Trends and risk factors of stillbirth in Taiwan 2006-2013: a population-based study.

PURPOSE: To examine temporal trends in stillbirth and its associated risk factors in Taiwan. METHODS: This was a population-based cohort study. Data were extracted from the Birth Certificate Application database. Singleton births at 28 or more gestational weeks were included. A total of 1,536,796 births, including 3741 stillbirths, were analyzed from January 2006 to December 2013. RESULTS: The stillbirth rate was 2.4 per 1000 births and there was no change in the stillbirth rate during the study period. The adjusted odds ratio (aOR) for stillbirth was 1.28 for maternal age between 35 and 40 years and 1.79 for maternal age ≥ 41 years, with 21-34 years as the reference. The risk for stillbirth increased in single women (aOR, 2.4), female baby (aOR, 1.08), small for gestational age (aOR, 6.34) and large for gestational age (aOR, 1.52) infants, and women with hypertension (aOR, 3.78), diabetes mellitus (aOR, 2.04), anemia (aOR, 1.65), and oligohydramnios or polyhydramnios (aOR, 2.46).Women with heart disease and maternal age ≤ 20 years had no significant association with stillbirth after adjusting for various risk factors. CONCLUSIONS: Although the rate of stillbirth was stable during the study period, the incidence of risk factors associated with stillbirth, such as advanced maternal age, hypertension, diabetes mellitus, and anemia, had increased over time. Understanding about the risk factors might change protocols and allow for earlier detection of problems and prevention of stillbirths. Prevention or management of risk factors should be undertaken to reduce stillbirth rate.

Feasibility study for epidemic prevention and control in a regional hospital.

Epidemic prevention policies in hospitals address issues such as, indoor air quality control, cleanliness of medical staff clothing and employee hand-washing procedures. Our hospital employed Bio-Kil to treat air-conditioning filters and nursing staff uniforms. We also assessed the efficacy of different detergents. Using Bio-Kil technology, the mean bacterial count in the air was reduced from 108.8 CFU/h/plate (n=420) to 68.6 CFU/h/plate (n=630). On the lower hems of the Bio-Kil-treated gowns, the mean bacterial count was 1,201 CFU/100 cm(2), markedly lower than the bacterial count of 7,753 CFU/100 cm(2), found on the parts of the gowns not treated with Bio-Kil (p=0.0401). On the cuffs of sleeves treated with Bio-Kil, the mean count was 1,165 CFU/100 cm(2), markedly lower than that of 2,131 CFU/100 cm(2), found on the cuffs not treated with Bio-Kil (p=0.0073). With regard to the mean bacterial eradication rates of antimicrobial solutions, Steridal Solution, 75% alcohol and Bio-Kil (3rd generation) were shown to be the most effective, with rates exceeding 80%. Hibiscrub with paper towels and Fresh Protect Skin were the second most effective. Bio-Kil (1st generation), tap water with paper towels, liquid hand soap with paper towels and ozone water were the least effective. One important observation was that hand-washing without the use of paper towels increased the bacterial count by as much as 84% . Bio-Kil is effective in reducing bacterial counts in the air, on nursing staff uniforms and is an effective detergent.

[Self-role perception of nurse practitioners in northern Taiwan].

BACKGROUND: The Nurse Practitioners (NP) is a position title introduced into the Taiwanese nursing care system in 2006. NP perception of themselves is critical to successful development of the NP position as well as to good coordination with other healthcare team members. Understanding NP self-perception can help determine self- or policy deficiencies and facilitate necessary changes to ameliorate such in order to advance the NP system in Taiwan. PURPOSE: This study investigated the self-role perception of NPs in northern Taiwan. METHODS: Researchers used a qualitative research design. Participants comprised ten nurses recruited from a general hospital in northern Taiwan. Data were collected using a semi-structured interview format and analyzed using qualitative content analysis. RESULTS: Two themes that evolved from data analysis included negative and positive self-role perception. Negative self-role perception included feelings of regret, helplessness, frustration and volatility. Positive self-role perception included feelings of enjoying success, reflecting on the present, connecting with nursing, happiness, and self-improvement. CONCLUSION: Enhancing clinical, educational, and policy requirements for NPs can promote positive self-role perception. Based on the medical culture in Taiwan, NPs receive clearly defined roles and clear and specific job descriptions to expand their role functions. Continued self-growth and mutual respect among team members are essential to improving professional cooperation and medical care quality.

Predictors of adherence to an antidepressant medication regimen among patients diagnosed with depression in Taiwan.

This study explored the predictors of medication adherence among Taiwanese people with major depression and dysthymic disorder. Previous research indicates that depressed patients vary in compliance with their medication regimen. Poor compliance reduces the therapeutic effect of medication. Self-report questionnaires were used for this cross-sectional study conducted with 181 outpatients diagnosed with major depression or dysthymic disorder. About 50% of depressed patients reported good medication adherence. The predictors of adherence were patient income, treatment efficacy, and understanding the importance of continuing medication. Professionals should use collaborative communication and cultural values clarification with depressed patients and their families to improve the awareness of illness and to increase the likelihood of medication compliance.

Self-care behavior, hope, and social support in Taiwanese patients awaiting heart transplantation.

OBJECTIVE: The purpose of this study was to examine the self-care behavior, hope, and social support in patients awaiting heart transplantation and to explore all the correlative and related factors. METHODS: In total, 45 participants who met the selection criteria were selected by purposive sampling from four medical centers in Taiwan. The three instruments Self-Care Behavior Scale, Herth Hope Index (HHI), and Social Support Inventory were used for data collection. RESULTS: Significant, positive correlations among self-care behavior, hope, and social support were observed. Social support was the best predictive factor for both self-care behavior and hope. CONCLUSION: The outcomes of this study can help medical care personnel better understand the self-care behavior, hope, and social support in patients awaiting heart transplantation and can also serve as a reference when developing relevant interventions for these patients.

Husbands' experiences before wives' hysterectomy.

After Caesarean section, hysterectomy ranks as the surgical procedure most frequently performed on women. To most women, the partner's support is vital. Currently, there is a lack of research on the experiences of husbands facing their wife's hysterectomy. The aim of this study was to understand husbands' experiences when their wives were to undergo a hysterectomy. The study used a phenomenological approach and purposive sampling; data were collected at three teaching hospitals in northern Taiwan. Twenty participants were interviewed and data were analyzed by Colaizzi's method. The findings demonstrated that, when their wives were to undergo a hysterectomy, six major themes emerged among the husbands, as follows: (1) limited knowledge about the surgical process; (2) considerations about and adjustments to changes in one's sex life; (3) support in making necessary decisions; (4) difficulty in acquiring information on uterine disorders; (5) ensuring the wife's safety during the operation; and (6) expecting full communication with medical personnel. The findings from this study should contribute significantly to advances in practice, education and research concerning Taiwanese males' experiences as they face their wife's hysterectomy. These findings highlight the significance of the husband's involvement in meeting his wife's needs as regards providing information and communicating. Implications for nursing practice and further research are discussed.