of exhaled TXB2 and increased levels of 15-HETE were prominent at convalescence.

The evolution of medical students' preparedness for clinical practice during the transition of graduation: a longitudinal study from the undergraduate to postgraduate periods.

BACKGROUND: Graduating from medical school and beginning independent practice appears to be a major transition for medical students across the world. It is often reported that medical graduates are underprepared for independent practice. Most previous studies on undergraduates' preparedness are cross-sectional. This study aimed to characterize the development and trend of medical students' preparedness and its association with other objective and subjective indicators from the undergraduate to postgraduate periods. METHODS: This was a prospective cohort study. The participants were recruited and followed from two years before graduation to the postgraduate period. The preparedness for independent practice, professional identity, and teamwork experience were biannually measured using previously validated questionnaires. The participants' basic demographic information, clinical learning marks from the last two years, and national board exam scores were also collected. RESULTS: A total of 85 participants completed 403 measurements in the 5 sequential surveys. The mean age at recruitment was 23.6, and 58 % of participants were male. The overall total preparedness score gradually increased from 157.3 (SD=21.2) at the first measurement to 175.5 (SD=25.6) at the fifth measurement. The serial individual preparedness scores revealed both temporal differences within the same learner and individual differences across learners. Despite the variations, a clear, steady increase in the overall average score was observed. Participants were least prepared in the domain of patient management at first, but the score increased in the subsequent measurements. The participants with better final preparedness had better professional identity (p<0.01), better teamwork experience (p < 0.01), and higher average clinical rotation marks (p<0.05). CONCLUSIONS: The preparedness for practice of medical students from the undergraduate to postgraduate periods is associated with their professional identity, teamwork experience, and objective clinical rotation endpoint. Although preparedness generally increases over time, educators must understand that there are temporal fluctuations and individual differences in learners' preparedness.

Active learning of medical students in Taiwan: a realist evaluation.

BACKGROUND: Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why. METHODS: Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the 'context-mechanism-outcome' (CMO) configurations. RESULTS: Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers' guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes). CONCLUSIONS: We identified three CMO configurations of Taiwanese medical students' active learning. The connections among hierarchical culture, fear, teachers' guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.

Examining the association of career stage and medical specialty with personality preferences - a cross-sectional survey of junior doctors and attending physicians from various specialties.

BACKGROUND: Personality preference research on medical students and physicians demonstrates that personality preferences may affect one's choice of specialty and transform over the course of one's academic career as well as during one's time spent in the clinical setting. The literature offers valuable methods for evaluating medical curricula, understanding medical specialties, and rethinking communication techniques between educators and learners. In line with this encompassing body of work, this study examines the personality preferences of junior doctors and attending physicians from various specialties to investigate how career stage and medical specialty are associated with personality preferences. METHOD: The Myers-Briggs Type Indicator (MBTI) was applied to assess the personality preferences of junior doctors (postgraduates year 1-3) and attending physicians from six major medical specialties. Participants completed a self-administered 93-item questionnaire, while a certified MBTI practitioner explained the personality dichotomies as well as facilitated the self-evaluation process and the questionnaire's interpretation. Contrasted dichotomous scores and radar plots were employed to illustrate the distinction between junior doctors and attending physicians' personality preferences. All analyses were performed using the SAS statistical software, while a Wilcoxon rank-sum test was used to quantify the polarisation of personality preferences between junior doctors and attending physicians. RESULTS: In total, 98 participants were recruited, of whom 59 were attending physicians and 39 were junior doctors. The most common personality types among the junior doctors were ESTJ (15.4%), INTP (12.8%), and ESFJ (10.3%), while among the attending physicians, the most common types were ISTJ (23.7%) and ESTJ (18.6%). Both junior doctors and attending physicians expressed personality preferences for sensing, thinking, and judging. However, compared to the junior doctors, more polarised personality preferences were noted among the attending physicians for sensing (p = 0.038), thinking (p = 0.032), and judging (p = 0.024). Moreover, junior doctors exhibited less distinct personality preferences in this study. CONCLUSION: Attending physicians and junior doctors exhibited greater personality inclinations for sensing, thinking, and judging, although the former expressed these personality preferences more strongly than the latter. These findings highlight that, amongst physicians, career stage is strongly associated with the expression of personality preferences.

Clinical learning in the context of uncertainty: a multi-center survey of emergency department residents' and attending physicians' perceptions of clinical feedback.

BACKGROUND: Feedback is an essential part of clinical teaching and learning, yet it is often perceived as unsatisfactory in busy clinical settings. Clinical teachers need to balance the competing demands of clinical duty and feedback provision. The influence of the clinical environment and the mutual relationship between feedback giving and seeking has been inadequately investigated. This study therefore aimed to quantify the adequacy, perceptions, and influential factors of feedback provision during resident training in emergency departments (EDs). METHODS: A multicenter online questionnaire study was undertaken. The respondents comprised ED residents and clinical teachers from four teaching hospitals in Taiwan. The questionnaire was developed via an expert panel, and a pilot study ensured validity. Ninety clinical teachers and 54 residents participated. RESULTS: The respondents reported that the majority of feedback, which usually lasted 1-5 min, was initiated by the clinical teachers. Feedback satisfaction was significantly lower for the clinical teachers than for the residents (clinical teachers M = 13.8, SD = 1.83; residents M = 15.3, SD = 2.14; p < 0.0001), and positive feedback was provided infrequently in clinical settings (31.1%). Both groups of participants admitted hesitating between providing/seeking feedback and completing clinical work. Being busy, the teachers' clinical abilities, the learners' attitudes, and the relationship between both parties were reported as the most influential factors in feedback provision. CONCLUSION: ED clinical feedback provision is often short, circumstantial, and initiated by clinical teachers. Providing or seeking feedback appears to be an important part of clinical learning in the context of uncertainty. The importance of the relationship between the feedback seeker and the provider highlights the interactive, reciprocal nature of clinical feedback provision.

Sexual satisfaction and sexual function in women with gynecologic cancer: validation of the Sexual Satisfaction Scale for Women in Taiwan.

OBJECTIVE: To date, there are few validated multidimensional measures of sexual satisfaction that have been translated and empirically validated among Chinese speaking women with gynecologic cancer. The study was undertaken to validate the Sexual Satisfaction Scale for Women and to examine sexual satisfaction and sexual functioning in a sample of women with gynecologic cancer. METHODS: A cross-sectional survey was conducted in 209 women, of which 106 had gynecologic cancer and 103 were in the non-cancer group with no history of cancer. Self-evaluations included the Female Sexual Function Index and Sexual Satisfaction Scale for Women Traditional Chinese version. Analyses for internal consistency, test-retest reliability, and construct validity were performed. Analysis of variance was conducted for group comparison on sexual satisfaction and sexual functioning. RESULTS: The Sexual Satisfaction Scale for Women Traditional Chinese version showed good internal consistency reliability (Cronbach's α=0.965) and acceptable test-retest reliability (r=0.954). The confirmatory factor analysis on the Sexual Satisfaction Scale for Women Traditional Chinese version suggested the goodness of fit indices (χ²/df, root mean square residual, goodness of fit index, normed-fit index, comparative fit index, and adjusted goodness of fit index) were good. The women with gynecologic cancer gave significantly lower ratings (mean 102.18) than those without cancer (mean 118.09) for each of the Sexual Satisfaction Scale for Women Traditional Chinese version domains and total score. Significant differences between women with cancer (mean 13.08) and without cancer (mean 22.92) were noted for each of the Female Sexual Function Index domains and total scores (all p<0.0001). CONCLUSIONS: This translated version of the Sexual Satisfaction Scale for Women appears to be a reliable and valid instrument for measuring multifaceted components of sexual satisfaction in the general and clinical population of women rooted in Chinese culture.

The Sexual Satisfaction Scale for Women (SSS-W): Adaptation and Validation of a Traditional Chinese Version in Taiwan.

Sexual satisfaction is a key factor in an individual's sexual health and overall well-being. The aim of this study was to validate the most comprehensive index of sexual satisfaction-the SSS-W-for use among Chinese-speaking individuals. A total of 103 women (20-65 years old) participated in this survey study. An SSS-W traditional Chinese version (SSS-W-TC) was developed following the guidelines for cross-cultural translation and adaptation. The translated version, the SSS-W-TC, demonstrates psychometric properties within the satisfactory range, suggesting the feasibility of the SSS-W-TC for use in Taiwan. In terms of internal consistency, the reliability of the SSS-W-TC and its subscales is excellent. High test-retest reliability coefficients were obtained for all subscales of the translated version, demonstrating acceptable stability of the SSS-W-TC across measurement intervals. The ability of the SSS-W-TC to discriminate sexually functional and dysfunctional women shows evidence of concurrent validity. Low to modest correlations between the total and domain scores of the SSS-W and the Female Sexual Function Index Satisfaction domain echo the need for a multidimensional measure of sexual satisfaction in this population. The development of the SSS-W-TC lays the groundwork for future researchers who wish to conduct cross-cultural work in sexual satisfaction using Chinese-speaking samples.

Adaptation and validation of a measure of health literacy in Taiwan: The Newest Vital Sign.

BACKGROUND: Health literacy (HL) refers to the ability to obtain, read, understand, and use basic health care information required to make appropriate health decisions and follow instructions for treatment. The Newest Vital Sign (NVS) is an instrument developed for assessing aspects of HL relevant to reading and numeracy skills. This study aimed to develop a traditional Chinese version of the NVS (NVS-TC) and assess its feasibility, reliability, and validity in Taiwanese patients with type 2 diabetes. METHODS: The original NVS was translated into traditional Chinese in accordance with established guidelines. A cognitive testing procedure was subsequently performed to evaluate the ease of understanding and acceptability of the test in 30 patients with diabetes. Thereafter, a quantitative survey (N = 232) was administered for validating the NVS-TC against the accepted standard tests of HL and participant education level. RESULTS: The internal consistency (Cronbach's α) was 0.76. In accordance with a priori hypotheses, we found strong associations between the NVS-TC and objective HL and weaker associations between the NVS-TC and subjective HL. The known group validity of the NVS-TC was demonstrated through multivariate regression analyses, which showed that educational differences in the NVS-TC scores remained significant after adjustment for age, gender, and working in healthcare. CONCLUSIONS: The results suggest that the NVS-TC is a reliable and valid tool that facilitates international comparable HL research in Taiwan. The NVS-TC can be used to investigate the role of HL in health care and can be easily incorporated into daily clinical practice for diabetes management.

Work Stress, Resilience, and Professional Quality of Life Among Nurses Caring for Mass Burn Casualty Patients After Formosa Color Dust Explosion.

A Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This tragedy inundated hospitals across northern Taiwan with an unprecedented number of burn patients. It caused extreme pressure and challenges for nurses. The purpose of this study is to investigate factors associated with nurses' work stress, resilience, and professional quality of life in caring for dust exposure patients. A cross-sectional survey data was collected from nurses in caring for dust explosion patients. A total of 83 nurses in burn unit, plastic surgery ward, and reconstructive microsurgery unit returned valid data for analysis. Structured questionnaires included demographic inventory, Nurse Stress Checklist, Connor Davidson Resilience Scale, and Professional Quality of Life Scale version 5. The study results showed that work stress deteriorated the professional quality of life, while resilience was a protective factor. Significant positive relationships were observed between work stress, burnout, and secondary traumatic stress. Results of hierarchical regression analysis indicated that resilience helps to ease the deterioration effect of secondary traumatic stress. Results confirm the importance of both work stress and resilience in explaining aspects of professional quality of life. More importantly, resilience was shown as a significant variable impacting level of secondary trauma stress. Intervention in promoting resilience should be targeted in order to reduce secondary trauma among nurses after facing disastrous mass causality incidents.

Association of professional identity, gender, team understanding, anxiety and workplace learning alignment with burnout in junior doctors: a longitudinal cohort study.

OBJECTIVES: To examine how burnout across medical student to junior doctor transition relates to: measures of professional identity, team understanding, anxiety, gender, age and workplace learning (assistantship) alignment to first post. DESIGN: A longitudinal 1-year cohort design. Two groups of final-year medical students: (1) those undertaking end-of-year assistantships aligned in location and specialty with their first post and (2) those undertaking assistantships non-aligned. An online questionnaire included: Professional Identity Scale, Team Understanding Scale, modified Hamilton Anxiety Rating Scale and modified Copenhagen Burnout Inventory. Data were collected on four occasions: (T1) prior to graduation; (T2) 1 month post-transition; (T3) 6 months post-transition and (T4) 10 months post-transition. Questionnaires were analysed individually and using linear mixed-effect models. SETTING: Medical schools and postgraduate training in one UK country. PARTICIPANTS: All aligned assistantship (n=182) and non-aligned assistantship students (n=319) were contacted; n=281 (56%) responded: 68% (n=183) females, 73% (n=206) 22-30 years, 46% aligned (n=129). Completion rates: aligned 72% (93/129) and non-aligned 64% (98/152). RESULTS: Analyses of individual scales revealed that self-reported anxiety, professional identity and patient-related burnout were stable, while team understanding, personal and work-related burnout increased, all irrespective of alignment. Three linear mixed-effect models (personal, patient-related and work-related burnout as outcome measures; age and gender as confounding variables) found that males self-reported significantly lower personal, but higher patient-related burnout, than females. Age and team understanding had no effect. Anxiety was significantly positively related and professional identity was significantly negatively related to burnout. Participants experiencing non-aligned assistantships reported higher personal and work-related burnout over time. CONCLUSIONS: Implications for practice include medical schools' consideration of an end-of-year workplace alignment with first-post before graduation or an extended shadowing period immediately postgraduation. How best to support undergraduate students' early professional identity development should be examined. Support systems should be in place across the transition for individuals with a predisposition for anxiety.

Different perceptions of narrative medicine between Western and Chinese medicine students.

BACKGROUND: Western medicine is an evidence-based science, whereas Chinese medicine is more of a healing art. To date, there has been no research that has examined whether students of Western and Chinese medicine differentially engage in, or benefit from, educational activities for narrative medicine. This study fills a gap in current literature with the aim of evaluating and comparing Western and Chinese Medicine students' perceptions of narrative medicine as an approach to learning empathy and professionalism. METHODS: An initial 10-item questionnaire with a 5-point Likert scale was developed to assess fifth-year Western medical (MS) and traditional Chinese medical (TCMS) students' perceptions of a 4-activity narrative medicine program during a 13-week internal medicine clerkship. Exploratory factor analysis was undertaken. RESULTS: The response rate was 88.6% (412/465), including 270 (65.5%) MSs and 142 (34.5%) TCMSs, with a large reliability (Cronbach alpha = 0.934). Three factors were extracted from 9 items: personal attitude, self-development/reflection, and emotional benefit, more favorable in terms of enhancement of self-development/reflection. The perceptions of narrative medicine by scores between the two groups were significantly higher in TCMSs than MSs in all 9-item questionnaire and 3 extracted factors. CONCLUSIONS: Given the different learning cultures of medical education in which these student groups engage, this suggests that undertaking a course in Chinese medicine might enhance one's acceptance to, and benefit from, a medical humanities course. Alternatively, Chinese medicine programmes might attract more humanities-focused students.

Stages of change concept of the transtheoretical model for healthy eating links health literacy and diabetes knowledge to glycemic control in people with type 2 diabetes.

AIMS: Health literacy has been recognized as a key construct associated with clinical outcomes; however, few studies have explored the mechanism underlying the association. The transtheoretical model (TTM) has long been considered a useful conceptualization in the process of intentional behavior change. Stages of change lies at the heart of the TTM as studies of change have found that people move through a series of stages when modifying behavior. This study focuses on the role of knowledge and stages of change (SOC) as serial mediators linking health literacy to glycemic control. METHODS: In this cross-sectional survey, a total of 232 patients with type 2 diabetes participated in this study. Participants completed questionnaires for assessing health literacy, readiness to consume healthy foods, and a dietary knowledge test specific to diabetes. RESULTS: Low health literacy was significantly associated with worse glycemic control. Statistical evaluation supported the serial mediation model, in which knowledge and SOC formed a serial mediation chain that accounted for the indirect effect of health literacy on glycemic control. In other words, dietary knowledge significantly motivated participants to move into the later stages of behavior change, which in turn improved the outcome of glycemic control. CONCLUSIONS: The results indicate that the ordering of mediators in the pathway between health literacy and health outcome may be complex, help explain the conflicting results of the past, and form a basis for the development of interventions promoting self-management of diabetes through glycemic control.

Developing a measure of medication-related quality of life for people with polypharmacy.

PURPOSE: To develop a measure of medication-related quality of life (MRQoL) and to validate the measure in a hospital-based population of patients with polypharmacy. METHODS: The Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0) included 14 items developed on the basis of interviews with elderly patients with polypharmacy, defined as taking five or more medications simultaneously. This scale was tested in 219 outpatients (99 with polypharmacy and 120 without polypharmacy). Two measures were used to establish construct validity the Psychological Distress Checklist, for convergent validity, and the Medication Adherence Behavior Scale (MABS), for discriminant validity. RESULTS: The 14-item scale was found to be both reliable and valid. Internal consistency reliability evaluated using Cronbach's alpha for this scale was 0.91. Scores on the MRQoLS-v1.0 correlated statistically significantly and negatively with those on the Psychological Distress Checklist. Discriminant validity was demonstrated by low correlation with MABS, indicating that the MRQoLS-v1.0 measured concepts different from medication adherence. Significant differences in the MRQoLS-v1.0 between patients with polypharmacy and those without polypharmacy provided evidence for known-group validity. CONCLUSIONS: The study presents a psychometric evaluation of a measure used to assess MRQoL of patients with polypharmacy. The instrument is practical to administer in clinics and provides a valuable adjunct to the outcome measurement for patients with polypharmacy. Further research on the sensitivity of this instrument to medication change in multi-medicated patients is warranted.

Team innovation climate and knowledge sharing among healthcare managers: mediating effects of altruistic intentions.

BACKGROUND: This paper aims to provide empirical evidence concerning the impact of team climate on knowledge sharing behavior and the mediating effects of individuals' altruistic intentions in the context of healthcare settings. METHODS: Questionnaire data were collected from 212 administrators employed at a medical center in Taiwan. Team climate was assessed by the Team Climate Inventory composed of four factors, participative safety, support for innovation, vision, and task orientation. The proposed hypotheses were tested using structural equation modeling. RESULTS: The influence of the team innovation climate on knowledge sharing behavior was evident. Furthermore, individuals' altruistic intentions played a full mediating role in the relationship between team innovation climate and knowledge sharing behavior. CONCLUSIONS: These results contribute to the field of the people-orientated perspective in knowledge management. The full mediating effect of employees' altruistic intentions provides healthcare team managers the direction to accelerate knowledge sharing behavior.

Evaluation of a common variant of the gene encoding clara cell 10 kd protein (CC10) as a candidate determinant for asthma severity and steroid responsiveness among Chinese children.

OBJECTIVE: The gene (SCGB1A1) encoding Clara cell 10-kDa protein (CC10), a steroid-inducible immune modulator, is a candidate gene for asthma, but the evidence is equivocal. The potential influence of a common variant on asthma severity and serum CC10 levels during acute exacerbation and after corticosteroid treatment in Chinese case-control children and its functional relevance was investigated. METHODS: Genotyping of a non-coding variant G+38A was performed in 489 children, of whom 277 had asthma with varying severity, and 212 healthy controls. Associations were tested for asthma, asthma severity, and responsiveness to steroid treatment. The transcriptional activity of this variant was examined in a Clara-like cell line (H358) using transient transfection assays. RESULTS: Significant association was observed for the combined GA and AA genotypes of the CC10 G+38A variant and an increased risk of asthma [odds ratio (OR), 2.62, p < .001]. This association was correlated with asthma severity (moderate: OR, 2.85, p < .001; near-fatal: OR, 4.81, p < .001). Also, patients with the GA and AA genotypes showed significantly lower serum CC10 (p < .01) and provocation concentration causing a 20% fall (PC(20)) in forced expiratory volume in 1 s (FEV(1)) (p < .0001) when compared with those with the GG. After glucocorticoid treatment, the CC10 levels were significantly increased in asthmatic patients with GG (p < .0001), but not those with the GA and AA genotypes. Moreover, a lower dexamethasone-induced reporter (luciferase) activity was observed for H358 cells transiently transfected with the G38A risk allele (A) compared with wild-type allele (G). CONCLUSIONS: These findings suggest that the CC10 G+38A variant may contribute to the severity of asthma and lower level of steroid responsiveness.

Positive mood as a mediator of the relations among musical preference, postconsumption product evaluation, and consumer satisfaction.

This study of how positive mood mediates the influences of musical preference and postconsumption product evaluation on consumer satisfaction focuses specifically on a model in which positive mood fully mediates the influences. The proposed model is compared with two competing models, and a structural equation model is used to test and compare the three theory-driven models. This study sampled 247 students majoring in management at a single university. They had mean age of 23 yr. (SD=2.5). This study used questionnaires to measure subjects' evaluations of a cup of coffee, preference for the music broadcast in the coffee shop, positive mood, and satisfaction after they had the coffee. Analysis indicated that the proposed model outperformed the two competing models in describing the data using chi-square difference tests. Positive mood was identified as a full mediator of the relationship between musical preference and consumer satisfaction. Moreover, the results demonstrate for service managers the importance of creating positive consumer mood.