Health literacy competency requirements for health professionals: a Delphi consensus study in Taiwan.

BACKGROUND: Cumulative evidence supports the importance of health literacy in determining the quality of healthcare delivery and outcomes. To enhance health literacy competencies among professionals and alleviate healthcare barriers owing to patients' inadequate health literacy, evidence-based health literacy competency guidelines are needed for the development of health professionals' training curricula. The aim of this study was to validate and refine a set of health literacy competencies, including knowledge, attitude, and skills of health professionals, and to prioritize the importance of health literacy practices among healthcare professionals. METHODS: We employed a consensus-building approach that utilized a modified three-round Delphi process conducted in 2017. An online Delphi panel was assembled, comprising 20 Taiwanese health literacy experts from diverse fields such as medicine, nursing, public health, language, and communication. A set of health literacy competencies previously identified and validated by an international panel of health literacy experts was cross-culturally translated. RESULTS: After three rounds of ratings and modifications, a consensus agreement was reached on 42 of 62 health literacy competencies, including 12 of 24 knowledge items, 9 of 11 attitude items, and 21 of 27 skill items. Of the 32 health literacy practices, "avoidance using medical jargon," "speaking slowly and clearly with patients," and "using analogies and examples" were deemed most important by the panelists. CONCLUSIONS: The Delphi panel's consensus helped to identify a set of core health literacy competencies that could serve as measurable learning objectives to guide the development of a health literacy curriculum for health professionals. The prioritized health literacy practices can be employed as indicators of health literacy competencies that health professionals should learn and routinely use in clinical settings.

Sleep and its association with dental caries or myopia in first graders.

AIM: First grade is a transition from pre-school to school-age. The change in lifestyle behaviours such as sleep may have a physiological response, which contributes to the presence or absence of two highly incident diseases: dental caries or myopia. The aim of the study was to examine the association between sleep and myopia as well as sleep and dental caries in first graders. DESIGN: It is a cross-sectional study. METHODS: This was a recruitment phase of an interventional study. A total of 338 children whose caregivers completed a Children's Sleep Habits Questionnaire. Caregivers also provided information regarding myopia and caries status of children and their parents. Binary logistic regression was applied to analyse the potential risk factors. RESULTS: Dental caries and myopia rates were 45.9% and 9.5%, respectively. After adjusting for children's gender, children's age, fathers with caries and mothers with caries, the odds ratio for dental caries in children who slept less than 9 h when compared to those who slept for nine and more hours was 1.94. Mothers with caries were 3.37 times more likely to have children with caries than mothers without caries. However, sleep was not associated with myopia in first graders. CONCLUSION: Sleeping less than 9 h and maternal caries were risk factors of children developing dental caries. Future sleep and myopia studies can be conducted on higher graders who may present prolonged exposure and accumulations of myopic risk factors. IMPLICATIONS: Screening of children with insufficient sleep is needed for nurses to enable the early identification of high-risk groups for dental caries in school settings. Family nurses are encouraged to work with family members to implement tailored sleep interventions, in order to facilitate better sleep and oral health practices in both school and home settings. REGISTRATION: This study protocol was registered on ClinicalTrials.gov (Registration number: Redacted).

A retrospective cohort study on the cardiotoxicity incidence rates of immune checkpoint inhibitors for oncology patients.

BACKGROUND: This present study investigated the incidence rates of cardiotoxicity among cancer patients treated with immune checkpoint inhibitors (ICIs) plus other anticancer drugs. METHODS: This was a retrospective hospital-based cohort study using the medical records and the Cancer Registry records from the Taipei Veterans General Hospital. We enrolled patients diagnosed with cancer between 2011 and 2017, who were over 20 years old and had received ICI therapy, including pembrolizumab, nivolumab, atezolizumab, and ipilimumab. Cardiotoxicity was defined by the diagnosis of myocarditis, pericarditis, arrhythmia, heart failure, and Takotsubo syndrome. RESULTS: We identified 407 patients who were eligible to participate in this study. We defined the three treatment groups as follows: ICI therapy, ICI combined with chemotherapy, and ICI combined with targeted therapy. Using ICI therapy as a reference group, the cardiotoxicity risk was not significantly higher compared to the ICI combined with chemotherapy group (adjusted hazard ratio 2.1, 95% confidence interval 0.2-21.1, p = 0.528] or to the ICI combined with targeted therapy group (adjusted hazard ratio 1.2, 95% confidence interval 0.1-9.2, p = 0.883). The total incidence rate of cardiotoxicity was 3.6 of 100 person-years, indicating an average incidence time of 1.0 ± 1.3 years (median: 0.5 years; range: 0.1-4.7 years) for 18 cardiotoxicity patients. CONCLUSION: The incidence rate of ICI-related cardiotoxicity is low. Combination of ICI with either chemotherapy or targeted therapy might not significantly increase the risk of cardiotoxicities among cancer patients. Nevertheless, it is recommend being careful in patients treated high-risk cardiotoxicity medications to avoid drug-related cardiotoxicity with a combination of ICI therapy.

Sleep changes in Taiwanese first graders before and after school closure during the COVID-19 pandemic.

PURPOSE: The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN AND METHODS: This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first-graders before and after school closure. Paired t-test and the general linear model were applied to data analysis. RESULTS: Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (p = .029) and less delayed sleep-wake patterns in their children. PRACTICAL IMPLICATION: Sleep is an indicator that reflects children's behavioral changes in response to the COVID-19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement.

The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis.

OBJECTIVE: To examine the effectiveness of cold oral stimuli in quenching postoperative thirst in patients undergoing surgery. DESIGN: A systematic review and meta-analysis of interventional studies. SETTING: Postoperative care units. METHODS: Seven electronic databases (Medline, Scopus, Web of Science, PubMed, CINHAL, PsycInfo, and EMBASE) were systematically searched from their inception to January 12, 2022. The Cochrane Handbook for Systematic Reviews of Interventions was followed. Two researchers examined the study quality using the Cochrane risk of bias tools. A meta-analysis with a subgroup analysis was performed. Sensitivity analysis, funnel plots and Egger's test were used to examine publication bias. MAIN OUTCOME MEASURE: A thirst intensity score was used to rate postoperative thirst. RESULTS: Data were collected from 11 interventional studies for this systematic review. Eight studies underwent a meta-analysis with a total of 1504 patients. Our meta-analysis showed that the thirst intensity scores decreased in the experimental groups by 1.42 points (95% confidence interval: -2.162 to -0.684) more than those of the control groups. Subgroup analysis indicated that Asian patients and age were two factors that moderated the thirst intensity score after applying cold oral stimuli. CONCLUSION: Cold oral stimuli were effective in mitigating postoperative thirst. Ice products such as ice cubes, or ice chips are easily available in postoperative units. When applying cold oral stimuli, health professionals should be aware of that in Asian and older patients. Cultural acceptance and physiological degeneration, respectively, may influence the thirst ratings. Future research should investigate various factors underlying the perioperative period. Network meta-analysis can be used to examine multiple strategies for thirst management.

Sleep and Its Disturbance in Parents of Children and Adolescents with Epilepsy: A Systematic Review and Meta-Analysis.

Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. This systematic review and meta-analysis was conducted to quantify pooled mean estimates of parental sleep variables and to determine the prevalence of sleep disturbances in parents of children and adolescents with epilepsy. Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Eleven observational studies examining parents of pediatric patients aged <18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were reviewed. Our results showed that the pooled nocturnal sleep duration was 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores compared to parents of healthy children (differences in means 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%). Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should proactively initiate screening for sleep disturbances in parents of children and adolescents with epilepsy and refer parents to a sleep specialist when necessary.

Bedtime routines and objectively assessed sleep in infants.

AIMS: To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability. DESIGN: This was a prospective observational study conducted between November 2012 and November 2016. METHODS: Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. RESULTS: One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b = -23.55, p < 0.01). Infants with a bedtime routine of <3-4 nights per week were associated with more variable night-time sleep duration than a bedtime routine of 5-6 nights per week (b = -7.81, p < 0.05) or every night (b = -8.47, p < 0.05). CONCLUSION: A bedtime routine of at least 5 nights a week and initiated no later than 9 PM was associated with longer and less variable night-time sleep in infancy. Findings suggest that a consistent bedtime routine implemented in accordance with age-appropriate bedtimes should be addressed as part of anticipatory guidance in the well-child clinics. Future studies should include infant sleep variability as an outcome in addition to the conventional mean-level sleep variable analyses to more thoroughly characterize bedtime routine effects.

Association between physician specialty and risk of prescribing inappropriate pill splitting.

BACKGROUND: Prescription errors that occur due to the process of pill splitting are a common medication problem; however, available prescription information involving inappropriate pill splitting and its associated factors is lacking. METHODS: We retrospectively evaluated a cohort of ambulatory prescriptions involving extended-release or enteric-coated formulations in a Taiwan medical center during a 5-month period in 2010. For this study, those pill splitting prescriptions involving special oral formulations were defined as inappropriate prescriptions. Information obtained included patient demographics, prescriber specialty and prescription details, which were assessed to identify factors associated with inappropriate pill splitting. RESULTS: There were 1,252 inappropriate prescriptions identified in this cohort study, representing a prescription frequency for inappropriate pill splitting of 1.0% among 124,300 prescriptions with special oral formulations. Among 35 drugs with special oral formulations in our study, 20 different drugs (57.1%, 20/35) had ever been prescribed to split. Anti-diabetic agents, cardiovascular agents and central nervous system agents were the most common drug classes involved in inappropriate splitting. The rate of inappropriate pill splitting was higher in older (over 65 years of age) patients (1.1%, 832/75,387). Eighty-seven percent (1089/1252) of inappropriate prescriptions were prescribed by internists. The rate of inappropriate pill splitting was highest from endocrinologists (3.4%, 429/12,477), nephrologists (1.3%, 81/6,028) and cardiologists (1.3%, 297/23,531). Multivariate logistic regression analysis revealed that the strongest factor associated with individual specific drug of inappropriate splitting was particular physician specialties. CONCLUSION: This study provides important insights into the inappropriate prescription of special oral formulation related to pill splitting, and helps to aggregate information that can assist medical professionals in creating processes for reducing inappropriate pill splitting in the future.

Involvement of p53 R72P polymorphism in the association of MDM2-SNP309 with breast cancer.

The allelic variant MDM2-SNP309 (T>G) has been suggested to influence cancer development, but the clinical correlation between the risk allele and breast cancer remains controversial. The genetic background and the ethnicity of selected subgroups may influence the power of these risk genotypes. In this study, we investigated whether MDM2-SNP309 is associated with p53 R72P genetic polymorphism for the risk of breast cancer development in Asian Taiwanese, which has not been well-studied in this regard. Two hundred and fifty-five patients and 324 cancer-free controls were included, and we found that the MDM2-SNP309 TG and GG genotypes displayed marginally increased risks of breast cancer (GG vs. TT: OR = 1.7, 95% CI = 0.93 to 3.09; TG + TT vs. TT: OR = 1.57, 95% CI = 0.98 to 2.56). The breast cancer risk associated with MDM2-SNP309 was enhanced after stratification for the homozygous GG genotype at p53 codon 72 representing the Arg form of this genotype (GG vs. TT: OR = 3.7, 95% CI = 1.144 to 12.02; TG + GG vs. TT: OR = 2.7, 95% CI = 1.027 to 6.895). Also, the median age at diagnosis of patients with MDM2-SNP309 GG increased from 4 years earlier to 9 years earlier than TT patients after stratification for the GG genotype at p53 codon 72. Moreover, the G-allele of MDM2-SNP309 exhibited a stronger capacity than the T-allele to drive the full-length P2 promoter of the MDM2 gene in several human cell lines, suggesting that the association between MDM2-SNP309 and breast cancer is likely multifactorial rather than due to inconsistent gene expression in different cancer sources.