Segregating Suspected Child Maltreatment from Non-Child Maltreatment Injuries: A Population-Based Case-Control Study in Taiwan.

Objective: To identify the differential patient characteristics, injury types, and treatment outcomes between hospitalized child abuse and non-child abuse injuries in Taiwan. Methods: Using the data from the National Health Insurance Research Database, we selected a total of 1525 patients under the age of 18 that were diagnosed with child abuse, as well as an additional 6100 patients as a comparison group. Chi-square test, Fisher exact test, and independent samples t-test were used to compare the differences between the abused children and the non-abuse-related injured children. The multivariate conditional logistic regression was performed to measure the risk factor of child maltreatment in injured children. Results: Intracranial injury was more frequent in the child abuse group than it was in the non-child abuse group (35.0% vs. 8.2%; p < 0.001). Children in the child abuse group tended to stay longer in the hospital and incur higher medical expenses (8.91 days vs. 4.41 days and USD 2564 vs. USD 880, respectively). In multivariate analysis, the Adjusted Odds Ratio (Adjusted OR) of abuse resulting in an injury for children in low-income families is 1.965 times higher than those in non-low-income families (p < 0.001). Children living in high urbanization areas had a significantly higher probability of being abused than those living in low urbanization areas (p < 0.001). Conclusion: Children under the age of 1 who were hospitalized with severe intracranial injuries are highly at risk for child maltreatment. Moreover, numerous high-risk environmental factors were observed in child abuse cases, including living in urban areas, families with low income, and seasonality, as child maltreatment cases occur more frequently in autumn.

Relationship between Injuries and Attention-Deficit Hyperactivity Disorder: A Population-Based Study with Long-Term Follow-Up in Taiwan.

OBJECTIVE: To investigate the association between various injuries and attention-deficit hyperactivity disorder (ADHD) and distinguish ADHD from non-ADHD with regards to risk of various injuries among children in Taiwan. METHOD: Using the data from the National Health Insurance Research Database, we selected a total of 1802 subjects under the age of 18 who were diagnosed with ADHD as well as an additional 7208 subjects as a comparison group. RESULTS: Compared with children who were not diagnosed with ADHD, children diagnosed with ADHD were more likely to intentionally injure themselves. During the school year, ADHD children were injured less frequently than were non-ADHD children on traffic-related incidents. The adjusted hazard ratio of injury for the ADHD children was 2.493 times higher than that of comparison subjects. The ADHD children had a greater length of stay and medical cost when compared to those of the non-ADHD children. Age showed a significant inverse relationship with injury. Among the ADHD children, the injury rate was evidently higher for the low-income group than for the non-low-income group. CONCLUSIONS: Age, cause of injuries, low-income household status, and school season all have a significant connection to the risk of injury for ADHD children.

Tailored education enhances healthy behaviour self-efficacy in childhood cancer survivors: A randomised controlled study with a 4-month follow-up.

This study was to evaluate the acceptability and effectiveness of a tailored education on healthy behaviour self-efficacy (HBSE) and health promotion lifestyle (HPL) for childhood cancer survivors. A two-group, randomised study with repeated measures was conducted in Taiwan. Participants were randomly assigned to receive six 45-60 min individual education and follow-up telephone counselling sessions (n = 34) or standard of care only (n = 35). Each participant was assessed with HBSE and HPL questionnaires and was evaluated at three time points (at baseline, and then 1 and 4 months after intervention). The attrition rate was 7.2%. HBSE and HPL scores increased across the three time points in the experimental group (all p < 0.05), except for the HBSE exercise subscale (p = 0.85). HBSE scores were significantly higher for the experimental group than for the control group after 4 months of intervention (F = 5.32, p = 0.02, η2  = 0.25). No significant improvements in HBSE were observed over time in the control group. The intervention was acceptable and effective in promoting HBSE in childhood cancer survivors. Further empirical work is needed to reveal the effects of the intervention over a longer period of time and to improve patient engagement in exercise.

Perceived Stress, Parent-Adolescent/Young Adult Communication, and Family Resilience Among Adolescents/Young Adults Who Have a Parent With Cancer in Taiwan: A Longitudinal Study.

BACKGROUND: Family resilience helps family members successfully overcome adversity, for example, chronic disease or unpleasant situations. However, few studies have identified correlates of family resilience among adolescents/young adults having a parent with cancer. OBJECTIVE: This longitudinal study explored (1) relationships among family resilience, adolescents' perceived stress, and parent-adolescent/young adult communication; (2) trends in family resilience with data collection time; and (3) differences in parent-adolescent/young adult communication by parent gender (ie, father or mother). METHODS: Participants were teenagers and young adults (12-25 years) with a parent who had cancer. Data were collected using structured questionnaires at 3 times for 4 to 5 months, with 2 months between each collection. RESULTS: Of 96 adolescent/young adult participants enrolled at T1, only 32 completed all measurements at T3. We found that (1) family resilience was negatively associated with adolescents' perceived stress (B = -0.35) and positively associated with adolescent/young adult communication with both the father (B = 0.58) and the mother (B = 0.36), (2) the degree of family resilience at T3 was significantly lower than at T1 (B = -4.79), and (3) at all 3 data collection times, the degree of adolescent/young adult communication was higher with mothers than with fathers, whether the mother had cancer or did not have cancer. CONCLUSIONS: Family resilience was positively associated with parent-adolescent/young adult communication and negatively related to perceived stress. Family resilience tended to decline with longer parental survival since cancer diagnosis. IMPLICATIONS FOR PRACTICE: We suggest nursing interventions to reduce adolescent/young adult stress and develop optimal parent-adolescent/young adult communication to enhance family resilience.

A positive perspective of knowledge, attitude, and practices for health-promoting behaviors of adolescents with congenital heart disease.

BACKGROUND: Health-promoting behaviors could serve as a major strategy to optimize long-term outcomes for adolescents with congenital heart disease. The associations assessed from a positive perspective of knowledge, attitudes, and practice model would potentially cultivate health-promoting behaviors during adolescence. AIM: The purpose of this study was to examine the relationships between disease knowledge, resilience, family functioning, and health-promoting behaviors in adolescents with congenital heart disease. METHODS: A total of 320 adolescents with congenital heart disease who were aged 12-18 years were recruited from pediatric cardiology outpatient departments, and participated in a cross-sectional survey. The participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease; Haase Adolescent Resilience in Illness Scale; Family Adaptability, Partnership, Growth, Affection, and Resolve; and Adolescent Health Promotion scales. The collected data were analyzed using descriptive statistics and three multiple regression models. RESULTS: Greater knowledge of prevention of complications and higher resilience had a more powerful effect in enhancing health-promoting behaviors. Having symptoms and moderate or severe family dysfunction were significantly more negatively predictive of health-promoting behaviors than not having symptoms and positive family function. The third model explained 40% of the variance in engaging in health-promoting behaviors among adolescents with congenital heart disease. CONCLUSION: The findings of this study provide new insights into the role of disease knowledge, resilience, and family functioning in the health-promoting behavior of adolescents with congenital heart disease. Continued efforts are required to plan family care programs that promote the acquisition of sufficient disease knowledge and the development of resilience for adolescents with congenital heart disease.

Factors influencing transitional care from adolescents to young adults with cancer in Taiwan: A population-based study.

BACKGROUND: To investigate the progress of transition from paediatric to adult health care for patients with cancer in Taiwan's medical system. METHODS: The data were retrieved from the Longitudinal Health Insurance Database (LHID), which contains the original inpatient and outpatient medical claims data for 1,000,000 enrollees randomly sampled from the NHIRD between 1997 and 2010. RESULTS: Among the 1,411 cancer patients selected for this study, 98.09 % received adult-oriented therapy before the age of 18. In addition, only 1.91 % of the patients received paediatric-oriented therapy during adolescence. The primary factors that determine whether these patients would receive paediatric-oriented therapy or adult-oriented therapy at an early age were as follows: the age of the patient at the first visit and the performance-level of the hospital (p < 0.001). CONCLUSIONS: Previous studies conducted in developed countries have demonstrated that the unwillingness of patients to switch from paediatric-oriented therapy to adult-oriented therapy being the major obstacle that hinders the transition process. However, this study revealed a different result: the implementation of the National Health Insurance system in Taiwan makes healthcare affordable for the adolescent patients who may not possess adequate knowledge about paediatric health care and may not appreciate paediatric-oriented therapy, thereby hindering the transition process.

[Concept Analysis of Postpartum Depression].

Postpartum depression (PPD) affects the health of women and is an important issue that impacts negatively on the happiness of affected families. Previous studies have demonstrated that PPD impairs the mother-child attachment, impacts the marital relationship, and may cause family dysfunction. Although PPD is a common phenomenon, the concept of PPD is easily confused with other similar concepts such as postpartum blues and postpartum psychosis, which may delay proper prevention and management. This paper identifies the definitions, characteristics, antecedents, and consequences of PPD as well as provides empirical screen measurements and examples of model, borderline, and contrary cases in order to differentiate between the concepts of PPD and other disorders using Walker and Avant's (2011) concept analysis methodology. Three defining characteristics of postpartum depression were identified. First, depression begins four to six weeks after delivery and continues for at least two weeks. Second, we benchmarked over 5 depressive symptoms. Third, postpartum depression may disrupt puerperal women's lives by making it difficult for them to care for their babies and to concentrate on daily tasks. We hope that this article enhances nurses' professional competences to detect PPD as early as possible and to promote the quality of care received by postpartum women and their family members.

Meshing Gears: Mothers and Their Adolescents Returning to Their Social Life After Cancer Treatment in Taiwan.

Adolescents with cancer and their parents have to deal with the challenge of returning to their pre-diagnosis social life. The purpose of this study was to describe the subjective lived experiences of Taiwanese mothers and their adolescents who had completed cancer treatment and were returning to school. Eight Taiwanese mother-adolescent dyads were recruited by purposive sampling. Core themes were extracted using phenomenological method and dyadic analysis. Findings were metaphorically captured by the theme "meshing gears." The mothers and their adolescents were initially like 2 gears spinning alone, side by side due to experiencing different distress related to their social roles. To move toward a normal and healthy life journey, the mothers and their adolescents worked together as a well-tuned machine. This phenomenon is similar to gears meshing without friction to keep moving forward together. Our results suggest that health care professionals should provide follow-up care and interdisciplinary school reentry services to adolescent cancer survivors to improve their quality of life.

Comparison of resilience in adolescent survivors of brain tumors and healthy adolescents.

BACKGROUND: Resilience is essential for the psychological adjustment of adolescents experiencing difficulty. Comparing differences in resilience between adolescent survivors of brain tumors and healthy adolescents may help identify factors related to resilience in adolescents. OBJECTIVE: The purpose of this study was to clarify how illness impacts the normative development of adolescent survivors of brain tumors by comparing them to healthy adolescents in terms of resilience and how it is affected by various health problems. METHODS: This cross-sectional, case-control study used convenience sampling to recruit 13- to 18-year-old adolescent survivors of brain tumors and healthy adolescents matched by school level, gender, and living area. Data were collected by structured questionnaires. RESULTS: The sample included 60 adolescent survivors and 120 healthy adolescents. Participants in both groups were predominantly male adolescents (63.3%) and junior high school students (55%). The 2 groups did not differ significantly in resilience, but survivors without emotional problems had a higher mean resilience score than did healthy adolescents and survivors with emotional problems (F = 8.65, P < .01). CONCLUSIONS: Our results identify emotional problems as a risk factor for resilience in both adolescent survivors of brain tumors and healthy adolescents. In addition, the impact of emotional problems on resilience was more severe in brain tumor survivors than in healthy adolescents. IMPLICATIONS FOR PRACTICE: Our results suggest that pediatric oncology nurses design interdisciplinary school-based interventions to reduce the impact of emotional problems on resilience in both healthy adolescents and those who survived brain tumors.

[Resilience in cancer patients and related nursing interventions].

Cancer is a critical health problem in Taiwan. The range of physical, psychological, social, and existential stressors associated with cancer diagnosis and treatment can cause significant distress in cancer patients and survivors. The focus of cancer research has broadened in the past decade from the disease itself to factors that can have a positive influence on the health and life quality of cancer patients. However, few studies have explored how patients adapt and become resilient to the life challenges of their disease. This article introduces the concept of resilience and its influence factors. We analyze study findings and introduce four nursing interventions that have been used to nurture resilience in cancer patients. The authors hope findings help strengthen nurse competencies in order to enhance cancer patient quality of care.

Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomised controlled crossover trial.

BACKGROUND: Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management. OBJECTIVES: To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures. DESIGN: Prospective, randomised controlled crossover trial. SETTING: Level III Neonatal Intensive Care Unit in Taipei. METHOD: Thirty-four preterm infants (gestational age 29-37 weeks) needing three procedural heel sticks were recruited by convenience sampling and randomly assigned to a sequence of three treatments (two pain-relief interventions and the control condition): (1) routine care, non-nutritive sucking, facilitated tucking, (2) non-nutritive sucking, facilitated tucking, routine care, and (3) facilitated tucking, routine care, non-nutritive sucking. Each treatment condition was performed on a different day to avoid any carry-over effect. Pain was measured by the Premature Infant Pain Profile (PIPP), infant behaviour by a behavioural coding scheme, and physiological signals by electrocardiogram monitors. All data were collected 3 min without stimuli (baseline), during heel-stick procedures, and recovery. RESULTS: Infants receiving non-nutritive sucking and facilitated tucking had significantly lower mean (standard deviation) pain scores during heel-stick procedures (6.39 [3.35] and 7.15 [3.88], respectively) than those receiving routine care (9.52 [4.95]). Infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.39, p=0.011 and 0.34, p=0.005, respectively) for pain (PIPP score≥6) than infants receiving routine care after adjusting for time, baseline pain scores, and infants' characteristics. Similarly, infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.23, p<0.001 and 0.28, p=0.03, respectively) for moderate-to-severe pain (PIPP score≥12) than infants receiving routine care. Infants receiving facilitated tucking had lower frequency ratios for stress-related behaviours, abnormal heart rates, and decreased oxygen saturation than infants receiving routine care. CONCLUSIONS: Both non-nutritive sucking and facilitated tucking effectively reduced pain scores more than routine care during heel-stick procedures. Non-nutritive sucking reduced PIPP pain scores more effectively than facilitated tucking. However, facilitated tucking showed broader effects not only on relieving pain, but also on enhancing infants' physiological and behavioural stability during heel-stick procedures.

[Loneliness: a concept analysis].

Loneliness is a kind of mood that most people have experienced at one time or another. Individual experiences with loneliness as joyful or painful saturation are highly personal and can be defined only in such a context. Loneliness has differing effects on the long-term health of individuals. Although loneliness impacts greatly on individual health, there is little in the literature related to concept analyses of loneliness. The purpose of this article was to use Walker and Avant's (2005) concept analysis methodology to review conceptual definitions of loneliness, characteristics, antecedents and consequences; construct examples and establish empirical measurements. Results indicate that defining attributes of loneliness included an individual's subjective mood, descriptions of aloneness, depression, desolation or empty feelings, and the perception of the spirit isolated from others. It is hoped that nursing staffs may better understand loneliness through this article, provide an assessment of client loneliness as early as possible, and enhance client health condition.

Games of lives in surviving childhood brain tumors.

The purpose of this phenomenological study was to describe the commonality of the lived experience of adolescent and young adult survivors (AYAS) of brain tumors in Taiwan from a sociocultural perspective. Seven AYAS aged 13 to 22 years, who had survived 5 to 10 years from the time of diagnosis, participated in this study. In consideration of their emotional duress, each participant was interviewed only once. The data revealed an essential structure: the game of life. The essential structure included six themes as follows: (a) no longer playing well, (b) wandering on the outer edges of social life, (c) helplessly struggling with role obligations, (d) rationally regulating the meaning of surviving, (e) winning a new social face, and (f) mastering the game of life. The findings suggest how nurses might help AYAS to succeed in psychosocial adjustment.