Determinants of Parental Intentions to Vaccinate Kindergarten Children Against Seasonal Influenza in Xiamen, China.

Seasonal influenza epidemics occur almost every year, and children under 6 years of age constitute one of the most susceptible groups. While free vaccinations are offered to preschool children in some large cities in China, Xiamen lacks a free vaccination policy and other effective policies aimed at increasing parents' acceptance of the vaccine. Using the health belief model (HBM), we sought to: (1) investigate the determinants of parents' intentions to vaccinate their kindergarten children against seasonal influenza if the free policy were implemented, and (2) explore the possible interaction effects between "cues to action" and "perceived susceptibility" and/or "perceived severity." A total of 1350 parents with kindergarten children were selected by stratified random sampling from half the population in Xiamen, of whom 1211 responded effectively to our survey. Scobit models with testing for interactions among the key concepts of the HBM were used to investigate factors associated with parents' intentions to vaccinate their children. In total, 85.1% of 1211 parents reported that they were willing to vaccinate their children if free influenza vaccinations were offered, although only 37 children (3.1%) had received influenza vaccination in the previous year, and 261 (21.6%) had been vaccinated since birth. Parents' perceived susceptibility (AOR = 1.77), perceived benefits (AOR = 3.12), perceived barriers (AOR = 0.38) and cues to action (AOR = 3.54) in terms of childhood vaccination against influenza were significantly associated with their vaccination intentions. The only observed interaction effect was between perceived susceptibility and cues to action (AOR = 1.57), which had additive effects on strengthening parental intentions to vaccinate their children. Our findings can be used as a basis for formulating government strategies aimed at improving influenza vaccination coverage among children in kindergarten and guiding culturally informed primary prevention efforts among their parents.

A survey of how patient-perceived empathy affects the relationship between health literacy and the understanding of information by orthopedic patients?

BACKGROUND: There is a lack of research examining patient-perceived empathy and its effect on low-literacy patients' understanding of health information. This study investigated the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information. METHODS: During a 2-month period, a total of 144 patients took a survey that included the Chinese-edition Rapid Estimate of Adult Literacy in Medicine, the Barrett-Lennard Relationship Inventory and the Preoperative Information Understanding Scale. Hierarchical multiple regression analysis provided a test of moderator effects. RESULTS: All Cronbach's alphas exceeded 0.6, with REALM at 0.91, BLRI at 0.67, and PIUS at 0.77.The finding that the interaction term was significant suggests perceived empathy is a relevant factor when considering the relationship between health literacy and the understanding of information by patients. The relationship between the health literacy and understanding of information was stronger and positive among patients who perceived greater empathy from their physicians. CONCLUSION: Our study demonstrates that a focus on improving physician-patient empathy skills could be beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities. Healthcare providers who wish to improve the understanding of information by low health-literacy patients should first identify components of their empathic communication mechanisms, and then try to refine these skills to better serve their patients.

A change of PD-1/PD-L1 expression on peripheral T cell subsets correlates with the different stages of Alzheimer's Disease.

BACKGROUND: Immune checkpoints are a set of costimulatory and inhibitory molecules that maintain self-tolerance and regulate immune homeostasis. The expression of immune checkpoints on T cells in malignancy, chronic inflammation, and neurodegenerative diseases has gained increasing attention. RESULTS: To characterize immune checkpoints in neurodegenerative diseases, we aimed to examine the expression of the immune checkpoint PD-1/PD-L1 in peripheral T cells in different Alzheimer's disease (AD) patients. To achieve this aim, sixteen AD patients and sixteen age-matched healthy volunteers were enrolled to analyze their CD3+ T cells, CD3+CD56+ (neural cell adhesion molecule, NCAM) T cells, CD4+/CD8+ T cells, and CD4+/CD8+CD25+ (interleukin-2 receptor alpha, IL-2RA) T cells in this study. The expression of PD-1 on T cells was similar between the AD patients and healthy volunteers, but increased expression of PD-L1 on CD3+CD56+ T cells (natural killer T cells, NKT-like), CD4+ T cells (helper T cells, Th), CD4+CD25+ T cells, and CD8+ T cells (cytotoxic T lymphocytes, CTL) was detected in the AD patients. In addition, we found negative correlations between the AD patients' cognitive performance and both CD8+ T cells and CD8+CD25+ T cells. To identify CD8+ T-cell phenotypic and functional characteristic differences between the healthy volunteers and AD patients in different stages, a machine learning algorithm, t-distributed stochastic neighbor embedding (t-SNE), was implemented. Using t-SNE enabled the above high-dimensional data to be visualized and better analyzed. The t-SNE analysis demonstrated that the cellular sizes and densities of PD-1/PD-L1 on CD8+ T cells differed among the healthy, mild AD, and moderate AD subjects. CONCLUSIONS: Our results suggest that changes in PD-1/PD-L1-expressing T cells in AD patients' peripheral blood could be a potential biomarker for monitoring disease and shed light on the AD disease mechanism. Moreover, these findings indicate that PD-1/PD-L1 blockade treatment could be a novel choice to slow AD disease deterioration.

An intelligent approach to the discovery of luminescent materials using a combinatorial approach combined with Taguchi methodology.

A significant advance made in combinatorial approach research was that the emphasis shifted from simple mixing to intelligent screening, so as to improve the efficiency and accuracy of discovering new materials from a larger number of diverse compositions. In this study, the long-lasting luminescence of SrAl(2)O(4), which is co-doped with Eu(2+), Ce(3+), Dy(3+), Li(+) and H(3)BO(3), was investigated based on a combinatorial approach in conjunction with the Taguchi method. The minimal number of 16 samples to be tested (five dopants and four levels of concentration) were designed using the Taguchi method. The samples to be screened were synthesized using a parallel combinatorial strategy based on ink-jetting of precursors into an array of micro-reactor wells. The relative brightness of luminescence of the different phosphors over a particular period was assessed. Ce(3+) was identified as the constituent that detrimentally affected long-lasting luminescence. Its concentration was optimized to zero. Li(+) had a minor effect on long-lasting luminescence but the main factors that contributed to the objective property (long-lasting luminescence) were Eu(2+), Dy(3+) and H(3)BO(3), and the concentrations of these dopants were optimized to 0.020, 0.030 and 0.300, respectively, for co-doping into SrAl(2)O(4). This study demonstrates that the utility of the combinatorial approach for evaluating the effect of components on an objective property (e.g. phosphorescence) and estimating the expected performance under the optimal conditions can be improved by the Taguchi method.

Combinatorial approach to the development of a single mass YVO(4):Bi(3+),Eu(3+) phosphor with red and green dual colors for high color rendering white light-emitting diodes.

Instead of developing a novel red phosphor individually, this work proposes the production of white light by combining a near-ultraviolet/ultraviolet diode chip with blue and special yellow phosphors: the yellow phosphor includes the red and green components with high color saturation. The availability of this scheme is demonstrated by preparing a white light-emitting diode (WLED) with color rendering index (Ra) up to 90.3. The desired single-mass yellow phosphor is successfully screened out from the YVO(4):Bi(3+),Eu(3+) system by using a combinatorial chemistry approach. When the emission color and luminous efficiency are both considered, the best composition for producing white light is (Y(1-s-t)Bi(s)Eu(t))VO(4) with 0.040 < or = s < or = 0.050 and 0 < t < or = 0.015. The red component that is required for a high-Ra WLED is obtained through sensitizing luminescence of Eu(3+) by Bi(3+) in a YVO(4) host; meanwhile, both Bi(3+) and Eu(3+) emission are improved by keeping the Bi(3+) and Eu(3+) contents close to the critical concentration.

The effect of animal-assisted activity on inpatients with schizophrenia.

The aim of this study was to evaluate the effects of animal-assisted activity on self-esteem, control over activities of daily living, and other psycho-physiological aspects among Taiwanese inpatients with schizophrenia. Thirty participants were randomly assigned to either the treatment or control group. A weekly animal-assisted activity program was arranged for patients in the treatment group for 2 months. A questionnaire assessing self-esteem, self-determination, social support, and psychiatric symptoms was completed the week before and the week after the animal-assisted activity. Compared with the control group, the treatment group showed significant improvement on all measures except for social support and negative psychiatric symptoms. The results of this study showed that animal-assisted activity can promote significant improvements in many clinical aspects among inpatients with schizophrenia. Therefore, animal-assisted activity should be integrated into the treatment of institutionalized patients with schizophrenia.

Factors affecting parental intention to vaccinate kindergarten children against influenza: A cross-sectional survey in China.

BACKGROUND: The impact of influenza in children under 5 can be severe and fatal. However, the influenza vaccination uptake in China remains suboptimal. The objectives of this study were to investigate parents' perceptions on influenza vaccination and to assess vaccination promotional factors. METHODS: A cross-sectional survey among 1506 parents with children in kindergarten was conducted in two areas with different policies: self-paid vaccination and free vaccination. The questionnaire was based on the structure of the Health Belief Model (HBM). Multiple logistic regression was used to analyze the determinants of parental vaccination intention. Odds ratios (OR) and respective 95% confidence intervals (95% CI) are reported. RESULTS: Within the free policy group versus the non-free group, vaccination intention rates were 76.3% versus 83.4%, and vaccination rates were 34.2% versus 3.1%. Results from multivariate analysis showed that parents with high scores for perceived susceptibility (OR = 1.44; 95% CI: 1.09-1.91), perceived benefits (OR = 1.80; 95% CI: 1.30-2.50) and cues to action (OR = 3.32; 95% CI: 2.47-4.46) were more likely to get their children vaccinated, while those perceived more barriers (OR = 0.50; 95% CI: 0.37-0.68) had lower vaccination intention. More knowledge (OR = 1.74; 95% CI: 1.18-2.56) and preferable attitudes (higher perceived necessity: OR = 1.84; 95% CI: 1.53-2.22; less safety worry: OR = 1.35; 95% CI: 1.10-1.66) were associated with significantly higher vaccination intention. Adjusted for parents' gender, age, education, income and children's age, the same significant factors were found. Parental intention was found to be influenced by different vaccination policies. Under a free policy, past influenza vaccination uptake (OR = 4.52; 95% CI: 1.07-19.02) greatly promoted parents' willingness to vaccinate their children. CONCLUSION: Parents had high intention to get their kindergarten children vaccinated with the influenza vaccine in spite of the low uptake rate. Our results indicate that offering free influenza vaccines and parental education over the next years may increase the influenza vaccination rate.

Turnover factors revisited: a longitudinal study of Taiwan-based staff nurses.

BACKGROUND: The relationship between employees' intent to stay/leave a position and the actual turnover of employees merits further investigation. Most previous studies of this relationship have utilized cross-sectional designs to examine nurse turnover from a fixed point in time. Research using a longitudinal design could increase the ability to predict who will leave, and to identify factors that cause turnover behavior. OBJECTIVES: To investigate whether the same mechanisms and factors that affect employee's turnover intentions can be applied to actual turnover in a longitudinal way in an effort to expose causal relationships. DESIGN: After a review of existing literature, we collected baseline data on turnover determinants as well as two intervening variables: job satisfaction and intent to stay. Three years later, hospital personnel records were used to identify the actual turnover of nurses who responded in the first wave. SETTINGS: With its 600 beds and metropolitan site, the target hospital located in Taichung, Taiwan is representative of Taiwan's general hospitals. METHODS: The 412 registered staff nurses (managers excluded) at work in this hospital were reached by a mail questionnaire in the first wave. Three years later, the turnover data collected in wave two had divided the wave one's 308 respondents (74.8%) into 132 leavers (42.9%, coded as "1") and 176 stayers (57.1%, coded as "0"). The data were then processed by descriptive statistics, exploratory factor analysis, multiple regression, and logistic regression. RESULTS: As in previous studies of this type, distributive justice, workload, resource inadequacy, supervisory support, kinship support, and job satisfaction were again proven to be highly associated with intent to stay/leave. Nevertheless, with the exception of workload, these indicators worked poorly when predicting the actual turnover. CONCLUSIONS: The study confirms earlier findings on the relationships among turnover determinants, job satisfaction, and intent to stay, and suggests a more comprehensive selection of turnover factors must be taken into account when attempting to explain variations in actual turnover.

The Risk Factors, Costs, and Survival Analysis of Invasive VRE Infections at a Medical Center in Eastern Taiwan.

OBJECTIVE: To analyze 48 cases the risk factors of vancomycin-resistant Enterococcus (VRE) infections, the antibiotic costs after infection, and the survival conditions. DESIGN: 1:3 matched case-control study a medical center in the eastern Taiwan area. The case group, patients with VRE bacterial strains detected at the sterile sites, and the control group were randomly selected from invasive vancomycin-sensitive Enterococcus (VSE) infected patients at the nearest time point by taking the occurrence time of each VRE infection case as the reference time. Fisher exact tests were conducted in order to verify the existence of differences between the case and control groups; survival analysis was applied to explore the prognoses of the VRE infection cases. RESULTS: The mortality rate of the invasive VRE infection cases was 64.6%, which is obviously higher than that of the invasive VSE infection cases (39.4%); the fact of taking chemotherapy during a hospital stay as well as the use of third-generation cephalosporin, glycopeptides, and medicines of the metronidazole category before the infections, are the risk factors of future invasive VRE infections. Moreover, the antibiotic costs after the infections of invasive VRE infection cases are much higher than those of the VSE infection cases (the average daily cost is 3,433 new Taiwan dollars (NTD) vs. 1,742 NTD). CONCLUSIONS: The history of receiving chemotherapy, the use of third-generation cephalosporin, glycopeptides, and medicines of the metronidazole category before the infections are the risk factors of VRE infections. The antibiotic costs after the infections of invasive VRE infection cases are much higher than those of the VSE infection cases.

UV/VUV switch-driven color-reversal effect for Tb-activated phosphors.

The remarkable narrow-band emission of trivalent lanthanide-doped phosphors excited by the vacuum ultraviolet (VUV) radiation lines of Xe atoms/Xe2 molecules at 147/172 nm are extensively investigated in the development of plasma display panels and Hg-free fluorescent lamps, which are frequently used in our daily lives. Numerous solid materials, particularly Tb3+-doped oxides, such as silicates, phosphates and borates, are efficient green/blue sources with color-tunable properties. The excitation wavelength and rare earth concentration are usually varied to optimize efficiency and the luminescent properties. However, some underlying mechanisms for the shift in the emission colors remain unclear. The present study shows that a UV/VUV switch systematically controls the change in the phosphor (Ba3Si6O12N2:Tb) photoluminescence from green to blue, resulting in a green emission when the system is excited with UV radiation. However, a blue color is observed when the radiation wavelength shifts to the VUV region. Thus, a configurational coordinate model is proposed for the color-reversal effect. In this model, the dominant radiative decay results in a green emission under low-energy UV excitation from the 5D4 state of the f-f inner-shell transition in the Tb system. However, under high-energy VUV excitation, the state switches into the 5D3 state, which exhibits a blue emission. This mechanism is expected to be generally applicable to Tb-doped phosphors and useful in adjusting the optical properties against well-known cross-relaxation processes by varying the ratio of the green/blue contributions.

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.

Childbearing May Increase the Risk of Nondiabetic Cataract in Chinese Women's Old Age.

Backgrounds. Ocular changes may arise during pregnancy and after childbirth, but very few studies have reported the association between childbearing and cataract among older adults. Methods. 14,292 individuals aged 60+ years were recruited in Xiamen, China, in 2013. Physician-diagnosed cataract and diabetes status were assessed by a self-reported questionnaire. Childbearing status was measured by number of children (NOC). Structural equation modeling (SEM) analysis was conducted to examine the relationships among NOC, diabetes, and cataract. Gender-specific logistic models regressing nondiabetic cataract on NOC were performed by adjusting some covariates. Results. 14,119 participants had complete data, of whom 5.01% suffered from cataract, with higher prevalence in women than men (6.41% versus 3.51%). Estimates of SEM models for women suggested that both NOC and diabetes were risk factors for cataract and that no correlation existed between NOC and diabetes. Women who had one or more children faced roughly 2-4 times higher risk of nondiabetic cataract than their childless counterparts (OR [95% CI] = 3.88 [1.24, 17.71], 3.21 [1.04, 14.52], 4.32 [1.42, 19.44], 4.41 [1.46, 19.74], and 3.98 [1.28, 18.10] for having 1, 2, 3, 4-5, and 6 or more children, resp.). Conclusions. Childbearing may increase the risk of nondiabetic cataract in Chinese women's older age.

Joint effect of education and main lifetime occupation on late life health: a cross-sectional study of older adults in Xiamen, China.

BACKGROUND: The effects of education and occupation on health have been well documented individually, but little is known about their joint effect, especially their cumulative joint effect on late life health. METHODS: We enrolled 14,292 participants aged 60+ years by multistage sampling across 173 communities in Xiamen, China, in 2013. Heath status was assessed by the ability to perform six basic activities of daily life. Education was classified in four categories: 'Illiterate', 'Primary', 'Junior high school' and 'Senior high school and beyond'. Main lifetime occupation was also four categorized: 'Employed', 'Farmer', 'Jobless' and 'Others'. Odds ratios (ORs) were estimated by random-intercept multilevel models regressing health status on education and main lifetime occupation with or without their interactions, adjusting by some covariates. RESULTS: Totally, 13,880 participants had complete data, of whom 12.5% suffered from disability, and 'Illiterate' and 'Farmer' took up the greatest proportion (33.01% and 42.72%, respectively). Participants who were higher educated had better health status (ORs = 0.62, 0.46, and 0.44 for the 'Primary', 'Junior high school', and 'Senior high school and beyond', respectively, in comparison with 'Illiterate'). Those who were long term jobless in early life had poorest heath (ORs = 1.88, 95% CI 1.47 to 2.40). Unexpectedly, for the farmers, the risk of poor health gradually increased in relation to higher education level (ORs = 1.26, 1.28, 1.40 and 2.24, respectively). For the 'Employed', similar ORs were obtained for the 'Junior high school' and 'Senior high school and beyond' educated (both ORs = 1.01). For the 'Farmer' and 'Jobless', participants who were 'Illiterate' and 'Primary' educated also showed similar ORs. CONCLUSIONS: Both education and main lifetime occupation were associated with late life health. Higher education was observed to be associated with better health, but such educational advantage was mediated by main lifetime occupation.

Hospital nurse job attitudes and performance: the impact of employment status.

BACKGROUND: According to the 2007 Taiwan Labor Front Human Resources Report, as much as 47.6% of nurses at some public hospitals were contracted rather than full time. Furthermore, turnover rates for contract nurses were found to be as high as five to eight times of those for full-time nurses. Because high turnover rates are likely to induce negative impacts on the stability of care provided in the absence of staffing continuity, the association between nursing employment arrangement and nursing care quality is attracting greater attention. PURPOSE: This study was designed to investigate the work status of contract versus full-time nurses at a public hospital in Taiwan and to examine the impact of such on work-related attitudes, organizational citizenship behavior, and job performance. METHODS: Samples were recruited from a public hospital in Taiwan. In addition to self-rated items, researchers used supervisor-rated structured questionnaires for job performance to attenuate the possible effect of common method bias. The study investigated the impact of hospital nurse employment status on work-related attitudes, organizational citizenship behavior, and job performance using a regression model that included the critical work-related attitudes variables of job satisfaction and organizational commitment. RESULTS: Study findings included the following: (a) organizational commitment, job satisfaction, organizational citizenship behavior, and job performance correlate positively with one another. (b) No significant difference between contract and full-time nurses was found in terms of organizational commitment, job satisfaction, organizational citizenship behavior, and self-rated job performance. However, when rated by supervisors, reported job performance levels for full-time nurses were significantly higher than those of contract nurses. (c) Organizational citizenship behavior exhibited a mediating effect between job satisfaction, organizational commitment, and job performance. CONCLUSIONS: In this study, supervisors gave higher job performance ratings to full-time nurses than to contract nurses. This result deserves further investigation.

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.