Development and Validation of Age-Specific Resilience Instruments for Early Childhood Assessment: A Taiwan Birth Cohort Study.

BACKGROUND: We sought to develop and validate age-specific instruments for measuring early childhood resilience at ages 3, 5 and 8 in the Taiwan Birth Cohort Study, a national longitudinal study. METHODS: Using data from 18,553 mother-infant pairs, we conducted exploratory factor analysis (EFA) on a simple random half of our sample. We then used the remaining half of these data for confirmatory factor analysis (CFA) to further assess the fit of 3 CFA models (ie, first-order, second-order, and bifactor). Psychometric properties, distributions, and inter-item and inter-factor correlations of each instrument were also evaluated. RESULTS: EFA and CFA showed that the bifactor model of resilience (which included a general resilience factor and 5 specific factors) had the best fit for all 3 resilience scales, with 19 items at year 3, 18 items at year 5, and 19 items at year 8. All 3 resilience scales showed good psychometric properties, including construct validity, internal consistency, and normal distributions. For predictive validity, we found that in the face of adversity (measured by the High Risk Family Score), individuals with high resilience scores at age 3 had better general health scores at ages 3, 5, and 8 compared to those with low resilience scores. CONCLUSIONS: We describe the development and validation of age-appropriate survey instruments to assess resilience in young children at the population level. These instruments can be used to better understand how resilience can impact child health over time, and to identify key factors that can foster resilience.

Does cesarean delivery increase the occurrence of neurodevelopmental disorders in childhood?

OBJECTIVE: This study aimed to investigate whether cesarean delivery (CD) is associated with the occurrence of neurodevelopmental disorders (NDDs) at the age of 8 years. METHODS: A total of 19 142 children were included from the Taiwan Birth Cohort Study (TBCS) database. Associations between modes of delivery or modalities of CD and NDDs were evaluated before and after controlling for gestational age (GA) and clinical condition at birth, children's characteristics, maternal socioeconomic status and maternal clinical condition at childbirth. RESULTS: The odds ratio (OR) of occurrence of NDDs in children born via CD was 1.15 and the 95% confidence interval (CI) was 1.00-1.32. Emergency CD had a higher occurrence of NDDs (OR: 1.38; 95% CI: 1.16-1.65) compared with vaginal delivery. These associations were attenuated after controlling for children's and maternal characteristics and GA at birth. GA at birth had a significant reverse dose-effect on the occurrence of NDDs in children born via vaginal delivery and CD. CONCLUSION: Modes of delivery and GA could influence the occurrence of NDDs in childhood. However, association of risk of NDDs and modes of delivery or modalities of CD might be modified by males, lower socioeconomic status and mothers with gestational diabetes mellitus.

Mediating effects of early health on the relationship between early poverty and long-term health outcomes of children: a birth cohort study.

OBJECTIVE: This study analyses the mediating effects of early health prior to age 3 on the association between early poverty and the health outcomes of children at age 12. DESIGN: Population-based longitudinal birth cohort study. SETTING: Taiwan Birth Cohort Study (TBCS), 2005-2017. PARTICIPANTS: 16 847 TBCS children born in 2005 and followed up at 18 months, 3, 5, 8 and 12 years with available data on poverty and health status. MAIN OUTCOME MEASURES: Child's general health, measured by the mothers' ratings of their child's health, and hospitalisation experience at 12 years of age. RESULTS: Among the TBCS children, the prevalence of fair/poor health and hospitalisation was 20.8% and 2.5% at age 12. The ORs of experiencing fair/poor health and hospitalisation at age 12 were 1.33 (95% CI 1.21 to 1.45) and 1.35 (1.07 to 1.69) for early poverty, respectively. When early poor health was added in the multiple logistic regression models, the effects of early poverty were attenuated on poor general health and no longer significant on hospitalisation for children aged 12 years. Mediation analysis showed that 50%-87% of the total effect of early poverty on health at age 12 was mediated by early health status before age 3. CONCLUSIONS: Our findings suggest that poor health in early life plays as a significant mediator in the relationship between early poverty and the long-term health outcomes of children. Universal health coverage thus should be achieved to prevent the adverse health effects of poverty throughout the life course, as one of the most important strategies for children growing up in poverty.

Associations of caesarean delivery and the occurrence of neurodevelopmental disorders, asthma or obesity in childhood based on Taiwan birth cohort study.

OBJECTIVES: Whether birth by caesarean section (CS) increases the occurrence of neurodevelopmental disorders, asthma or obesity in childhood is controversial. We tried to demonstrate the association between children born by CS and the occurrence of the above three diseases at the age of 5.5 years. METHODS: The database of the Taiwan Birth Cohort Study which was designed to assess the developmental trajectories of 24 200 children born in 2005 was used in this study. Associations between children born by CS and these three diseases were evaluated before and after controlling for gestational age (GA) at birth, children's characteristics and disease-related predisposing factors. RESULTS: Children born by CS had significant increases in neurodevelopmental disorders (20%), asthma (14%) and obesity (18%) compared with children born by vaginal delivery. The association between neurodevelopmental disorders and CS was attenuated after controlling for GA at birth (OR 1.15; 95% CI 0.98 to 1.34). Occurrence of neurodevelopmental disorders steadily declined with increasing GA up to ≤40-42 weeks. CS and childhood asthma were not significantly associated after controlling for parental history of asthma and GA at birth. Obesity in childhood remained significantly associated with CS (OR 1.13; 95% CI 1.04 to 1.24) after controlling for GA and disease-related factors. CONCLUSIONS: Our results implied that the association between CS birth and children's neurodevelopmental disorders was significantly influenced by GA. CS birth was weakly associated with childhood asthma since parental asthma and preterm births are stronger predisposing factors. The association between CS birth and childhood obesity was robust after controlling for disease-related factors.

In utero and early childhood exposure to secondhand smoke in Taiwan: a population-based birth cohort study.

OBJECTIVES: This study provides secondhand smoke (SHS) exposure data in utero and after birth when children were at 18 months, 36 months and 66 months old, and it identifies risk factors for the early childhood SHS among 18-month-old infants living in smoker and non-smoker households. STUDY DESIGN: The data come from the Taiwan Birth Cohort Study, a longitudinal survey of a birth cohort born in 2005. This study used the survey wave when children were 18 months old (n=18 845) for statistical analysis of early childhood SHS exposure. Logistic regression was used to identify the risk factors of the SHS exposure. RESULTS: Approximately 62% of the 18-month-old infants lived in a household with at least one smoker, with the father being the smoker in 84% of those households. Among these infants living in a smoker household, 70% were exposed to SHS and 36% were exposed to heavy SHS in utero, and the prevalence was approximately 66% and 17% after birth for SHS and heavy SHS, respectively. The number and the existence of smokers in the household, parents' smoking status, father's educational attainment and being a first-born baby are strong predictors of early childhood heavy SHS exposure. CONCLUSIONS: Encouraging families to have a smoke-free home environment, empowering women to ensure their perspectives and rights are embedded into tobacco control efforts and educating families about the health risks from childhood SHS exposure, especially among people living in households with smokers, will protect non-smoking adults and children from SHS exposure.

Using a Medical Intranet of Things System to Prevent Bed Falls in an Acute Care Hospital: A Pilot Study.

BACKGROUND: Hospitalized patients in the United States experience falls at a rate of 2.6 to 17.1 per 1000 patient-days, with the majority occurring when a patient is moving to, from, and around the bed. Each fall with injury costs an average of US $14,000. OBJECTIVE: The aim was to conduct a technology evaluation, including feasibility, usability, and user experience, of a medical sensor-based Intranet of things (IoT) system in facilitating nursing response to bed exits in an acute care hospital. METHODS: Patients 18 years and older with a Morse fall score of 45 or greater were recruited from a 35-bed medical-surgical ward in a 317-bed Massachusetts teaching hospital. Eligible patients were recruited between August 4, 2015 and July 31, 2016. Participants received a sensor pad placed between the top of their mattress and bed sheet. The sensor pad was positioned to monitor movement from patients' shoulders to their thighs. The SensableCare System was evaluated for monitoring patient movement and delivering timely alerts to nursing staff via mobile devices when there appeared to be a bed-exit attempt. Sensor pad data were collected automatically from the system. The primary outcomes included number of falls, time to turn off bed-exit alerts, and the number of attempted bed-exit events. Data on patient falls were collected by clinical research assistants and confirmed with the unit nurse manager. Explanatory variables included room locations (zones 1-3), day of the week, nursing shift, and Morse Fall Scale (ie, positive fall history, positive secondary diagnosis, positive ambulatory aid, weak impaired gait/transfer, positive IV/saline lock, mentally forgets limitations). We also assessed user experience via nurse focus groups. Qualitative data regarding staff interactions with the system were collected during two focus groups with 25 total nurses, each lasting approximately 1.5 hours. RESULTS: A total of 91 patients used the system for 234.0 patient-days and experienced no bed falls during the study period. On average, patients were assisted/returned to bed 46 seconds after the alert system was triggered. Response times were longer during the overnight nursing shift versus day shift (P=.005), but were independent of the patient's location on the unit. Focus groups revealed that nurses found the system integrated well into the clinical nursing workflow and the alerts were helpful in patient monitoring. CONCLUSIONS: A medical IoT system can be integrated into the existing nursing workflow and may reduce patient bed fall risk in acute care hospitals, a high priority but an elusive patient safety challenge. By using an alerting system that sends notifications directly to nurses' mobile devices, nurses can equally respond to unassisted bed-exit attempts wherever patients are located on the ward. Further study, including a fully powered randomized controlled trial, is needed to assess effectiveness across hospital settings.

[Clinical ethic dilemmas and difficulties in reporting child abuse].

The number of reported cases of child abuse has been rising steadily in Taiwan. Although child abuse reporting is mandatory for healthcare professionals, Taiwan-specific social norms and traditional cultural values make the decision to report such abuse more complex and difficult. We used Jonsen's four topics method to examine a suspected case of child abuse and to analyze its associated dilemmas and ethical difficulties. We then discussed the identified conflicts among the three aspects of cultural values, legal obligations, and personal values. Findings indicate that healthcare professionals experience dilemmas among these three aspects. Reporting suspected child abuse appears the best resolution after considering and balancing the principles of non-malfeasance, beneficence, fidelity and follow-up care. Once reported, resources can be provided to the affected child and his ÷ her family. This case analysis provides a reference for healthcare professionals to deal with child abuse cases.

Incidence of hospitalization due to child maltreatment in Taiwan, 1996-2007: a nationwide population-based study.

OBJECTIVES: Little is known regarding the epidemiology of child maltreatment in Asian countries. This study aimed to examine the incidence of hospitalization coded as due to child maltreatment in Taiwan. METHODS: We used inpatient claims data of the National Health Insurance for the years 1996 through 2007 for estimation. Hospitalization of children aged 0-12 years with an ICD-9-CM code 995.5 "maltreatment syndrome" or E960-E969 "assault" in the main or secondary discharge diagnosis in claims data was defined as hospitalization due to child maltreatment. Poisson regression was used to examine the trends. RESULTS: A total of 1,726 children with 1,780 hospitalizations due to child maltreatment were identified during 1996-2007. The averaged annual incidence over 1996-2007 was 13.2/100,000 for infants, 3.5/100,000 for children aged 1-3 years, 2.1/100,000 for children aged 4-6 years and 3.3/100,000 for children aged 7-12 years. The incidence increased most among the infant group, from 4.8/100,000 in 1996-1997 to 25.4/100,000 in 2006-2007, a greater than 5-fold increase. The magnitude of the increase in incidence decreased with age, and no change in incidence was noted among children aged 7-12 years. The drastic increase in incidence in infants since 2003 corresponds with the introduction of use of ICD-9-CM code 995.55 "shaken infant syndrome" in Taiwan since 2003. Head injury was the main type of injury in all age groups. CONCLUSIONS: The incidence of hospitalization coded as due to child maltreatment in Taiwan differed by age group. Infants had the highest and the largest increase in incidence during the past decade. The increase might be due to improvement in awareness, competence and willingness to diagnose child maltreatment of medical staff in hospitals during the past decade after the revision of Child Welfare Law in 1993 and the new ICD-9-CM code for "shaken infant syndrome" being used since 2003. PRACTICE IMPLICATIONS: Physicians and nursing staff should be aware of and provide the detailed and specific information needed for proper discharge diagnosis coding, from which valid estimation of the incidence of hospitalization due to child maltreatment can be made. Administrative data should include both the N-code and E-code for each case of child maltreatment hospitalization to provide more complete information.