Exploring clinical judgment ability in second-degree baccalaureate of science nursing students: A mixed methods study.

BACKGROUND: As they have not yet embarked on clinical practice, most students who already have a bachelor's degree but require a bachelor's degree in nursing occasionally perceive the educator's instruction on clinical situations as abstract and challenging for making accurate clinical judgments. OBJECTIVES: This study aims to implement a clinical judgment model and case scenarios in classroom teaching to evaluate improvements in students' clinical judgment and critical thinking abilities. DESIGN: A mixed-method design. SETTING: A second-degree Bachelor of Science in Nursing at a university in Taiwan. PARTICIPANTS: First-year undergraduate nursing students. METHODS: This mixed-methods study featured a survey at the beginning and end of a course, followed by one-on-one online interviews. A purposive sample of sophomore nursing students was recruited from a university in northern Taiwan between March 2020 and May 2021. Semi-structured interviews were conducted after a preliminary analysis of the collected quantitative data. RESULTS: In total, 48 participants completed the study questionnaire, and 20 were interviewed. The results show that the students' ability to make clinical judgment and identify individual health problems from case scenarios significantly improved after completing the course. However, critical thinking did not differ significantly after the course. Qualitative data analysis revealed three key themes relevant to the participants' learning experiences: (1) establishing the context of clinical judgment, (2) building a bridge between basic medical science and clinical nursing, and (3) having a broader perspective. CONCLUSIONS: Incorporating clinical judgment measurement model and case scenarios in the curriculum may benefit second-degree Bachelor of Science in Nursing students who have not yet begun their clinical practice. Additionally, the result provides educators with valuable learning goals and evaluation strategies in the classroom and clinical practice.

[Advanced Practice Nursing Experience of a Female Adolescent With Leigh Syndrome and Her Family: A Family Strengths-Oriented Therapeutic Conversations Approach].

This article applied a family strengths-oriented therapeutic conversations approach to explore the advanced practice nursing experience of a female adolescent with Leigh Syndrome and her family. During the nursing care period from September 20 to November 19, 2022, the author collected data through direct care, observation, interview, telecare, home visits, and medical record reviews and confirmed the nursing problems to be the inadequate coping capability of the family. The author leveraged her advanced nurse practitioner role and used family strength-oriented therapeutic conversations to enable the parents of the patient to reflect on their experiences with this disease and to improve their quality of life and satisfaction with healthcare services. Three modes of care, including accessibility, coordination, and comprehensiveness, were offered to the female adolescent patient and her family to achieve the goal of family-centered, community-based, and medical-system-centered care. It is suggested that before making healthcare decisions, patients and their families should be given the opportunity to participate in the healthcare process and reach consensus on healthcare decisions based on existing evidence and their values and preferences. The medical decisions made by patients and their families after carefully considering their current situation and needs should be supported and assisted.

Psychometric evaluation of the traditional chinese version of PedsQL™ 3.0 cardiac module scale in adolescents with congenital heart disease: reliability, validity, measurement invariance, and adolescent-parent agreement.

BACKGROUND: In recent decades, 95% of children with congenital heart disease (CHD) can survive to adolescence and adulthood. However, adolescents with CHD are prone to poorer health-related quality of life (HRQoL). It is imperative to develop a reliable and valid instrument for health professionals to monitor the HRQoL. This study aims to: (1) evaluate the psychometric properties of the traditional Chinese version of Pediatric Quality of Life™ 3.0 Cardiac Module (PedsQL-CM) and measurement invariance across adolescents with CHD and their parents; and (2) investigate the adolescent-parent agreement in HRQoL. METHODS: A total of 162 adolescents and 162 parents were recruited. Internal consistency was examined using Cronbach's alpha and McDonald's Omega. The criterion-related validity was evaluated with intercorrelations between the PedsQL-CM and PedsQL™ 4.0 Generic Core (PedsQL-GC) Scale. The construct validity was examined by second-order confirmatory factor analysis (CFA). Measurement invariance was evaluated using the multi-group CFA. The adolescent-parent agreement was analyzed with the intraclass correlation (ICC), paired t-tests, and Bland-Altman plots. RESULTS: PedsQL-CM showed acceptable internal consistency (self-reports 0.88, proxy-reports 0.91). The intercorrelations were medium to large effect size (self-reports 0.34-0.77, proxy-reports 0.46-0.68). The CFA supported the construct validity (CFI = 0.967, TLI = 0.963, RMSEA = 0.036, 90% CI = 0.026-0.046, SRMR = 0.065). The multi-group CFA proved scalar invariance between self and parent proxy-reports. Parents significantly underestimated their adolescents' HRQoL in cognitive problems (Cohen's d = 0.21) and communication (Cohen's d = 0.23) subscales, while there was a negligible difference in total HRQoL (Cohen's d = 0.16). ICCs were poor to moderate effect size with the highest and lowest agreement in heart problems and treatment subscale (ICC = 0.70) and communication subscale (ICC = 0.27), respectively. The Bland-Altman plots showed lesser variability in the heart problem and treatment subscale and the total scale. CONCLUSION: The traditional Chinese version of PedsQL-CM has acceptable psychometric properties to measure disease-specific HRQoL in adolescents with CHD. Parents may be proxies for adolescents with CHD to rate total HRQoL. When the patient-reported score is the primary outcome, the proxy-reported score could serve as a secondary outcome for research and clinical evaluation.

Physical function mediates the effects of sensory impairment on quality of life in older adults: Cross-sectional study using propensity-score weighting.

AIMS: To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life. DESIGN: A cross-sectional study. METHODS: Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function. RESULTS: After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults. CONCLUSION: Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function. IMPACT: The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.

Association between lifestyle-related, psychosocial factors and obesity among female adolescents in Taiwan.

PURPOSE: To examine a wide range of potential contributors to the risk of obesity in female adolescents. DESIGN AND METHODS: Data for this study were collected using a cross-sectional design. A group of 175 female adolescents were recruited, and information on their demographic characteristics, lifestyle-related behaviors, and psychosocial factors was collected using a self-administered questionnaire during September 2018 to January 2019. Data were analyzed using SPSS 24.0. RESULTS: An overestimation of body weight was negatively correlated with overweight in the female adolescents. Age at menarche was negatively correlated with the arisk of overweight. Adolescents who slept for >7 h on weekend nights were less likely to be overweight. Eating more cheese, fish, seafood, and organ meats was negatively correlated with obesity risk. The female adolescents were more likely to become overweight if they ate dinners prepared by family and experienced more disturbances from parents and other family members. CONCLUSIONS: Female adolescents are a unique population affected by obesity. Although incorporating both lifestyle-related behavioral and psychosocial factors in future investigations and developing multicomponent interventions for obesity prevention are crucial, female adolescents should receive the utmost attention from researchers to alleviate the health burden of obesity. PRACTICE IMPLICATIONS: The intertwined nature of obesity-related factors warrants future investigations to elaborate their roles interplaying with the risk of obesity. Multicomponent interventions should be developed, and nurses and health-care providers should target their efforts on obesity prevention for this specific population.

The relationship between safety climate and nurses' safe handling of chemotherapy: A partial least squares structural equation modeling analysis.

PURPOSE: Safety climate plays a critical role in nurses' safety behaviors. However, few are aware of the safety climate sub-dimensions associated with safety behavior. This study aimed to investigate the relationship between nurses' perception of the workplace safety climate and their safety behavior regarding the handling of chemotherapy upon intravenous administration. METHODS: This study included a cross-sectional survey of nurses recruited by purposive sampling at three hospitals in Taiwan. A total of 484 self-administered questionnaires were returned. Each participant had to complete the questionnaire that was developed by the authors, including the Taiwanese Safety Climate Instrument and Chemotherapy Safety Precautions Questionnaire. Exploratory factor analysis and Confirmatory factor analysis was conducted to verify the psychometric properties. We used the samples (N = 247) for confirmatory factor analysis to verify the model using partial least squares structural equation modeling. RESULTS: We found that nurses' perceptions of workplace safety climate can explain and predict their safety behavior regarding administration chemotherapy, particularly the dimension of "perception of interaction with colleagues," "experience of clinical jobs hindering the use of personal protective equipment," "perception of comfort using personal protective equipment," and "easy usage of personal protective equipment." The study further revealed that the dimensions of the Taiwanese Safety Climate Instrument were moderate predictors of the Chemotherapy Safety Precautions. CONCLUSIONS: Nurses have a positive perception of the workplace safety climate and frequently implement behaviors regarding the safe handling of chemotherapy. Organizational managers should enable nurses to share their perceptions of workplace safety with their colleagues and purchase easy-to-use and comfortable personal protective equipment.

Comparison of long-term effects of exergaming (Xbox one kinet) and companionship programs on attitude towards dementia and the older adults among adolescents: a quasi-experimental longitudinal study.

BACKGROUND: Many studies have been performed on the use of intergenerational programs to improve the negative attitudes and misunderstandings of adolescents toward older people with dementia. However, the findings of these studies are inconclusive. The aim of this study was to compare the long-term effects of exergaming (Kinect) and companionship programs on attitudes toward dementia and the elderly among adolescents. METHODS: A quasi-experimental longitudinal design was used. A total of 200 adolescents aged 12-18 years old were recruited from nine schools in northern Taiwan. The adolescents were assigned to five different groups, namely, a 5-week exergaming group, a 5-week companion group, an 8-week exergaming group, an 8-week companion group, and a control group, using a single blinding procedure. Data collection was performed pretest, post-test and at 1, 3 and 6 months after the post-test. The long-term effects of the two programs (i.e., exergaming and companionship) were analyzed using a generalized estimating equation. RESULTS: Regarding attitudes toward dementia, the 8-week exergaming group had a significantly better attitude than the control group at the 6-month follow-up (p < 0.001). Similarly, the results of the 8-week companion group also showed a significantly improved attitude compared with the control group at the 6-month follow-up (p = 0.041). Regarding attitudes toward the elderly, the 8-week exergaming group had a significantly better attitude than the control group at the 6-month follow-up (p < 0.001). The 8-week companion group had a similar effect on better attitude compared with the control group at the 6-month follow-up (p = 0.016). Furthermore, the 5-week companion group showed a significant improvement compared with the control group at the 6-month follow-up (p = 0.004). CONCLUSIONS: Spending companionship time with older adults is beneficial for improving the attitudes of adolescents toward the elderly. Furthermore, exergaming improves the attitudes of adolescents toward both dementia and older adults. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2100053003 . Retrospectively registered on 07/11/2021.

Development and psychometric testing of the safety climate instrument suitable for nurses handling chemotherapy drugs.

AIM: To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs. DESIGN: This is an instrument development study. METHOD: All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis. RESULTS: The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43-item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value. CONCLUSION: Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties. IMPACT: This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions.

Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study.

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.

Energy Balance-Related Behaviors and Body Mass Index in Asian School-Aged Children With Congenital Heart Disease.

BACKGROUND: Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health. Most studies on CCHD have taken place in Western societies, leaving Asian populations understudied, especially children. OBJECTIVE: We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD. METHODS: In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8% moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurements were taken in the hospital. Independent predictors of EBRBs and health conditions were calculated through logistic regression analysis. RESULTS: Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the New York Heart Association classification II to IV were associated with being overweight/obese. CONCLUSIONS: Sedentary lifestyle is seemingly the only EBRB correlated with being overweight. Physical activity programs for children may help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries.

Validation of the Chinese version of the Life-Space Assessment in community-dwelling older adults.

The Life-Space Assessment (LSA) is a comprehensive tool for assessing mobility in older adults, but the evidence of its psychometric properties in Chinese older adults is lacking. The aim was to adapt and validate the psychometric properties of the Chinese version of the Life-Space Assessment (LSA-C) in community-dwelling older adults. A cross-sectional study was designed with 225 community-dwelling older adults. The content validity of the LSA-C was satisfactory. The criterion validity was supported by significant correlation between the LSA-C and the Multidimensional Functional Assessment Questionnaire (MFAQ). Additionally, the LSA-C was negatively correlated with the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and positively correlated with the General Health subscale of the Short-Form-36 Health Survey (GH of the SF-36), implying good construct validity. Finally, the LSA-C showed excellent stability (intraclass correlation coefficient = 0.88). The LSA-C demonstrates adequate psychometric properties, supporting its use in future research in the Chinese context.

Health literacy in children with asthma: A systematic review.

Health literacy (HL) is a key factor influencing asthma management outcomes and has primarily been focused on adult patients. The relationship between children's HL and asthma is unclear, and several research gaps are present in the direct assessment of children's HL. In this study, a systematic review of the relevant literature was conducted to elucidate the relationship between HL and asthma among children. An electronic database search was performed to obtain studies published between January 2005-August 2016. Inclusion and exclusion criteria and quality appraisal were applied to include only studies that would aid assessment of the relationship between HL and asthma among children. This review identified 13 such studies, most of which have explored the outcomes of the relationship between parental HL and children's asthma; the review revealed that having parents with low HL is associated with poor asthma control and increased health care utilization. However, children's HL is yet to be completely understood, and few studies have been conducted on the direct assessment of children's HL. In addition, our review found that, although only a few instruments have been developed to specifically assess children's HL, these were unsatisfactory and did not completely include the components of HL, particularly those specific to patients with asthma. The selection of controls for potential variables was different, and the variations in measuring instruments and research settings posed difficulties in the literature review. Additional longitudinal studies or structural equation modeling tests are required to identify the causal effects of HL and relative outcome variables.

Adolescent Perceptions of Peer Responses to Diabetes Self-Management: A Qualitative Study.

BACKGROUND: Type 1 diabetes (T1D) is more prevalent in adolescents than in adults, and the self-management of insulin-dependent diabetes is complex. T1D requires injections of insulin, self-management of blood testing, regular physical activity, and diet monitoring, which are challenging for growing and developing adolescents. Adolescents are often more concerned with how they are perceived by their peers than how they perceive themselves. Positive peer responses influence the self-care management of adolescents with T1D in school settings. By contrast, negative peer responses and avoidance behaviors threaten to negatively affect the health outcomes of adolescents with T1D. Evidence indicates that peer influence is crucial to the successful self-management of diabetes in adolescents. However, very few studies have investigated the effect of peer influence on adolescents with T1D. PURPOSE: This article describes how adolescents with T1D perceive the responses of their peers to their diabetes self-management in school settings. METHODS: Ten 12- to 17-year-old adolescents with diabetes were recruited from a pediatric endocrinology clinic at a university hospital in Taiwan. Audio-recorded interview data were transcribed verbatim and reviewed for accuracy. A thematic analysis approach was used to analyze the narrative content of semistructured interviews with participants. The rigor of the data collection and analysis was emphasized. RESULTS: Analysis of peer responses to the diabetes care practices of the participants revealed six themes: knowledge seeking, curiosity, enthusiasm, empathy, fearfulness, and isolation and bullying. Subthemes were categorized to illustrate how adolescents with T1D balance the challenge of diabetes self-care regimens and normal peer interactions. They were coping with the requirements of their T1D regimen and hoping to determine the perceptions of their peers toward this regimen and themselves. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Understanding the perception of peer identity for adolescents with T1D provides information for diabetes education and assists school nurses to facilitate successful T1D management in adolescents.

Suitability of asthma education materials for school-age children: Implications for health literacy.

AIMS AND OBJECTIVES: To investigate the suitability of asthma education materials for school-age children with asthma and elucidate how these children used their health-literacy abilities to identify whether the materials can be accepted, comprehended and applied. BACKGROUND: Effective asthma self-management education is influenced by the suitability of materials and an individual's health literacy. DESIGN: A mixed-method research design was developed using quantitative and qualitative surveys. METHODS: The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school-age children (age: 8-12 years) were recruited and interviewed. RESULTS: In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video-based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth-grade or younger children, whereas the remaining materials were considered suitable for sixth-grade or older children. The following six health-literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self-care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements. CONCLUSIONS: The video-based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children. RELEVANCE TO CLINICAL PRACTICE: The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for children to strengthen their literacy in asthma management.

Meta-prediction of MTHFR gene polymorphism-mutations, air pollution, and risks of leukemia among world populations.

The major objective of this study was to examine the association between Methylenetetrahydrofolate Reductase (MTHFR) polymorphisms and the risk of various types of leukemias across the lifespans of children and adults by using the meta-predictive techniques. The secondary objective was to examine the interactions among epigenetic risk factors (including air pollution), MTHFR polymorphisms, and the risks of developing leukemia. We completed a comprehensive search of 6 databases to find 54 studies (10,033 leukemia cases and 15,835 controls) for MTHFR 677, and 43 studies (8,868 cases and 14,301 controls) for MTHFR 1298, published from 1999 to 2014. The results revealed that, in European populations; childhood populations; children from Europe, East Asia, and America; and children with acute lymphocytic leukemia (ALL), MTHFR 677 polymorphisms (both TT and CT types together and individually) are protective, while CC wildtype was leukemogenic. In addition, MTHFR 1298 polymorphisms were protective against ALL and acute myeloid leukemia in European children, and in chronic myeloid leukemia in all adults worldwide and American adults. Air pollution played a role in the increased polymorphisms of MTHFR 677 genotypes in childhood leukemia.

Parental Body Mass Index Is Associated With Adolescent Obesity in Taiwan.

Adolescent obesity is a crucial public health concern, and understanding its risk factors can facilitate the establishment of prevention policies. In this study we investigated the prevalence of adolescent obesity in Taiwan, determined the influential factors, and compared the prevalence of obesity in our study population with international indices. The cross-sectional study was an analysis of data from the 2010-2011 Nutrition and Health Survey in Taiwan, an anthropometric measurement and questionnaire survey of adolescents aged 11-18 years. Our sample was 1,826 adolescents (910 males and 916 females). Data were analyzed using logistic regression modeling. Based on body mass index standards specific to Taiwan norms, the prevalence of overweight and obesity in Taiwan adolescents was 12.4% and 16.8%, respectively. The prevalence was lower when international indices of overweight and obesity were applied. In logistic regression, obesity was linked to male gender, an obese father, overweight or obese mother, poor dietary attitudes, and perceived low dietary benefits. Monitoring and preventing adolescent obesity should focus on both adolescents and their parents. When planning behavioral change and education for adolescent obesity, health professionals and policy-makers should view the family as a unit. © 2016 Wiley Periodicals, Inc.

Integrative traditional Chinese medicine therapy reduces the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus.

ETHNOPHARMACOLOGICAL RELEVANCE: Life-long insulin is the standard treatment for type 1 diabetes mellitus (T1DM). The role of traditional Chinese medicine (TCM) in T1DM is still not clear. The aim of this study is to explore the prescription pattern of TCM and its impact on the risk of diabetic ketoacidosis (DKA) in patients with T1DM. MATERIALS AND METHODS: We retrieved samples from the registry for catastrophic illness patients from the National Health Insurance Research Database (NHIRD). Based on a frequency (1:4) matched case-control design, patients with T1DM in 2000-2011 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with T1DM was analyzed. The incidence of DKA and the annual costs of emergency visits and hospitalizations were evaluated for all causes. RESULTS: Overall, 416 subjects were TCM users, whereas a total of 1608 matched subjects were classified as non-TCM users. The most common Chinese herbal formula and single herb is Liu-wei-di-huang-wan (Six-ingredient pill of Rehmannia) and Huang-qi (Radix Astragali; Astragalus membranaceus (Fisch.) Bunge, Astragalus membranaceus var. mongholicus (Bunge) P.K.Hsiao), respectively. Compared with non-TCM users, we found a 33% reduction in DKA incidence for all TCM users (aHR 0.67, 95% CI 0.56-0.81, p <0.000) and a 40% reduction for users receiving TCM treatment for more than 180 days (aHR 0.58, 95% CI 0.41-0.82, p <0.01). There were no significant differences between TCM users and non-users in the frequency and medical costs of emergency visits and hospitalizations. CONCLUSIONS: Integrative TCM use may reduce the risk of DKA in patients with T1DM. Our results suggest that TCM may have a substantial positive impact on the management of TIDM.

Physical Activity in School-Aged Children with Asthma in an Urban City of Taiwan.

BACKGROUND: It has been reported that physical activity is limited in children with asthma. The aims of this study were to compare and quantify the physical activity levels between asthmatic children and their healthy peers. Factors associated with limitation of physical activity in asthmatic children were also investigated. METHODS: A total of 120 asthmatic children and 262 age-matched healthy controls were enrolled in this study. Clinical phenotype including severity and lung function were obtained from medical records. A questionnaire addressing physical activity, asthma diagnosis, symptoms, parental health beliefs, physician's advice and, community resources was accomplished by children and their parents. The physical activity levels of children with and without asthma were compared. Factors that might limit the activity level were analyzed. RESULTS: Children with asthma were less active than their peers. The significant difference was between normal controls and moderate-to-severe asthmatic children, but not children with mild asthma. Among children with asthma, physical activity was associated with the severity level but not parental health beliefs, physician's advice, or the convenience for physical activity. Children with moderate or severe persistent asthma were more likely to be inactive. CONCLUSION: Children with asthma had a lower level of physical activity, particularly those with moderate-to-severe asthma. To achieve an appropriate level of physical activity, improvement of asthma management and control is considered important.

Development and psychometric testing of a chinese version of the caregiver burden index for parents of children with allergies.

UNLABELLED: BACKGROUNG: No specific instrument has thus far been developed for measuring the caregiver burden perceived by parents of children with allergies (CWA). OBJECTIVES: To determine the psychometric properties of the Caregiver Burden Index (CBI). METHODS: A mixed-methods design was adopted to evaluate the psychometric properties of the scale. RESULTS: The content validity index was 0.89, and the internal consistency was high with a coefficient alpha of 0.98. Three factors were extracted after exploratory factor analysis. CONCLUSION: The study findings suggest that the CBI has sufficient reliability and validity to evaluate the caregiver burden of parents of CWA.