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Effects of Learned Resourcefulness on Depression and Quality of Life among Solitary Elderly Residents of Communities
No full text[[abstract]]Objectives: This study examines how perceived health status, learned resourcefulness, depression and quality of life are related in solitary elderly residents of communities. Methods: A cross-sectional correlation design was adopted to examine the effects of demographic variables, perceived health status and learned resourcefulness on depression and quality of life. Data were collected from a purposive sample of 79 community-dwelling elders living alone. All subjects lived in Taipei and were directly interviewed by the investigator. Results: Analysis results indicated that the two variables ”perceived health status and learned resourcefulness” are negatively correlated with depression (r=-.77, r=-.73, p＜.001) and positively corrected with quality of life (r=.58, r=.73, p＜.001). Additionally, depression is negatively correlated with quality of life (r=-.88, p＜.001). A hierarchical regression was performed to eliminate the influence of demographic variables on the relationship between independent variables (perceived health status and learned resourcefulness) and dependent variables (depression and quality of life). The analytical results demonstrated that the independent variables (perceived health status and learned resourcefulness) directly and negatively affect depression. Additionally, the independent variables (perceived health status and learned resourcefulness) directly and positively affect quality of life. Conclusion: Based on the results of this study, we recommend that nursing intervention facilitates learned resourcefulness by teaching or reinforcing its constituent skills
The experiences of public health nurses during the COVID-19 in Taiwan: A qualitative study
No full text[[abstract]]Aim: The coronavirus disease 2019 (COVID-19) pandemic has had a substantial effect on frontline health care workers and caused public health nurses (PHNs) to come under various forms of pressure. PHNs face high-risk challenges in their work environment, and their professional commitment and adaptability are key concerns. The aim of this qualitative study was to describe the experiences of PHNs during the COVID-19 outbreak.
Methods/design: Twenty PHNs who worked during the COVID-19 outbreak were recruited from seven public health centres through posters. Data were collected through in-depth interviews that comprised semi-structured and open-ended questions; subsequently, the data were analysed through content analysis.
Results: Three themes emerged from the study findings, namely (1) the disorderliness of COVID-19 pandemic prevention work, (2) managing stress and fear, and (3) the establishment of a new normal. Because of the severity of the pandemic, the workload and stress associated with epidemic prevention policies continue to increase. PHNs may infect their family members and experience a sense of alienation and distance. They must also deal with irrationality and reactions in the people within their community.
Conclusion: Health department directors and policymakers should provide the necessary support and assistance to frontline pandemic prevention workers to increase the efficiency of pandemic prevention efforts.
Patient or public contribution: The participants agreed to participate in the qualitative study during the study period
The Design Requirements for an E-Health Management Platform: Addressing the Needs of Adolescent Girls at High Risk of Metabolic Syndrome
No full text[[abstract]]背景 青少年代謝症候群盛行率日益增加，然而在校園中之健康宣導成效有限。運用青少年喜愛的網際網路方式，有助於專業人員提供相關的健康管理照護。目的 探討青少女的健康管理網頁設計需求，以作為設計健康促進生活型態的護理介入措施之參考。方法 採質性研究法，以滾雪球方式，利用半結構性訪談指引深度訪談20位16－20歲代謝症候群高危險群、能以國台語溝通者且有意願接受訪談與錄音之青少女，以內容分析法進行資料分析與歸納。結果 研究結果發現，青少女的E化健康管理平台設計需求有五大主題：一、網頁介面具吸引力且便於操作；二、可信的資訊與資源；三、個人化量身訂做的健康訊息；四、同儕支持；五、自我監測與學習。結論／實務應用 根據研究發現，建議未來可針對其特質加以設計，建立可輕鬆存取、具有激勵並注意隱私保密功能的網站。期望本研究結果可作為醫護人員提供青少女代謝症候群健康照護與支持之參考
[[alternative]]Meta-analysis of type 2 diabetes genome-wide association studies
No full text[[abstract]]摘要研究目標本研究的目的是將全基因組關聯分析(genome-wide association study, GWAS) Catalog中的第2型糖尿病(type 2 diabetes, T2D)相關研究成果整合與再次分析，以期更準確地評估T2D與基因變異之間的關聯性。此外，利用次群組分析，揭示不同人群間這種關聯性的差異研究缺口雖然對T2D的GWAS研究已相當豐富，這些研究結果缺乏一個有效的整合與分析，同時，對於不同人群T2D關聯基因變異差異的了解仍然不足，這顯示了深入進行次群組分析的重要性。研究方法本研究檢索全基因組關聯分析資料庫中與基因變異關聯的研究，数據蒐集至2023年9月。下載資料以關鍵字"Type 2 diabetes”篩選，並經過兩位研究人員討論設定之排除條件排除部分後，將保留之部分以MetaXL軟體進行隨機效應模型的統合分析，並以統合p<5.0 x10-8為統合顯著結果。本研究旨在合併各研究筆數之摘要數據計算整體、次群組的估計值，從中找到與T2D發生有關聯的基因，統合分析結果以勝算比(odds ratio, OR)、95%信賴區間(confidence interval, CI)及p值(p value)、森林圖表示。研究結果通過45篇文獻、10個基因片段和10個基因的統合分析，並以統合p<5.0 x10-8為統合顯著結果，得到研究結果如下：整體統合分析結果• 基因顯著性：在所研究的10個基因中，有7個基因的整體統合分析結果為p<5.0 x10-8，顯示出與T2D發生有正關聯。次群組分析結果• 血統差異：所有10個基因在血統次群組分析中均有統合顯著結果，表明基因對T2D的發生在不同人群中存在差異。• 各基因在不同人群中的影響：1. CDKAL1基因：在歐洲人群中，T2D發生odds增加15%-23%；在歐洲與亞洲人群中，增加16%；在亞洲人群中，增加21%；在歐洲、非裔美人..等多血統人群中，增加16%。2. CDKN2B-AS1 - DMRTA1基因：在歐洲人群中，T2D發生odds增加22%；在亞洲人群中，增加18%；在歐洲、非裔美人..等多血統人群中，增加17%。3. FTO基因：在歐洲人群中，T2D發生odds增加18%；在歐洲與亞洲人群中，增加12%；在亞洲人群中，增加14%；在歐洲、非裔美人..等多血統人群中，增加13%。4. HHEX - Y_RNA基因：在歐洲人群中，T2D發生odds增加16%；在亞洲人群中，增加18%。5. HNF1B, HNF1B基因：在歐洲與亞洲人群中，T2D發生odds增加8%；在亞洲人群中，增加13%。6. IGF2BP2基因：在歐洲人群中，T2D發生odds增加14%； 在歐洲和亞洲人群中均增加14%；在亞洲人群中，增加14%；在歐洲、非裔美人..等多血統人群中，增加12%。7. JAZF1基因：在歐洲人群中，T2D發生odds增加12%；在歐洲與亞洲人群中，增加11%；在歐洲、非裔美人..等多血統人群中，增加12%。8. KCNQ1, KCNQ1基因：在歐洲與亞洲人群中T2D發生odds增加12%；在亞洲人群中，增加29%；在歐洲、非裔美人..等多血統人群中，增加22%。9. SLC30A8基因：在歐洲人群中，T2D發生odds增加13%；在亞洲人群中，增加12%；在歐洲、非裔美人..等多血統人群中，增加10-12%。10. TCF7L2基因：在歐洲與亞洲人群中，T2D發生odds增加37%；在亞洲人群中，增加37%；在歐洲、非裔美人..等多血統人群中，增加31%。研究發現本研究的發現強調了在不同人群中，特定基因變異與T2D發生odds之間存在顯著的關聯性。這些結果不僅為理解T2D的遺傳基礎提供了重要見解，也為未來的預防、診斷和治療策略的發展指明了方向。此外，透過揭示不同人群中基因變異的差異性影響，本研究為精准醫療在T2D管理中的應用提供了有價值的資訊。結論本研究利用統合分析加強了基因對T2D發生風險的理解，提供更深入的遺傳基礎訊息，並為基於人群差異的精準醫療策略開闢了新途徑。这不僅填補了现有的研究空白，也為未来的遗傳學研究指明了方向。關鍵字：第2型糖尿病、單核苷酸多樣性、全基因組關聯分析、統合分析[[abstract]]ABSTRACTResearch objectives:The purpose of this study is to integrate and analyze type 2 diabetes (T2D) related research results in the genome-wide association study (GWAS) Catalog and more accurately evaluate the association between T2D and genetic variants. Furthermore, subgroup analyses were used to reveal differences in this association between different groups of people.Research gap:Although GWAS on T2D have been quite abundant, these research results lack an effective integration and analysis. At the same time, the understanding of the differences in T2D-related gene variants in different populations is still insufficient, which shows the importance of in-depth subgroup analysis.Research methods:Our study searched the GWAS database for studies related to genetic variations, and the data were collected until September 2023. The downloaded data were filtered with the keyword "Type 2 diabetes", and after the two researchers discussed and set the exclusion conditions to exclude the parts, the retained parts were used for meta-analysis of the random effects model using MetaXL software, and the integrated p<5.010-8 is an integrated statistically significant result. This study aims to combine the summary data of each study to calculate the overall and subgroup estimates, and to find genes associated with the occurrence of T2D. The meta-analysis results are expressed as odds ratio (OR) and 95% confidence interval (CI), p value and forest plot representation.Research results:Through meta-analysis of 45 literatures, 10 regions and 10 genes, and taking the integrated p<5.0 x10-8 as the integrated significant result, the research results are as follows:Overall meta-analysis results:• Gene significance: Among the 10 genes studied, the overall meta-analysis results of 7 genes were p<5.0 x10-8, showing a positive association with the occurrence of T2D.Subgroup analysis results:• Differences in ancestry: All 10 genes had statistically significant results in the ancestry subgroup analysis, indicating that genes contribute differently to the occurrence of T2D in different populations.• The impact of each gene in different populations:1. CDKAL1 gene: In European populations, the odds of T2D increased by 15%-23%; in European and Asian populations, the odds increased by 16%; in Asian populations, the odds increased by 21%; in Europeans, African Americans, etc. multi-ancestry populations, the increase was 16%.2. CDKN2B-AS1 - DMRTA1 gene: In Europeans, the odds of T2D increased by 22%; in Asians, the odds increased by 18%; in Europeans, African Americans, and other multi-ancestry populations, the odds increased by 17%.3. FTO gene: In European populations, the odds of T2D increased by 18%; in European and Asian populations, the odds increased by 12%; in Asian populations, the odds increased by 14%; in Europeans, African Americans, and other multi-ancestry populations, an increase of 13%.4. HHEX - Y_RNA gene: In European populations, the odds of T2D increased by 16%; in Asian populations, the odds increased by 18%.5. HNF1B, HNF1B gene: the odds of T2D increased by 8% in European and Asian populations; the odds increased by 13% in Asian populations.6. IGF2BP2 gene: In European populations, the odds of T2D increased by 14%; in both European and Asian populations, the odds increased by 14%; in Asian populations, the odds increased by 14%; in Europeans, African Americans, and other multi-ancestry populations , an increase of 12%.7. JAZF1 gene: In European populations, the odds of T2D increased by 12%; in European and Asian populations, the odds increased by 11%; in Europeans, African Americans, and other multi-ancestry populations, the odds increased by 12%.8. KCNQ1, KCNQ1 gene: The odds of T2D increased by 12% in European and Asian populations; in Asian populations, the odds increased by 29%; in European, African-American and other multi-ancestry populations, the odds increased by 22%.9. SLC30A8 gene: In European populations, the odds of T2D increased by 13%; in Asian populations, the odds increased by 12%; in Europeans, African Americans, and other multi-ancestry populations, the odds increased by 10-12%.10. TCF7L2 gene: In European and Asian populations, the increase was 37%; in Asian populations, the increase was 37%; in Europeans, African Americans, and other multi-ancestry populations, the increase was 31%.Our study findings:Our study highlight the significant association between specific genetic variants and the odds of developing T2D in different populations. These results not only provide important insights into understanding the genetic basis of T2D, but also point the way for the development of future prevention, diagnosis, and treatment strategies. In addition, by revealing the differential impact of genetic variation in different populations, this study provides valuable information for the application of precision medicine in T2D management.Conclusion:Our study uses meta-analysis to strengthen the understanding of genes on the odds of T2D, provides more in-depth genetic basic information, and opens up new ways for precision medicine strategies based on population differences. This not only fills the existing research gap, but also points out the direction for future genetic research.Keywords: type 2 diabetes, single nucleotide polymorphism, genome-wide association study, meta-analysi
[[alternative]]The Effect of Medical Care Information App on Emergency Department Medical Seeking Behavior: A Case Study of an Administrative District in Taipei City
No full text[[abstract]]背景與目的：本研究旨在透過設計製作一款提供醫療資訊的仿真App，名為「就醫資訊App 」（Medical Information App），並透過實地訪談問卷調查，了解民眾在不同就醫情境下，使用就醫資訊App後是否有不同的急診就醫選擇，並分析其不同的原因。研究方法：本研究屬橫斷性研究、初級資料研究法，利用實地問卷訪談，採隨機便利取樣，針對臺北市民眾進行就醫資訊App問卷，並以「就醫資訊App對民眾急診就醫選擇探討問卷」做為研究工具，回收有效問卷200份。該問卷使用Andersen就醫行為模式為基楚，內容有三大部分，包括基本資料17題、就醫選擇偏好10題與三種不同情境19題。使用EXCEL2019、SAS 9.4進行資料整理及統計分析。研究結果：表示本研究提供之就醫資訊App有助於民眾急診就醫選擇。本研究受訪者所需要的就醫資訊偏好有距離較近、到達較快較便利、等候人數、聲譽、服務品質、評鑑等級等資訊。在三種情境，其中情境二是否從急診選擇去門診和情境三是否從原急診選擇去其它急診，使用App前後之就醫醫療機構選擇皆有差異（ρ<0.0001）；在三種情境下，受訪者使用App前後之就醫選擇皆具有差異並達統計之顯著意義（ρ<0.0001）。情境一婚姻關係中離婚/喪偶的受訪者使用App後會就醫選擇不同的勝算比為未婚受訪者的0.284倍，且具有統計上顯著意義（ρ=0.0158），而在情境二年齡層為65歲以上的受訪者使用App後會就醫選擇不同的勝算比為18到35歲受訪者的0.223倍，且具有統計上顯著意義（ρ=0.0158）。而在受訪者使用App後若有與原就醫選擇不同，追問其原因，最多受訪者表示「等待看診人數較少或等候時間較短」是致使其就醫選擇不同的主要因素，分別為情境一80人、情境二104人和情境三72人。結論：本研究提供之就醫資訊App有助於民眾急診就醫選擇。建議政府與醫療院所可提供更完整且公開的就醫資訊，有助改善急診壅塞問題。受訪者關注等候人數和App提供的資訊，突顯了App在提供關鍵資訊方面的重要性。然而，受訪者也重視醫療機構距離、到達速度、便利性等因素，顯示就醫決策的多元考量。研究指出醫療院所資訊不均衡，呼籲政府和醫療機構提供更全面公開資訊，以確保資訊平衡和公正。總結而言，強調加強即時公開資訊，特別針對急診情況，改善醫療體系運作，提高民眾就醫選擇效率，進一步提升公共健康水平。[[abstract]]Background and Objective: This study aims to design and develop a simulation App named "Medical Information App" to provide medical information. Through on-site interviews and questionnaire surveys, the study seeks to understand whether there are differences in emergency medical care seeking among the public in different medical situations after using the Medical Information App and analyze the reasons for these differences.Methods: This study adopts a cross-sectional research design and primary data research method. Utilizing on-site questionnaire interviews with random convenience sampling, the study focuses on residents of Taipei City, collecting 200 valid questionnaires using the "Questionnaire on the Influence of Medical Information App on Public Emergency Medical Care Seeking" as the research tool. The questionnaire is based on Andersen's healthcare behavior model and consists of three main parts: basic information (17 questions), preferences in medical seeking (10 questions), and three different scenarios (19 questions). Data organization and statistical analysis are conducted using Excel 2019 and SAS 9.4.Results: The results indicate that the Medical Information App provided in this study contributes to the public's emergency medical care seeking. Respondents preferred medical information related to proximity, accessibility, waiting times, reputation, service quality, and evaluation ratings. In all three scenarios, there were significant differences in medical facility choices before and after using the App (ρ<0.0001). Respondents showed significant differences in medical seeking before and after App use across all scenarios (ρ<0.0001). For respondents whose medical seeking differed after using the App, the most common reason cited was "fewer waiting patients or shorter waiting times," with 80 respondents in scenario one, 104 in scenario two, and 72 in scenario three.Conclusion: The Medical Information App provided in this study contributes to the public's emergency medical care seeking. It is recommended that governments and medical institutions provide more comprehensive and publicly available medical information to alleviate emergency department congestion. Respondents' emphasis on waiting times and the information provided by the App highlights the importance of the App in providing critical information. However, respondents also value factors such as proximity, speed of arrival, and convenience, indicating diverse considerations in medical decision-making. The study points out information imbalances in medical institutions, urging governments and healthcare institutions to provide more comprehensive and openly available information to ensure information balance and fairness. In conclusion, there is an emphasis on enhancing real-time public information, especially regarding emergency situations, to improve the operation of the healthcare system, increase the efficiency of public medical seeking, and further enhance public health levels
[[alternative]]Application of machine learning on language problems analysis
No full text[[abstract]]在兒童的成長過程中，語言發展是一項關鍵任務，不僅是他們早期學習和社交的基礎，同時也深刻影響他們未來在學業和社會上的成就。因此，有效評估和支持兒童的語言發展狀況至關重要。在這方面，語言樣本分析是其中一種關鍵的評估工具。它通過專家蒐集、轉錄和分析兒童的語言樣本資料，評估受測者的語言發展狀況。本研究旨在結合語言樣本分析與人工智慧機器學習技術，以建立分類模型，用於區分正常發展的兒童與可能存在語言問題的兒童。本研究以共用語料ASDBank Mandarin Shanghai Corpus 和CHILDES Mandarin Chang Toy Play Corpus，作為可能有語言問題和正常兒童的語言樣本資料來源，先透過一套流程再利用語料做語言樣本分析，得到8項語言樣本指標(MLU-w、MLU-c、MLU5-w、MLU5-c、CTTR-w、CTTR-c、VOCD-D、VOCD-c)特徵數據。並將指標作為模型特徵，以合成資料(Synthetic data)技術解決兩類資料不足問題，生成六種組合資料。組合一含生成854筆品質為91.50%的資料共1000筆；組合二含生成854筆品質為91.07%的資料共1000筆；組合三含生成1854筆品質為91.14%的資料共2000筆；組合四含生成1854筆品質為91.26%的資料共2000筆；組合五含生成4854筆品質為91.08%的資料共5000筆；組合六含生成4854筆品質為91.40%的資料共5000筆。最後研究透過六種組合資料，利用單純貝氏分類、隨機森林、梯度提升機方法建置監督式機器學習分類模型。若考量生成的適當的合成資料筆數，和模型整體評估表現，則應選擇以組合二(生成854筆品質為91.07%的合成資料)資料，建置的隨機森林模型為最佳分類模型，達到了高靈敏度(Sen=0.96)、高精確度(Prec=0.83)、Odds Ratio=1.15、AUC=0.73 和F1=0.89 的結果。從本研究結果可知，資料量的最大化並不一定能帶來模型性能的提升，這表明適當的合成資料量對模型的性能有正面影響，但這種影響在達到一定數量後會趨於穩定，額外增加資料量不再顯著提升模型性能。期望本研究成果的人工智慧資料分析，有助於未來研究參考和應用。[[abstract]]Language development is a critical task in children's growth, not only forming the basis of their early learning and socialization, but also profoundly impacting their future academic and societal achievements. As such, effectively evaluating and supporting children’s language development is crucial. In this regard, language sample analysis is one of the key assessment tools. It involves experts collecting, transcribing and analyzing children’s language samples to evaluate their language development status. This study aims to incorporate language sample analysis with artificial intelligence machine learning techniques to develop classification models for distinguishing typically developing children from those who may have language issues.This study uses the shared corpora ASDBank Mandarin Shanghai Corpus and CHILDES Mandarin Chang Toy Play Corpus as sources of language samples from children with potential language issues and typical development. Through a process of reutilizing the corpora for language sample analysis, 8 language sample metrics (MLU-w, MLU-c, MLU5-w, MLU5-c, CTTR-w, CTTR-c, VOCD-D, VOCD-c) were obtained as feature values. These metrics were used as model features. Synthetic data techniques were applied to address insufficient data, generating six combinations of data. Combination 1 contained 854 records of 91.50% quality data totaling 1000 records. Combination 2 contained 854 records of 91.07% quality data totaling 1000 records. Combination 3 contained 1854 records of 91.14% quality data totaling 2000 records. Combination 4 contained 1854 records of 91.26% quality data totaling 2000 records. Combination 5 contained 4854 records of 91.08% quality data totaling 5000 records. Combination 6 contained 4854 records of 91.40% quality data totaling 5000 records.Finally, supervised machine learning classification models including Naive Bayes, Random Forest, and Gradient Boosting Machine were built on the six data combinations. Considering appropriate synthetic data volume and overall performance, combination 2 data (generating 854 records at 91.07% quality) with the Random Forest (RF) model was the optimal classifier, achieving high sensitivity (Sen=0.96), high precision (Prec=0.83), Odds Ratio=1.15, AUC=0.73 and F1=0.89. The results show maximizing data does not necessarily improve model performance, indicating appropriate synthetic data volume benefits performance, but this impact stabilizes after a certain level with additional data no longer significantly improving performance. It is hoped this artificial intelligence data analysis approach will benefit future research and applications
[[alternative]]Assessment of systematic Review of differences in the 3rd, 4th and 5th editions of Diagnostic and Statistical Manual of Mental Disorders (DSM) for Research on Reading Comprehension in Autism
No full text[[abstract]]自閉症人數逐年增加，然而在過去對自閉症閱讀理解介入之文獻分析中，哪種閱讀理解策略對於自閉症有明顯成效，似乎並無定論。 本研究旨在探討自閉症閱讀理解之介入措施相關文獻回顧，以了解自閉症閱讀理解之介入措施是否會因DSM(Diagnostic and Statistical Manual of Mental Disorders )版本不同導致對自閉症定義不同而有所改變，即以DSM版本年代分組，1994年以前(DSM第三版)、1994年-2013年5月(DSM第四版)及2013年5月以後(DSM第五版)分組，不同版本及年代在各個背景項目與特徵之間的差異，包括介入方式、自閉症診斷標準、年齡層、生理性別、研究設計、高功能自閉症、研究執行者。其中介入方式，細分為視覺及非視覺閱讀理解策略。 本研究共納入33篇文獻進行質性評估，1994年-2013年5月(DSM第四版)文獻較多，佔18篇，而在介入方式區分，以圖形與語意組織方式介入佔6篇，以版本區分比較各個研究特徵，經過統計檢定後，不同年代及版本的研究特徵無明顯差異(p > 0.05)。雖然各年代及版本研究特徵雖無明顯差異，但研究設計及執行者兩個特徵有漸進顯著意義。此外，以研究設計觀察不同年代差異，1994年以前(DSM第三版)沒有研究採用實驗設計，但1994年(DSM第四版及第五版)之後，實驗設計的研究比率有增加趨勢，其他研究設計比率有減少的趨勢(p = 0.57)，又以執行者來觀察，早期以老師介入的比率較多，但有逐年下降的趨勢，以研究者介入方式比率則呈現逐年增加的趨勢(p = 0.05)。[[abstract]]The prevalence of autism has been steadily increasing; however, there appears to be no consensus on which reading comprehension strategy yields significant effectiveness for individuals with autism in the literature analysis of past interventions. This study aims to investigate the literature related to interventions for reading comprehension in autism, examining whether variations in the Diagnostic and Statistical Manual of Mental Disorders (DSM) versions contribute to divergent definitions of autism and subsequent alterations in intervention measures. The study categorizes different epochs based on DSM versions: pre-1994 (DSM-III), 1994-2013 (DSM-IV), and post-May 2013 (DSM-V). It explores discrepancies across various contextual factors and characteristics, encompassing intervention modalities, autism diagnostic criteria, age groups, physiological gender, research designs, high-functioning autism, and study implementers. Specifically, intervention modalities are further subdivided into visual and non-visual reading comprehension strategies. This study qualitatively assessed a total of 33 literature sources, with a higher prevalence of publications from the period between 1994 and May 2013 (DSM-IV), comprising 18 articles. When categorizing interventions, those employing graphic and semantic organizational methods accounted for 6 articles. Upon conducting statistical tests to compare research characteristics across different eras and DSM versions, no significant differences were found (p > 0.05). Despite the absence of pronounced variations in research characteristics across eras and versions, there is a gradual significance observed in research design and implementers. Notably, an analysis of research design over different eras revealed that studies before 1994 (DSM-III) lacked experimental designs, whereas after 1994 (DSM-IV and DSM-V), there was an increasing trend in the proportion of studies adopting experimental designs, with a decreasing trend in other research design types (p = 0.57). Regarding implementers, an observation showed a higher prevalence of teacher interventions in earlier years, gradually decreasing annually, while researcher-led interventions exhibited an increasing trend (p = 0.05)
[[alternative]]Action research on coaching childcare providers in an infant care center
No full text[[abstract]]本研究旨在發展托嬰中心托育人員之托育現場培育方案，並以教練式領導培訓的方式，協助托育人員在嬰幼兒發展與親師溝通專業能力的提升。本研究採取行動研究法，以一家托嬰中心的 6 位托育人員為研究參與者。在行動研究修正的循環下透過研究者和托育人員的對話、討論，經由觀察、訪談、支持、傾聽、同理、提問與回顧步驟，循環規劃與執行合宜的教練式領導培訓方案。包括運用「在職教育課程訓練」、「專家本位訓練」及「同儕教練訓練」三類型式輔以 1.日常例行照顧工 作 2.傾聽與交談 3.學習活動 4.互動 5.課程結構 6.家長與托育人員之評量指標檢核托育人員;再透過計畫(Plan)與執行(Do)方案，進行分析檢查(Check)，行動 (action)進行兩次行動循環階段，促成教練式領導培訓方案結果，聚焦於托育服務現場實務，以提升托育人員的專業能力。 研究結果發現，專家本位訓練類型中的輔導方式呈現循環式進行的過程，包括個案研討、班級觀察、教師座談、班級觀察、教學研討等階段。此循環式的輔導方式能提供具體的教學策略，並能提升托育人員在實際操作中所遭遇的問題，同時提升托育人員的專業能力。此外，同儕教練訓練的實施過程可細分為醞釀期、準備期、發展期、成長期、完成期等五個階段。以此五個輔導歷程運用於班級內的協同托育人員身上，透過鷹架技巧的合作，促使同儕間透過互相觀摩實現彼此學習，建立正向互動關係。在實施教練式領導培訓後，研究者本身亦從此研究中成長。在與托育人員互動上透過傾聽、支持、同理及回饋，也讓研究者在實施過程深思實務經驗的重要意義，提升研究者持續執行行動研究以回應實務的能力。[[abstract]]This investigation endeavors to construct an on-site pedagogical development program for childcare providers within infant care facilities, leveraging a coaching leadership paradigm to enhance pedagogical competencies in early childhood development and caregiver-guardian communication. This study engaged six childcare providers as participatory subjects using an action research methodology. The study seeks to cultivate an efficacious coaching leadership model through iterative cycles of action research encompassing dialogic engagement, observational strategies, supportive interventions, active listening, empathetic inquiry, and reflective evaluation. This model integrates "Expertise-driven training" with "Collegial peer-based learning", undergirded by systematic evaluation through routine care practices, communicative interactions, educational activities, interpersonal engagement, curricular organization, and joint caregiver-guardian evaluative measures. The research advances through iterative (Plan) and (Do) stages, incorporating analytical and evaluative (Check) phases to ascertain the impact of the coaching leadership program on the professional acumen of childcare providers and its translation into daily pedagogical application.The synthesis of the research findings reveals that within the expert-driven coaching framework, the iterative pedagogical approach transitions through case analysis, instructional observation, educator discourse, repeated classroom scrutiny, and pedagogical dialogues. This method imparts efficacious instructional methodologies, addressing the practical challenges confronted by childcare providers. The peer-to-peer coaching model unfolds through phases of inception, preparation, evolution, advancement, and culmination, evidencing its effectiveness in collaborative pedagogical interactions. Such cooperation, fostered by reciprocal observation and collective learning, nurtures a synergistic and constructive dynamic among stakeholders. Additionally, this study highlights the scholar's professional development, accentuated by applying coaching leadership strategies. Engaging in supportive, empathetic, and perspective-shifting interactions with childcare providers provides insightful, practical knowledge and refines the scholar's acumen in conducting and implementing action research
[[alternative]]The trend of changes in symptoms distress, sleep and quality of life in women with interstitial cystitis during intravesicle hyaluronic acid treatment: An mixed-methods research
No full text[[abstract]]研究動機與目的：間質性膀胱炎患者長期受下泌尿道症狀的困擾與折磨，這些症狀反覆啃蝕著患者的身心靈，使其生活品質受到極劇之影響。因此本研究目的為探討間質性膀胱炎婦女於接受玻尿酸治療前罹病經驗的感受、想法與態度，以及患者於接受治療期間症狀困擾、睡眠與生活品質之趨勢變化，期望透本研究結果對接受玻尿酸治療之間質性膀胱炎婦女有全貌性的了解，提升此類患者之照護品質。研究設計：本研究採質量性混合研究設計(mixed method)，質性研究以立意取樣；取樣條件為年滿20歲經醫師診斷為間質性膀胱炎且欲接受膀胱內玻尿酸治療之婦女，意識清楚，能聽說讀寫中文，願意參與本研究，並完成簽署研究同意書；有其他慢性病、重大疾病、泌尿道之相關疾病、癌症病史、被診斷具有精神疾病者、心智功能障礙、及吸食毒品者皆須排除。以半結構式訪談指引進行訪談，當受訪者的描述資料已無法再出現不同的新資訊、新編碼，或新主題，代表資料已達飽和不需再繼續收案，共訪談18位，資料以內容分析法進行分析。量性研究採描述性、縱貫性重複測量之研究設計，採方便取樣，以G-Power 3.10進行樣本數估計，共收案27人，以結構式問卷進行資料收集，資料以統計軟體SAS進行分析，包含描述性統計、皮爾森積差相關、獨立樣本T檢定、單因子變異數之推論性統計，相關性分析，治療期間症狀困擾、睡眠品質及生活品質之趨勢變化以廣義估計式(Generalized estimating equations, GEE)進行分析。研究結果：質性分析共歸納出5個類屬(categories)、18個次類屬(subcategories)及32個次次類屬(sub-subcategories)，5個類屬包含1、求醫確診的困難；2、身體心像改變；3、生活全面受到影響；4、身心崩潰與情緒憂傷；5、尋找生命的出路。量性研究發現：(1)隨著玻尿酸治療時間不同，相較於治療前間質性膀胱炎婦女在下泌尿症狀困擾及生活品質方面具有顯著改善。(2)症狀困擾、睡眠品質與生活品質呈顯著負相關，症狀困擾越嚴重、睡眠品質越差則生活品質也越差。(3)隨治療時間增加，間質性膀胱炎婦女的生活品質顯著提升。結論與建議：間質性膀胱炎目前仍是無法治癒的疾病，患者身心靈處於囹圄桎梏的磨難中，甚至出現對生命的無望感，需要透過外部支持和內在積極的認知重建，給予疾病正確的認知及調整正確的飲食觀念，修正自我行為及壓力管理，同時關注患者心理層面的影響，透過心理支持及心理諮商師的專業介入，增加及強化病人的正能量，尋找與病共存的生活模式，調整因應策略，提升生活品質。[[abstract]]Background and Study Purposes: Patients with interstitial cystitis suffer from long-term lower urinary tract symptoms, which repeatedly erode their physical, mental, and emotional well-being, severely impacting their quality of life. Therefore, this study aims to explore the experiences of women with interstitial cystitis prior to initiating hyaluronic acid treatment. Additionally, this study aims to investigate the changes in symptom distress, sleep quality, and quality of life throughout the course of treatment. The ultimate objective is to cultivate a thorough understanding of the experiences of women undergoing hyaluronic acid treatment for interstitial cystitis, thereby elevating the standard of care provided to these patients.Methods: This study adopts a mixed-methods research design. The qualitative research involves purposive sampling of women aged 20 and above diagnosed with interstitial cystitis, willing to undergo intravesical hyaluronic acid treatment, able to communicate in Mandarin or Chinese, without a history of chronic diseases, major illnesses, urinary-related diseases, cancer, mental disorders, cognitive impairments, or substance abuse. Semi-structured interviews continue until data saturation is achieved, resulting in 18 interviews, which are analyzed using content analysis. The quantitative research employs a descriptive, longitudinal repeated-measures design, with convenience sampling. G-Power 3.10 is used for sample size estimation, resulting in a total of 27 participants. Data collection utilized structured questionnaires, and statistical analysis is performed using SAS software, including descriptive statistics, Pearson correlation, independent samples t-test, one-way analysis of variance, and inferential statistics. The changes in symptom distress, sleep quality, and quality of life during treatment are analyzed using generalized estimating equations (GEE).Results: The qualitative analysis yielded five categories, 18 subcategories, and 32 sub-subcategories. These categories include: 1) challenges in seeking medical diagnosis, 2) transformations in body image and self-perception, 3) holistic impact on daily life, 4) emotional breakdown and distress, and 5) seeking a way out of life. The quantitative findings indicate that: 1) women with interstitial cystitis experience notable enhancements in lower urinary tract symptom distress and overall quality of life post-treatment compared to pre-treatment, 2) symptom distress, sleep quality, and quality of life are significantly negatively correlated, with more severe symptom distress and poorer sleep quality associated with lower quality of life, and 3) as the treatment duration increases, the quality of life for women with interstitial cystitis exhibits a significant improvement.Conclusions and Recommendations: Interstitial cystitis remains an incurable disease, imposing physical, mental, and emotional hardships, often leading to feelings of hopelessness. To address these challenges, external support and internal cognitive reconstruction become imperative. This involves providing patients with accurate knowledge about the disease, rectifying dietary misconceptions, adapting self-behaviors and stress management, and addressing the psychological impact through professional psychological support and counseling. This approach aims to increase and strengthen patients' positive energy, facilitate the discovery of a harmonious coexistence with the disease, adjust coping strategies, and ultimately enhance their overall quality of life
[[alternative]]The Experience of Primary Caregivers in Caring for Children with Anorectal Malformations
No full text[[abstract]]肛門直腸畸形為一先天性發育不良疾病，隨著醫療技術改進與相關手術的發展，此類新生兒於出生後可接受到較良好的醫治及照護；然而，多數肛門直腸畸形孩童並非一次手術治療後即可與正常人一樣具有良好的排便功能，其中高位型者多數永遠無法達到正常排便功能。因此，此類病童的手術後照顧、管理及如何以家庭為中心的整合照護更為重要。本研究主要目的為探討肛門直腸畸形孩童主要照顧者在照顧過程中的經驗。深入了解孩童主要照顧者的照顧過程，希望能確立可能的照護困難所在與其心理壓力及調適過程。進而調整護理指導措施與護理支持方法，以達到符合孩童及家屬需求的照護。本研究設計以質性描述性研究方法，採立意取樣方式；採用質性研究深度訪談方式收集資料，以一對一半結構式訪談指引進行訪談，於111年12月至112年10月收集17位參與肛門直腸畸形孩童主要照顧者，訪談時間約60分鐘；利用半結構式訪談大綱收集資料。訪談後將訪談內容謄寫成逐字稿，再以質性內容分析法對訪談資料進行整理、歸納及分析，研究結果歸納出五個主題：「疾病造成的衝擊」、 「術前的不確定感」、 「術後的照護挑戰」、 「內心深處的隱憂」、 「安心力量的來源」。研究發現當孩子被診斷為肛門直腸畸形的情況下，父母呈現不知所措的情緒，在對疾病不熟悉的情況下，將造成父母心理上之衝擊，同時因國內文化背景人文風俗因素，父母對無肛症俗稱產生恥辱感及心理困擾。治療過程中亦擔心手術風險、術後的困難照護及擔心孩子未來之隱憂。雖此，在醫護詳細照護衛教、家人支持及自身配合復健治療下，隨著病情進展明朗化，父母因而轉變心態，使其學習妥善深入給予孩童適切的照護。本研究藉由了解照顧者照護過程中的心境感受，提供給醫護人員作為在面對此類孩童照顧者照護過程可給予的專業資訊提供及心理支持作為參考，以幫助照顧者更能適切給予孩童完善的照護。關鍵字: 肛門直腸畸形、無肛症、主要照顧者、父母親[[abstract]]Anorectal malformation (ARM) is a congenital anomalies disease. The most children with ARM do not achieve the normal function of bowel control after surgical correction. Therefore, it is distinctly important how to carry out the care and management after surgery as a family integrated care strategy for these children. The purpose of this study is to realize the experience of the main caregivers of the children with ARM. Through the study, we may gain an in-depth understanding of the whole care process, the difficulties in care and its underlying factors, psychological pressure and adaptation process of the main caregivers.This study is designed with qualitative descriptive research and purposive sampling method. From December 2022 to October 2023, the 17 main caregivers of ARM children were recruited, through one-to-one in-depth interviews. The interview materials were sorted, summarized and analyzed by qualitative content analysis. Five themes were identified on review of extracted data: (1)Psychological impact caused by the disease, (2)Uncertain feeling before surgery, (3) Challenges of postoperative care, (4)The hidden worries deep in heart, (5)Source of a sense of security.The results revealed that parents feel at a loss when their children were diagnosed as ARM and a great psychological impact occurred on them. They feeled stigma and psychological distress due to the domestic cultural background and humanistic customs about ARM. They also worried about the risks of surgeries, difficulties in postoperative care, and the children's future. However, parents may change their mentality and learn to provide appropriate care to their children, under the careful medical care, education, and family support. This study provides medical staff with professional informations in the care process for children of ARM.Keywords: Anorectal malformation, Imperforate anus, Caregiver, Parent