A Preliminary Study on Self-Healing and Self-Health Management in Older Adults: Perspectives From Healthcare Professionals and Older Adults in Taiwan.

The human body has tremendous self-healing capacity and regeneration after injuries and pathogen invasions. These factors are particularly important in older adults which take longer to heal and recover physically. In addition to clinical investigations, perspectives from both experts in the field and the living experiences of the general public could play significant roles to enhance the body's healing mechanisms in older adults. A semi-structured interview was conducted which included 15 participants (9 experts and 6 older adults aged 65 years and older). Content analysis with an inductive approach was employed about participants' experiences and perspectives. All participants in this study revealed that self-healing mechanisms can be enhanced through physiological, psychological, and socio-environmental factors. When more of these factors can be integrated into a recovery management plan, it can hasten self-healing in older adults. Social capability has a profound impact on an individual's mental health while oral health and hygiene significantly affect the nutritional intake status. In regards to physical aspects, regular daily activity patterns, nutritious eating, moderate exercise, and sleep quality are significant, while psychological aspects such as cheerfulness, positive attitudes, and good interpersonal relationships can help control chronic diseases.

The experience of urgent dialysis patients with end-stage renal disease: A qualitative study.

PURPOSE: Taiwan is among the countries with the highest global prevalence of chronic renal disease. However, when advised to undergo dialysis therapy, patients with end-stage renal disease often hesitate. Attitudes toward medication and Taiwanese cultures are the main reasons for this delay, and delay conditioning requires urgent dialysis. This study aimed to explore the experience of urgent dialysis patients with end-stage renal disease. METHODS: This study used a purposive sampling strategy with semi-structured interviews leading to in-depth interviews. Patients were recruited from the nephrology ward and hemodialysis center of a northern Taiwanese hospital. All participants were aged over 20 years with end-stage renal disease. Although advised by doctors to undergo dialysis, these patients delayed their treatment and later suffered severe complications. After emergency hospitalization, the patients' condition improved. Data were analyzed by content analysis. RESULTS: Interviews with five participants suffering from end-stage renal disease identified six themes: "experiencing a sudden jolt," "silent organ brings the most pain," "feeling angry: why me?," "facing a dilemma," "taking risks," and "facing consequences." CONCLUSION: These patients delayed their treatment and later suffered severe complications, even though doctors advised them to undergo dialysis. Health professionals play an important role in communication and coordination, assisting patients in coping with their situation. The analysis of the reasons for the delay in undergoing dialysis, therefore, should help health professionals provide proper guidance and care to patients who are faced with the decision to accept dialysis treatment.

Does Jaundice in Newborn Infants Affect Exclusivity and Duration of Breastfeeding in Taiwan?

BACKGROUND: Cases of breastfeeding- and breast-milk-related jaundice tend to increase with increased rates of breastfeeding. Diagnoses of jaundice often lead mothers to discontinue breastfeeding because of assumptions that breastfeeding may exacerbate neonatal jaundice and lengthen the duration of phototherapy treatment. PURPOSE: This study was designed to explore the effect of neonatal jaundice on breastfeeding duration and exclusivity during the first 4 months postpartum. METHODS: This study applied a two-group comparative and follow-up design. The two groups comprised 135 and 160 mothers of infants, respectively, with and without neonatal jaundice. All of the participants were recruited from three certified baby-friendly hospitals in northern Taiwan. Follow-up was conducted by telephone at 1 and 4 months postpartum. RESULTS: Mean breastfeeding duration was longer in the group of participants whose infants had neonatal jaundice (group with neonatal jaundice) than in the group whose infants did not have this condition (group without neonatal jaundice; 102.00 vs. 89.85 days, p = .007). The degree of breastfeeding was higher in the group with neonatal jaundice, although the difference was significant only at 1 month postpartum and not during hospitalization or at 4 months postpartum. The results of a Cox regression model showed that the group without neonatal jaundice was more likely to discontinue breastfeeding (adjusted hazard ratio = 1.68, 95% CI [1.08, 2.62]). A generalized estimating equation model suggests that infants with neonatal jaundice had a higher likelihood of being breastfed for at least half of their feedings (adjusted OR = 1.53, 95% CI [1.04, 2.25]). CONCLUSIONS: On the basis of the results of this study, neonatal jaundice is not an obstacle to breastfeeding in pro-breastfeeding hospital environments. Participants whose infants developed neonatal jaundice were found in this study to breastfeed more often, which promotes breastfeeding success.

Breastfeeding Experiences of Taiwanese Mothers of Infants with Breastfeeding or Breast Milk Jaundice in Certified Baby-Friendly Hospitals.

PURPOSE: The purpose was to explore the breastfeeding experiences of mothers of infants with breastfeeding or breast milk jaundice. METHODS: In-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with breastfeeding and/or breast milk jaundice who breastfed their babies during the first year postpartum. RESULTS: Mothers' experiences can be described in four phases and six themes. (1) Prenatal stage: build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) stage after neonatal jaundice started to appear: include two themes, questioning beliefs in breastfeeding and happiness in being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worried about insufficient breast milk; they also felt an intimate mother-infant bond through breastfeeding; (3) stage when newborns had confirmed diagnosis of breastfeeding or breast milk jaundice that required medical attention: include two themes, diagnosis of breastfeeding or breast milk jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation are needed. Then, they decided breastfeeding or breast milk jaundice is only temporary and retrieved initial beliefs of breastfeeding. (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: insisting and adapting. CONCLUSION: Breastfeeding mothers were unaware of neonatal jaundice until medical attention was required; they experienced physical and mental distress and gradually learned to manage jaundice while insisting on breastfeeding through their breastfeeding beliefs and happiness in being mothers.

Nationwide trends and in-hospital complications of trachelectomy for surgically resectable cervical cancer in Taiwanese women: A population-based study, 1998-2013.

OBJECTIVE: To describe the nationwide trends in the utilization of trachelectomy among Taiwanese women with surgically resectable cervical cancer over the past decade, and to compare associated demographic characteristics, in-hospital complications and related outcomes using a population-based dataset from 1998 to 2013. MATERIALS AND METHODS: We conducted a population-based, cohort study using inpatient admission claims data of Taiwan's National Health Insurance program. Women who underwent trachelectomy for cervical cancers were compared by age at surgery (younger than 40 years, 40-59 years, and 60 years or older). RESULTS: Our study cohort consisted of 156 women. The overall utilization increased considerably during the study period, particularly in younger women aged 30-39 years. Compared with older women who had trachelectomy, women younger than 40 years were diagnosed more frequently in the later years of study (2007-2013, 69.9% vs 37.3%), were treated more frequently at medical centers (89.0% vs 60.2%) by physicians aged 55 years or older (50.7% vs 22.9%) with high case volume (50.7% vs 26.5%), were less likely to undergo concomitant surgeries for bilateral oophorectomy (1.4% vs 21.7%) and lysis of peritoneal adhesion (2.7% vs 24.1%), and were more likely to undergo lymph node excision (74.0% vs 47.0%) (P < 0.05 for all). During a median of follow-up of 5.4 (2.4-9.5) years, 5.1% received future hysterectomy after trachelectomy (n = 8) with a median time-to-future hysterectomy of 0.6 (0.2-5.0) years. The estimated risks of disease recurrence for cervical cancer and readmission within 30-days (n = 35) were 3.8% and 22.4%, respectively. Women's age at trachelectomy had no apparent association with the length of hospital stay (P = 0.11), in-hospital mortality, readmission within 30-days (P = 0.33), future hysterectomy (P = 0.14), and in-hospital complications (P = 0.47). CONCLUSION: Substantial increase in the trend of delayed childbearing may have influenced the decision-making of Taiwanese women with cervical cancer in favor of trachelectomy over hysterectomy over the past 16-years from 1998 to 2013. When considering the uterine preservation for future fertility, women should be counseled about the risk of disease recurrence for cervical cancer before making surgical decision for trachelectomy over hysterectomy.

Evaluation of health-related quality of life in patients with tuberculosis who completed treatment in Kiribati.

Objective To examine the health-related quality of life (HRQoL) and related factors among patients with smear-positive and smear-negative pulmonary tuberculosis (TB) within 2 years after completion of directly observed treatment, short course (DOTS), and to compare their HRQoL with a comparison group of community-dwelling individuals without TB in South Tarawa, Kiribati. Methods A cross-sectional questionnaire survey was conducted among 206 pulmonary TB patients who had completed DOTS and 214 individuals without TB, from July to September 2012. HRQoL was measured using the Short Form (36) Health Survey (SF-36). Results The patients with TB had a statistically significantly higher physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 than the comparison group after adjustment for background characteristics. However, the differences did not exceed the 3-point threshold for clinically significant differences. Multiple liner regression showed that older age and presence of persistent symptoms after completion of DOTS were related to a lower PCS score in TB patients. Patients who were smear-positive before DOTS treatment had higher MCS scores than those who were smear-negative. Conclusions Our results suggest the effectiveness of DOTS treatment. Health professionals can enhance HRQoL among posttreatment TB patients by managing their symptoms.

Factors Associated With Drinking Behavior Among Immigrant Women in Taiwan.

BACKGROUND: Transnational marriage-based immigrant women in Taiwan have moved to a country where alcohol use is prevalent and they face the challenge of adaptation into a new society, which could influence their drinking behavior. OBJECTIVES: To describe the prevalence of alcohol drinking and examine factors associated with drinking patterns among immigrant women in Taiwan. METHODS: This study was a cross-sectional questionnaire survey and data were collected from June through November in 2013. Convenience samples of 757 immigrant women were recruited across Taiwan. Alcohol use patterns during the past year were divided into abstinent, low-risk drinking, and hazardous drinking based on the Alcohol Use Disorder Identification Test. Measures included subject characteristics, exposure to cigarettes and alcohol, acculturation level, and perceived stress. RESULTS: The prevalence of drinking during the past year among immigrant women was 29.9% (low-risk drinking 27.6% and hazardous drinking: 2.3%). Multinomial logistic regression showed that women who were employed, who smoked, whose husbands drank, and who interacted with Taiwanese friends frequently were significantly more likely to be in the low-risk drinking group compared with the abstinent group. Women who were divorced/widowed, who had low education levels, who smoked, and whose husbands drank were significantly more likely to be in the hazardous drinking group compared with the abstinent group. CONCLUSIONS: More acculturation in immigrant women as indicated by working and frequently interacting with friends in mainstream society was related to low-risk drinking behavior; adversities as indicated by loss of marriage and low education level were related to hazardous drinking behavior.

In-hospital complications of bilateral salpingo-oophorectomy at benign hysterectomy: a population-based cohort study.

OBJECTIVE: The study compared the in-hospital complications and related outcomes between women who underwent bilateral salpingo-oophorectomy at hysterectomy for benign diseases and those who had hysterectomy only. METHODS: We conducted a population-based, retrospective cohort study using data from Taiwan's National Health Insurance program. Women who underwent concurrent bilateral salpingo-oophorectomy at hysterectomy for benign indications (n = 34,509) were compared with those who had hysterectomy only (n = 176,305). Separate models were estimated to account for the effect of baseline comorbid condition, age, and hysterectomy approach on the relationship between bilateral salpingo-oophorectomy and study outcomes. A secondary analysis was also performed to evaluate the association of inpatient readmission within 30 days and complications among women who underwent bilateral salpingo-oophorectomy. RESULTS: The addition of a bilateral salpingo-oophorectomy to hysterectomy was associated with a lower risk of surgical complications, a longer length of hospital stay, and an increased risk of inpatient readmission within 30 days. Among women who underwent bilateral salpingo-oophorectomy, women with complications were also more likely to require inpatient readmission within 30 days than those without complications. Our data also suggested that bilateral salpingo-oophorectomy was not associated with an overall risk of medical complications, with the exception of urethral obstruction. The relationships remained even after adjustments by age, surgical indications, hysterectomy approach, and health-related risk factors, such as baseline comorbid condition and status of any prior catastrophic illness. CONCLUSIONS: Bilateral salpingo-oophorectomy at hysterectomy for benign conditions is not associated with an increased risk of in-hospital complications.

Development and Validation of the Self-Efficacy Regarding Vaginal Birth Scale.

OBJECTIVES: The purpose of this study was to develop a scale to measure self-efficacy regarding a vaginal birth (SEVB) during pregnancy and to assess its reliability and validity among nulliparous Chinese women. DESIGN: A panel study. SETTING: Five hospitals in Northern Taiwan. PARTICIPANTS: The analysis included 700 (second trimester), 637 (third trimester), and 585 (before birth) women who did not have medical indications for cesarean births at the indicated time points. METHODS: The SEVB scale was used to measure the level of confidence in ability to carry the pregnancy to term and give birth vaginally. The scale included nine items, and each was scored on a numeric rating scale from 0 to 10. A higher score indicated a higher level of self-efficacy. RESULTS: Factor analysis confirmed the one-factor structure, which explained 62.77% and 67.08% of the variance, with Cronbach's alphas for the scale of 0.93 and 0.94 during the second and third trimesters, respectively. The test-retest reliability was 0.73 as determined by the intraclass correlation coefficient. Contrasted group validity supported that those women who preferred cesarean births had significantly lower SEVB scores than women who preferred vaginal births during the second and third trimesters. Those women who tried vaginal births had higher SEVB scores than women who had cesareans without trying vaginal births. CONCLUSION: The scale showed acceptable reliability and validity. Health professionals could use the scale to screen women with low self-efficacy during pregnancy and provide appropriate intervention to increase their willingness to try vaginal births.

Caesarean delivery before 39 weeks associated with selecting an auspicious time for birth in Taiwan.

BACKGROUND: Caesarean delivery before 39 weeks of gestation increases the risk of morbidity among infants. Taiwan has one of the highest caesarean rates in the world, but little attention has been paid to this issue. This study aimed to describe the rate of caesarean delivery before 39 weeks gestation among women who did not have labour signs and had a non-emergency caesarean delivery in Taiwan and to examine whether the phenomenon was associated with the Chinese cultural practice of selecting an auspicious time for birth. METHODS: We recruited women at 15-28 weeks of pregnancy at 5 hospitals in northern Taiwan and followed them at 4 or 5 weeks after delivery using structured questionnaires. This analysis included 150 primiparous mothers with a singleton pregnancy who had a non-emergency caesarean delivery without the presence of labour signs. RESULTS: Ninety-three of these women (62.0%) had caesarean deliveries before 39 weeks of gestation. Logistic regression analysis showed that women who had selected an auspicious time for delivery (OR=2.82, 95% CI: 1.15-6.95) and delivered in medical centres (OR=5.26, 95% CI: 2.25-12.26) were more likely to deliver before 39 weeks of gestation. CONCLUSION: Non-emergency caesarean delivery before 39 weeks of gestation was common among the study women, and was related to the Chinese cultural practice of selecting an auspicious time for birth. Further studies are needed to examine the risks and benefits associated with timing of caesarean delivery in Taiwan in order to generate a consensus among obstetricians and give pregnant women appropriate information.

Cognition and social-physiological factors associated with malnutrition in hospitalized older adults in Taiwan.

BACKGROUND: Malnutrition is prevalent among hospitalized geriatric patients. PURPOSE: The aim of this study was to explore the impact of cognitive status and its associated factors on the nutritional status of hospitalized geriatric patients. METHODS: A descriptive and cross-sectional study design was conducted. Two instruments, the Mini Nutritional Assessment and the Mini-Mental State Examination (MMSE), were administered to 401 geriatric participants. Linear regression was used to examine the contribution of cognitive status and its associated factors to the nutritional status of participants. RESULTS: Participants had a mean age of 85 years, and three quarters (73.6%) were men. Participants earned a mean MMSE score of 19.1 ± 8.0 and a mean Mini Nutritional Assessment score of 20.2 ± 5.2. Two thirds (67.1%) were at risk for malnutrition, and 22.7% experienced malnutrition. One third (33.1%) had mild-to-moderate cognitive impairment, and 32.2% had severe cognitive impairment. The MMSE scores accounted for 21% of the total variability in nutritional status. In addition, the Charlson Comorbidity Index score and care status were also significant predictors of malnutrition and, together with the MMSE scores, accounted for 53% of the variability in the nutritional status of participants in the regression model. CONCLUSIONS: Findings indicate that cognitive status, concomitant comorbidities, and care status are significant predictors of malnutrition. The results of this study provide information to help clinicians identify at-risk populations for malnutrition and develop appropriate nutrition programs based on individual needs.

Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery.

BACKGROUND: The rate of cesarean delivery was 35% in 2007 in Taiwan. It is unclear how many of the cesarean deliveries were without medical indications. Women's preference for cesarean delivery during their course of pregnancy has rarely been studied and therefore our objectives were to examine rate of cesarean deliveries without medical indications, to explore women's preference for cesarean delivery as their gestation advances, and to compare background and perinatal factors among women who underwent different modes of delivery in Taiwan. METHODS: This prospective study applied a longitudinal design. The study participants were 473 women who received prenatal care at four hospitals in Taipei and answered structured questionnaires at 20 to 24 weeks of pregnancy, 34 to 36 weeks of pregnancy, and 5 to 7 weeks after delivery. RESULTS: Of the 151 women (31.9%) who had cesarean deliveries, 19.9% were without medical indication. Three indications: malpresentation, prior cesarean section, and dysfunctional labor together accounted for 82.6% of cesarean section with medical indications. The prevalence of maternal preference for cesarean delivery was found to be 12.5% and 17.5% during the second and third trimester, respectively. Of the women who preferred cesarean delivery during the second trimester, 93.2% eventually had a cesarean delivery. Women who were older, with older spouses, and who had health problems before or during pregnancy were more likely to have cesarean deliveries. CONCLUSIONS: About 20% of cesarean deliveries were without medical indications. Women's preference for cesarean delivery during the second trimester predicts subsequent cesarean delivery. Counseling regarding mode of delivery should be offered early in pregnancy, especially for women who are older or with older spouses, have health problems, or had a prior cesarean section.

The number of Baby Friendly hospital practices experienced by mothers is positively associated with breastfeeding: a questionnaire survey.

OBJECTIVES: The objective of this study was to examine the association between number of Baby Friendly hospital practices (based on World Health Organization/United Nations Children's Fund Ten Steps to successful breastfeeding) experienced by mothers and breastfeeding initiation during hospital stay, breastfeeding at 1 month and breastfeeding at 3 months after delivery. METHODS: The study population consisted of mothers who gave birth to infants without congenital anomalies at hospitals in Taiwan from June to October of 2003, inclusively. A total of 2079 mothers participated in the postal questionnaire survey. RESULTS: Only 1% of women reported experiencing all 10-step practices, while 5.7% of women did not report experiencing any Baby Friendly practices. Mothers who delivered at certified Baby Friendly hospitals experienced more 10-step practices. The level of breastfeeding increased as the number of 10-step practices experienced increased at all three time points when confounders were controlled in the model. CONCLUSIONS: This study found a dose-response relationship between number of 10-step practices experienced and breastfeeding. However, very few women in Taiwan reported experiencing all 10 steps. Our findings highlight the need for greater attention to implement the 10 steps.

National prevalence of breastfeeding in Taiwan.

The objectives of this study were to describe the national prevalence of breastfeeding during hospitalization and at 1 and 3 months after delivery in Taiwan. A stratified proportional probability sampling method was used, with a total of 2079 mothers participating in the postal questionnaire. The prevalence of exclusive and partial breastfeeding (to any degree) was 17.9% and 47.0% during hospitalization, 22.3% and 48.4% at 1 month, and 16.7% and 17.4% at 3 months, respectively. There were significant regional variations in the rate of breastfeeding, with the highest rates demonstrated for Taipei City. Prevalence of breastfeeding in this study was generally higher than previously reported; however, a decline of more than 50% was noted between 1 and 3 months. In addition, the rates of exclusive breastfeeding were low. The results suggest the need to increase breastfeeding duration and encourage exclusive breastfeeding in Taiwan. Regional variations in prevalence of breastfeeding merit further study.

[The relationship between in-hospital breastfeeding rates and hospital type].

The objective of this study was to examine the impact of hospital environment on breastfeeding rates during maternal hospitalization. This study applied a descriptive correlational design. The study population consisted of mothers who had given birth to infants in the Taiwan area between June and October 2003. A proportional probability sampling method was used. Samples were drawn based on the mother's residence in one of six regions: eastern, central, southern, and northern Taiwan, Taipei City, or Kaohsiung City. The rates of exclusive and mixed breastfeeding during hospitalization were found to be 17.9% and 47%, respectively. Bi-variable analysis showed that higher-level hospitals, certified baby-friendly hospitals, teaching hospitals, hospitals with higher annual birth numbers, and public hospitals all had higher rates of breastfeeding. Logistic regression results demonstrated the positive influence of institutional factors associated with breastfeeding (any and exclusive breatfeeding) when social demographic and perinatal variables were controlled in the model. Baby-friendly and higher-level hospitals had the highest breastfeeding rates. Women who delivered at baby-friendly and teaching hospitals had higher exclusive breastfeeding rates. The results of this research can serve as a reference to the government and medical institutions in relation to efforts to promote breastfeeding.