Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior.

BACKGROUND: There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients' adherence behavior. In addition, the moderating effect of hospital facility levels is examined. METHODS: A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach's alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs. RESULTS: The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (ß = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (ß = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (ß = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals. CONCLUSIONS: This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes. TRIAL REGISTRATION: CRREC104107. Date: 22/01/2016. Prospectively Registered.

The association between the exacerbation of irritable bowel syndrome and menstrual symptoms in young Taiwanese women.

Studies of irritable bowel syndrome (IBS) have focused on the relationship between IBS and the menstrual cycle in Western societies. Specifically, an exacerbation of bowel symptoms, gas, distention, diarrhea, and constipation in the premenstrual and menstrual phases has been recognized among female IBS clients. Menstrual experience is culturally specific. Thus, the purpose of this study is to determine the prevalence rate of IBS in young Taiwanese women and to identify the most prevalent symptoms of IBS among this population. Moreover, this study explores the exacerbation of IBS during menses among young Taiwanese women. A cross-sectional survey was applied. A composite of validated questionnaires including the Modified Woods Daily Health Diary and Talley's Bowel Disease Questionnaire were administered to a stratified random sample of 971 female high school students in Taipei City, Taiwan. The results indicated that exacerbation of gastrointestinal symptoms during menstruation is present among young Taiwanese women with IBS. The IBS prevalence rate was 16.2% based on the Rome II criteria. Abdominal pain had the highest severity level, and bloating was ranked second among young Taiwanese women with IBS. These symptoms significantly increased in magnitude across time from postmenstrual to premenstrual to menses.

Prevalence of 3-rooted primary mandibular second molars among chinese patients.

PURPOSE: The purpose of this study was to determine the prevalence of 3-rooted primary mandibular second molar teeth in Chinese patients via vertical bitewing radiography. METHODS: Vertical bitewing radiographs of 227 patients previously obtained from the Department of Pediatric Dentistry, Taichung Veterans General Hospital, Taichung City, Taiwan, from June 2004 to July 2007 were retrospectively screened and examined. Images of 185 patients (92 boys and 93 girls; mean age=5.6 [range=2.5-11.9] years old) with bilateral primary mandibular second molars were studied. The gender, symmetry, and frequencies of occurrence of 3-rooted primary mandibular second molars were compared. RESULTS: Eighteen (9%) 3-rooted primary mandibular second molars were found in the 185 patients, with a bilateral incidence of a symmetrical distribution of 28% (5/18). The prevalence of 3-rooted primary second molars did not differ significantly between the mandible's right and left sides (P<.41), or with gender (P<.31). CONCLUSIONS: The data presented here indicate that approximately one tenth of Chinese individuals have a 3-rooted primary mandibular second molar and that this condition is bilaterally symmetric in approximately one third of such individuals in a Taiwan hospital.

Understanding the cultural context of Chinese mothers' perceptions of breastfeeding and infant health in Canada.

AIMS AND OBJECTIVES: The purpose of this study was to explore Chinese mothers' perceptions about breastfeeding and infant health in the Canadian context. BACKGROUND: Chinese mothers' breastfeeding perceptions are challenging for health professionals in North America, but few studies have focused on this issue in depth. DESIGN: An interpretive qualitative methodology was used. METHODS: Data were collected through semi-structured individual interviews with 15 purposively sampled Chinese mothers two months after delivery in Vancouver, British Columbia. Interviews were audiotaped and transcribed verbatim. Constant comparative analysis was used to develop coding categories and identify themes. RESULTS: Two main themes emerged: (1) the idea of harmony within change and (2) the meaning of infant health. The first represents mothers' perceptions about breastfeeding: the value of common sense, purity of breast milk and the laws of nature. The second represents notions of infant health, including its indicators and the relationship between mother's health and infant health. CONCLUSIONS: Chinese mothers' concepts of breastfeeding are associated with Western biomedical thought, traditional Chinese medicine and personal experiences, especially those embedded in the traditional Chinese cultural context. Perceptions of breastfeeding and infant health regarding notions of harmony within natural dynamic patterns must be considered when promoting breastfeeding. RELEVANCE TO CLINICAL PRACTICE: This study highlights the cultural context affecting Chinese mothers' breastfeeding practices. Nurses and other health professionals require sensitivity when assessing Chinese mothers' breastfeeding practice so that they are able to provide appropriate postnatal and breastfeeding support.

[Reflections on technology and nursing profession development].

Discussions of the impact of technological innovation on nursing practices have focused on how technology enhances nursing professional abilities to deliver quality nursing care, on one hand, and the sacrifice of artistic and humanistic aspects of nursing on the other. The debate highlights the fundamental incompatibilities between technology and nursing. Instead of examining the interplay of technology and nursing with the view of technological optimism and romanaticism, the authors apply a social history of technology perspective and emphasize that technology is socially constructed and historically contingent. The technological system and its dissemination produce and reproduce the enduring patterns of power relations in areas such as gender, class and self-identity. This article discusses medical technology in the context of the nursing practice in an attempt to reveal the interplay between technology and nursing with four major themes including the transformation of the ownership of technology, the transformation of nurses' professional identity, the transformation of the relationship between physicians and nurses, and the transformation of the nursing labor process. Implications for nursing practice and directions for future research are suggested.

Irritable bowel syndrome: the bodily experiences of Taiwanese women.

Irritable bowel syndrome (IBS) results in a poor quality of life and absenteeism due to unpredictable abdominal pain, diarrhea, and bloating. IBS has prevalence rates of approximately 6% to 22% in various countries, and more women than men are diagnosed with this disorder. This study explored how Taiwanese women with IBS gain knowledge about the disorder and studied their experiences in using alternative remedies. An ethnographic study design involving interviews and Internet online discussions was used. Women (18-45 years) either diagnosed with IBS or with self-reported symptoms that met the Rome II criteria were included. All interviews were transcribed verbatim and analyzed by the constant comparison method. Results showed that symptom pattern recognition was used most often by participants to interpret symptoms. The bodily practices of the IBS women followed Taiwanese gender norms, with bodily experiences being represented as a dialogue between the disordered body and the social body. Linking diarrhea with social norms of female slenderness, IBS women applied cultural strategies to manage symptoms. The findings facilitate a partnership between healthcare professionals and IBS women, which can facilitate the development of an appropriate self-management manual, self-help groups, and Internet discussion groups to facilitate symptom management. It is hoped that this study will enhance nurse understanding of the traditional Chinese view of the body and the corresponding dietary practices used to harmonize the body's yin and yang. Although Asian women may resist Western medications due to their side effects, study results provide nurses with information on alternative therapies that may be more acceptable in the Asian context. In conclusion, the bodily experiences and practices of women with IBS are developed from personal cultural views of the body and gender norms.

Prevalence of three-rooted mandibular first molars among Taiwanese individuals.

The purpose of this study was to evaluate the prevalence of mandibular first molars featuring a distolingual root among a Taiwanese population. A total of 731 patients' periapical radiographs were screened and examined to obtain 166 samples for this study. The gender, symmetry, and frequencies of occurrence of three-rooted mandibular first molars were recorded. The prevalence of three-rooted mandibular first molars was 21.09%. The bilateral incidence of a symmetrical distribution was 68.57%. There was a significantly greater incidence of three-rooted teeth on the right side of the mandible than on the left, but gender did not show a significant relationship with this variant prevalence. Clinicians should be aware of the high racial prevalence of the distolingual root in mandibular first molars among the Taiwanese (Chinese) population before initiating endodontic treatment.