Reliability and validity of the Taiwanese version of the collaborative practice assessment tool: A pilot study.

Objectives: To promote teamwork communication and collaboration between health-care professionals, educators emphasized proper training programs to develop interprofessional collaborative practice (IPCP) among postgraduate (PG) trainees. A literature review indicated that the faculty necessarily measured the competency in IPCP with structured and applicable assessment tools in collocation to training programs domestically. A cross-sectional psychometric study was conducted to construct a reliable assessment tool for measuring PG learning outcome in Taiwan through a bidirectional translation. The study aimed to assess the interprofessional team behavior of trainees using the Taiwanese version of the collaborative practice assessment tool (T-CPAT). Materials and Methods: The study recruited 43 participants to undergo a PG training program in a single institute and to complete T-CPAT. Data were analyzed using SPSS 22.0 software. We employed descriptive analysis of demographic variables. The validity of T-CPAT was analyzed by experts in different specialties and its availability was assessed by item-level analysis. Furthermore, the T-CPAT reliability was tested using Cronbach's α. Results: The average score was 305.2 (standard deviation = 38.08), and the expert validity of the T-CPAT was 0.96. In the item-level analysis, there were no failure items in T-CAPT. Cronbach's α reached 0.94 (95% confidence interval = 0.90-0.96). Conclusion: The study demonstrated good reliability and validity for the T-CPAT. Thus, the T-CPAT can be used to accurately measure and assess the competence of IPCP in PG trainees in general medicine in Taiwan. The results were deemed sufficient to provide faculties with related arrangements for future teaching plans.

Hypertension: A National Cross-Sectional Study in India.

OBJECTIVE: Hypertension is a global public health problem. This article aimed to estimate the national prevalence of hypertension in India for both women and men. The study had also examined the demographic and socioeconomic status of hypertensive women and men. METHODS: The study used the National Family Health Survey 4 from all over India. Hypertension of 661 771 women (15-49 years) and 104 357 men (15-54 years) and their demographic and socioeconomic variables were assessed. Crosstabulation, chi-square tests, and multivariate logistic regression were used. RESULTS: The prevalence of hypertension in women and men were 11.40% and 18.10%, respec- tively. State-wise, Sikkim had shown the maximum prevalence. Older women (45-49 years) and men (50-54 years) had the highest hypertension prevalence among all age groups. Urban people had shown proportionately more hypertension than rural people. Education, working status, and richer economic status emerged as significant risk factors. Women with lower edu- cational status and men with higher educational status were more likely to be hypertensive. Working people were more hypertensive than their non-working peers. Economically, sound men were more hypertensive than poor people. Hypertensive people accessed medical care more. CONCLUSION: There are various modifiable risk socioeconomic factors associated with hyperten- sion. Policymakers can consider the current findings for better preventive planning. The risk factors identified in the study should be considered with appropriate weightage.

The Efficacy of Acupuncture Treatment for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis.

BACKGROUND: This study aimed to assess the efficacy of acupuncture for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents. PATIENTS AND METHODS: Systematic review and meta-analysis including randomized controlled trials that compared the effects of acupuncture treatment (AT) with pharmacotherapy (methylphenidate hydrochloride, MPH) among patients with ADHD. A total of 12 electronic databases were searched from inception until February 3, 2020. The main outcomes were the effective rate and post-treatment hyperactivity scores. We also assessed the incidence of adverse events and follow-up course. RESULTS: A total of 10 studies involving 876 patients were included in this study. The meta-analysis revealed that AT yielded a significantly higher effective rate than MPH (odds ratio 2.239, 95% CI 1.438-3.487, p < 0.001, 8 studies), and that AT can reduce the hyperactivity scores to a lesser degree than MPH (standardized mean difference = -0.882, 95% CI -1.295 to -0.469, p < 0.001, 3 studies). Two studies reported no adverse events in the AT group, while one study suggested that AT can reduce adverse drug reactions. Furthermore, 3 studies concluded that the effects of AT were maintained, even after completion of treatment. CONCLUSION: This study suggests that AT may be more beneficial than MPH therapy for ADHD patients. However, the evidence may be highly limited, especially considering the outcome of hyperactivity scores with the high risk of bias, very low GRADE, and small number of studies. Thus, further studies of rigorous design and high quality are needed to confirm and strengthen the results, especially in the Western part of the world. Additionally, well-designed randomized controlled trials that evaluate adverse events and include a long-term follow-up should be conducted to determine the efficacy, safety, and side effects of AT for ADHD in children and adolescents.

Prevalence of intimate partner violence against women in Republic of Benin.

The present study was conducted to estimate the prevalence of intimate partner violence against women (IPVAW) of reproductive age in Benin and to assess the factors related to the experience of IPVAW and attitude towards wife beating among women. The study also assessed whether a family history of violence is a risk factor for experiencing IPVAW. The study used the Benin Demographic and Health Survey 2017-18 data for analyses. A national representative sample of 4488 ever married women was selected to respond to a domestic violence and abuse questionnaire. Cross-tabulation and multivariate logistic regression analyses were performed. The prevalence of IPVAW experience in Benin was as follows: emotional violence, 35.4%; physical violence, 18.4%; and sexual violence, 8.2%. Older age, rural residence, the practice of Vodoun religion, living in a household headed by a male member, family history of domestic violence, and attitudes towards wife beating were significantly associated with the prevalence of IPVAW. Thirty-two percent of women supported wife beating. Women residing in urban areas, having higher educational qualification, higher socioeconomic status, and no family history of domestic violence were less likely to support wife beating. Policymakers should place emphasis on evidence-based prevention programs, gender equality, women empowerment, and policy priority for curbing IPVAW.

Maternal Delivery at Home: Issues in India.

INTRODUCTION: Maternal delivery at home without skilled care at birth is a major public health issue. The current study aimed to assess the various contributing and eliminating factors of maternal delivery at home in India. The reasons for not delivering at healthcare facilities were also explored. METHODS: The study used the National Family Health Surveys (NFHS)-4 (2015-2016) data from states and union territories of India for analysis. A national representative sample of 699,686 women of reproductive age group (15-49 years) was used. Cross-tabulation and multivariate logistic regression analyses were performed. RESULTS: The prevalence of home delivery in India was 22%, among which 34% of women believed that institutional delivery was not a necessity. Financial constraints, lack of proper transportation facilities, non-accessibility of healthcare institutions and not getting permission from family members were the main reasons cited by the women for delivering at home. The proportion of home deliveries was much higher among women from more disadvantaged socioeconomic areas than women from less disadvantaged socioeconomic areas. Domestic violence and partner control were essential factors contributing to the prevalence of home delivery. However, the women who owned mobile phones and used a short message service (SMS) facility delivered at home less often. CONCLUSION: Policymakers should focus more on the women living in disadvantaged socioeconomic areas and other marginalised populations with less education and low economic levels to provide them with optimum delivery care utilisation. Strengthening of public healthcare facilities and more effective use of skilled birth attendents and their networking are essential steps. Electronic and economic empowerment of women should be emphasised to bring about a significant reduction in the proportion of home deliveries in India.

Fill the gap between traditional and new era: The medical educational reform in Taiwan.

The 7-year medical education program in Taiwan has been established since 1949. More than 60 years later, many medical professionals have observed and voiced its deficiencies following the outbreak of severe acute respiratory syndrome. The deficiencies are three-fold: (1) specialties are excessively institutionalized, (2) students engage in passive learning and memorization, and (3) passing one written national examination serves as the means of granting permanent physician qualification. The situation has aroused concerns and discussions among medical professionals and educators for a new medical education program. Authorized by the Conference of Deans of Medical Schools in Taiwan, Prof. Chyi-Her Lin assembled a team for planning medical curricular reform. Subsequently, Prof. Shan-Chwen Chang organized a task force team which has been monitoring the new 6-year program since 2013. The aims of medical reform by Prof. Lin are (1) to eliminate the specialty training part, (2) to use innovative teaching methods to motivate students to learn proactively, and (3) to implement competency-based medical education. Now, the first class of physicians will enter the workplace in 2019, subject to various clinical challenges.

Adolescent girls' attitudes toward female genital mutilation: a study in seven African countries.

Background: The study's aim is to examine adolescent girls' attitudes toward the continuation or discontinuation of female genital mutilation (FGM) in association with their demographics in seven different countries in Africa. Methods: Data from the women's survey of the Demographic and Health Surveys (DHS) conducted by the respective ministries (of Health and Family Welfare) in Egypt, Guinea, Kenya, Mali, Niger, Senegal and Sierra Leone were used. Adolescent girls (15-19 years) were included in the current analysis: Egypt (N=636), Guinea (N=1994), Kenya (N= 1767), Mali (N=2791), Niger (N=1835), Senegal (N=3604), Sierra Leone (N=1237). Results: Prevalence of supporting the continuation of FGM among adolescent girls was in Egypt 58%, Guinea 63%, Kenya 16%, Mali 72%, Niger 3%, Senegal 23%, and Sierra Leone 52%. Being Muslim and having low economic status were significantly associated with supporting the continuation of FGM in five of the participating countries. Girls having no education or only primary education in Guinea, Kenya, Mali and Sierra Leone exhibited a higher likelihood of supporting FGM than girls with secondary or higher education. In Egypt, Niger and Senegal there was no association between education and supporting FGM. The girls who stated that they had no exposure to media showed the higher likelihood of supporting FGM in Guinea, Kenya, and Senegal than those with exposure to media. Conclusions: The current study argues that increasing media coverage and education, and reducing poverty are of importance for shifting adolescent girls' attitudes in favor of discontinuation of FGM.

Analyzing the effectiveness of teaching and factors in clinical decision-making.

OBJECTIVE: The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an "Analogy guide clinical decision-making" as a learning intervention for junior doctors. MATERIALS AND METHODS: This study had a "quasi-experimental design" and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the "Analogy guide for teaching clinical decision-making" every day for 3 months. Program Evaluation: A "Clinical decision-making self-evaluation form" was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted. RESULTS: We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience. CONCLUSION: Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making.

Translation, adaptation, and validation of the behavioral pain scale and the critical-care pain observational tools in Taiwan.

This study describes the cultural adaptation and testing of the behavioral pain scale (BPS) and the critical-care pain observation tools (CPOT) for pain assessment in Taiwan. The cross-cultural adaptation followed the steps of translation, including forward translation, back-translation, evaluation of the translations by a committee of experts, adjustments, and then piloting of the prefinal versions of the BPS and the CPOT. A content validity index was used to assess content validities of the BPS and the CPOT, with 0.80 preset as the level that would be regarded as acceptable. The principal investigator then made adjustments when the content validity index was <0.80. The pilot test was performed with a sample of ten purposively selected patients by 2 medical staff from a medical care center in Taiwan. The BPS and the CPOT are adequate instruments for the assessment of pain levels in patients who cannot communicate due to sedation and ventilation treatments.

The effects of Chinese five-element music therapy on nursing students with depressed mood.

This study aimed to evaluate the effects of Chinese five-element music therapy on nursing students with depressed mood. We randomly assigned 71 nursing students from Taiwan with depressed mood to the music and control groups. The music group (n = 31) received Chinese five-element music therapy, whereas the participants in the control group (n = 40) maintained their routine lifestyles with no music therapy. All of the participants were assessed using the Depression Mood Self-Report Inventory for Adolescence, and their salivary cortisol levels were measured. The study found that there was a significant reduction in depression between the pre- and posttherapy test scores and in salivary cortisol levels over time in the music group. After receiving the music therapy, the nursing students' depression levels were significantly reduced (P = 0.038) compared with the control group (P < 0.001). These results indicate that the Chinese five-element music therapy has the potential to reduce the level of depression in nursing students with depressed mood.

Cyber bullying prevention: intervention in Taiwan.

BACKGROUND: This study aimed to explore the effectiveness of the cyber bullying prevention WebQuest course implementation. METHODOLOGY/FINDINGS: The study adopted the quasi-experimental design with two classes made up of a total of 61 junior high school students of seventh grade. The study subjects comprised of 30 students from the experimental group and 31 students from the control group. The experimental group received eight sessions (total 360 minutes) of the teaching intervention for four consecutive weeks, while the control group did not engage in any related courses. The self-compiled questionnaire for the student's knowledge, attitudes, and intentions toward cyber bullying prevention was adopted. Data were analysed through generalized estimating equations to understand the immediate results on the student's knowledge, attitudes, and intentions after the intervention. The results show that the WebQuest course immediately and effectively enhanced the knowledge of cyber bullying, reduced the intentions, and retained the effects after the learning. But it produced no significant impact on the attitude toward cyber bullying. CONCLUSIONS/SIGNIFICANCE: The intervention through this pilot study was effective and positive for cyber bulling prevention. It was with small number of students. Therefore, studies with large number of students and long experimental times, in different areas and countries are warranted.

The development and psychometric evaluation of the Chinese version of the Maternal Attachment Inventory.

AIMS AND OBJECTIVES: To develop the Maternal Attachment Inventory (MAI) into Chinese and assess its psychometric properties. BACKGROUND: The MAI measures of maternal affectionate attachment. This scale displays the most appropriate indicators associated with attachment and has been widely adopted in different fields for measuring maternal-infant attachment. DESIGN: Cross-sectional survey design. METHODS: The study was carried out in two clinics. From the accessible population of 507 samples, a simple random sampling method of selection was used to randomly choose 200 names of mothers at 4-8 months after delivery using a computer. One hundred and eighty-one mothers agreed to participate in the study. The Chinese version of the MAI (CMAI) was developed in five stages: translation, review, back-translation, a review by a panel of specialists and a pilot test. Regarding the reliability of the CMAI, a test of correlations between the subscales and the entire scale was performed consecutively. With respect to the validity of the MAI, exploratory factor analyses, a test of relationships between items and subscales, and an analysis of concurrent criterion-related validity were conducted. RESULTS: The CMAI contains four factors in its structure. The CMAI and its subscales possess good internal consistency; the Cronbach's α coefficient was 0·94. In addition, the Pearson product-moment correlation coefficient between the CMAI and the Maternal-Fetal Attachment Inventory (MFAI) and between the CMAI and the Maternal-Infant Attachment Inventory (MIAI) was 0·38 and 0·5, respectively. This suggests significant medium and high respective correlations between the CMAI and these two scales. One major limitation of this study is that participants were recruited from two clinics located in central Taiwan. CONCLUSIONS: The CMAI possesses acceptable reliability and validity for use in measuring the levels of attachment and affectional ties between mothers and their infants. RELEVANCE TO CLINICAL PRACTICE: The CMAI provides further evidence of the applicability of the CMAI in clinical maternity care services.

Male adolescents' attitudes toward wife beating: a multi-country study in South Asia.

PURPOSE: This study has aimed to address the gaps in knowledge about male adolescents and their attitudes toward wife beating in multi-country study in Bangladesh, India, and Nepal. METHODS: The study used secondary data generated from nationally representative samples of male adolescents (aged 15-19 years) in the demographic and health surveys data in Bangladesh, India, and Nepal. These were household surveys using structured questionnaires, with 275 boys in Bangladesh, 13,078 boys in India, and 939 boys in Nepal. Chi-square tests and logistic regressions were used to assess the associations. RESULTS: In Bangladesh, 42% of 275 respondents had justified wife beating; in India, 51% of 13,078 male adolescents had supported wife beating; and in Nepal, 28% of 939 respondents had supported wife abuse. Individual-level factors, such as rural residency, low educational attainment, low economic status, being unemployed, and having a history of family violence, were positively associated with the justification of wife abuse. CONCLUSIONS: This multi-country study indicates a general trend of male adolescents' strong supportive attitude toward wife beating, and hence may suggest that policy makers can specifically target young groups of the population for various interventions for reducing violence against women.

The impact of social support and job stress on public health nurses' organizational citizenship behaviors in rural Taiwan.

OBJECTIVE: To examine the relationship between job stress, social support, and organizational citizenship behaviors, by using job satisfaction and organizational commitment as intervening variables among public health nurses (PHNs) in rural areas of Taiwan. DESIGN: A cross-sectional design was used to sample all 265 PHNs in two rural counties of Taiwan. Of those, 231 (87.2%) PHNs responded. METHOD: A mailed survey questionnaire was sent to subjects for completion in early 2004. Responses were analyzed using descriptive statistics, exploratory factor analyses, and multiple regression analyses. With six multiple regression models, intervening effects were explored by the approach of Baron and Kenny (1986). RESULTS: Supervisor support indirectly influenced organizational citizenship behaviors through the intervening effect of organizational commitment, whereas, kinship support, role ambiguity, and workload demonstrated direct impacts on organizational citizenship behaviors. CONCLUSIONS: This study provides insights into how social support and job stress impacted PHNs' organizational citizenship behaviors. Those PHNs who experienced more supervisor support exhibited higher levels of organizational citizenship behaviors via the intervening effect of organizational commitment.

The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan.

BACKGROUND: Agitated behaviours are identified by caregivers as the most challenging in dementia care. Alternative approaches reducing occurrence of agitated behaviours and the need for chemical or physical restraints become valuable for institutionalized elders with dementia. OBJECTIVE AND SETTING: This study was to evaluate the effects of group music with movement intervention on occurrence of agitated behaviours of institutionalized elders with dementia in Taiwan. METHODS: A randomized controlled trial was used. Thirty-six institutionalized elders with dementia completed the study, with 18 in the experimental group receiving group music with movement intervention twice a week for 4 weeks and 18 in the control group receiving usual care without intervention. Modified Cohen-Mansfield Agitation Inventory was used to assess agitated behaviours at baseline, weeks 2 and 4. RESULTS: Agitated behaviours were significantly reduced in the experimental group following 4 weeks of group music with movement intervention compared to that of the control group (p<0.001). CONCLUSIONS: Group music with movement intervention can be beneficial in managing agitated behaviours of those with dementia and should be incorporated into care routines in residential facilities.

Clarification of the antecedents of hospital nurse organizational citizenship behavior -- an example from a Taiwan regional hospital.

Organizational citizenship behaviors (OCB) are deemed indispensable due to their importance in promoting positive relationships among employees and involving employees in the organization's activities. OCB is believed to facilitate attainment of a hospital's goals and enhance a hospital's performance. The aim of this study is to extend the work of previous studies by providing an integrated model of OCB and demonstrate its applicability in a non-Western culture. Questionnaires were completed by 314 non-supervisory hospital nurses, each of whom was given a supervisor rating for their OCB. Exploratory factor analysis was used to assess the convergent and discriminant validity of the variables in the model. Multiple regression analysis was used because it provided estimates of net effects and explanatory power. The results showed that job satisfaction, supervisor support, job involvement, and procedural justices had significant effects on the nurses' citizenship behaviors. Since the study used a non-Western site in one of Taiwan's health care institutions, its overall findings should contribute to further understanding of the cross-cultural aspects of OCB.