Mei Chih Huang

Long-term cognitive and motor deficits after enterovirus 71 brainstem encephalitis in children

OBJECTIVES. Several large outbreaks of enterovirus 71 infections have occurred in Taiwan during the past decade. Brainstem encephalitis was the most common neurologic complication. This study was designed to determine the long-term cognitive and motor outcomes of children with enterovirus 71 brainstem encephalitis. METHODS. We conducted a prospective follow-up study of children who met the case definition for enterovirus 71 brainstem encephalitis. Subjects were stratified into isolated brainstem encephalitis (stage II), autonomic nervous system dysregulation (stage IIIa), and pulmonary edema (stage IIIb). The subjects and their parents or guardians were interviewed using structured questionnaires and received comprehensive cognitive and neurologic examinations. Motor coordination, visual-motor skill, and intellectual ability were evaluated. RESULTS. Follow-up studies were conducted in 63 previously healthy children with enterovirus 71 brainstem encephalitis (49 stage II, 7 stage IIIa, and 7 stage IIIb). The mean time to follow-up was 2.8 ± 1.0 years (range: 1.4–4.9 years). Boys outnumbered girls by 3 to 2. The mean age at diagnosis was 2.4 ± 1.4 years (range: 0.3–7.1 years). The most common abnormal neurologic findings on admission were altered consciousness (47.6%), followed by abnormal activities of daily living (52.4%), cerebellar dysfunction (17.5%), and cranial nerve palsy (15.9%). At follow-up, 51 of 63 children had no detectable deficits. Among the remaining 12 children, 3 died during the follow-up. The remaining 9 children (14.3%) had residual deficits. Two of these with stage IIIb disease continued to have severe motor and respiratory failure. CONCLUSIONS. Residual defects were still present in a significant proportion of children with enterovirus 71 brainstem encephalitis at >2 years after their hospitalization. Children with stage II disease were most likely to have residual cerebellar defects. Those with stage IIIb disease continued to have severe respiratory and motor impairment. Long-term follow-up of this cohort is needed to determine the ultimate prognosis.

Analysis of Risk Factors for Bacteremia in Children with Nontyphoidal Salmonella Gastroenteritis

Abstract.To identify the risk factors for Salmonella bacteremia in infants and children with Salmonella gastroenteritis, a retrospective study of a 10-year period was conducted to evaluate 456 infants and children with culture-proven nontyphoidal Salmonella infection. Salmonella typhimurium was the most common isolate found. Among the 257 patients with gastroenteritis who had a concomitant blood culture performed, 50 exhibited bacteremia. Statistically significant differences were noted between patients with gastroenteritis and bacteremia and those without bacteremia in duration of fever ≥5 days (P<0.001; OR, 5.6; 95% CI, 2.6–12.1) and infection with group D1 Salmonella (P<0.001; OR, 6.5; 95% CI, 2.5–16.9) after adjustment for multivariate analysis. Of the 320 Salmonella strains that were serotyped, Salmonella panama was shown to be strongly associated with bacteremia (P<0.001) in children with gastroenteritis. In summary, in children with nontyphoidal Salmonella gastroenteritis, prolonged fever lasting 5 days or more and infection with a specific Salmonella serotype were risk factors closely associated with development of bacteremia.

The association between rainfall rate and occurrence of an enterovirus epidemic due to a contaminated well.

Aims:  To determine the association between rainfall rate and occurrence of enterovirus infection related to contamination of drinking water.

Differences in HIV disclosure by modes of transmission in Taiwanese families

Abstract HIV serostatus disclosure is a crucial decision, and often perceived as a double-edged sword for people living with HIV. This study was intended to determine the extent of disclosure according to interpersonal relationships, compare the characteristics of disclosure by modes of HIV transmission, and to describe perceived consequences after disclosure to Taiwanese families. Data were collected by in-depth interviews and chart reviews at HIV primary care clinics in a university hospital in southern Taiwan from 2004 to 2005. Of 105 male participants interviewed, 76 (72.4%) had disclosed their HIV status to at least one person, including 62% to an immediate family member and 21% to friends. The HIV disclosure rates were different in three groups divided by modes of transmission, 36% in men having sex with men (MSM), 34% in heterosexuals, and 21% in injection drug users (IDUs). MSM were more likely than heterosexual men or male IDUs to disclose their HIV status directly to friends immediately after leaning of their HIV diagnosis. Heterosexual men and male injection drug users often disclosed to their immediate families a few days after obtaining an HIV diagnosis. Perceived consequences after disclosure included: increased substantial support from family, assistance with medical and healthcare, encouragement of living positively with HIV, being rejected, treated as contagion, and condemnation. Disclosure of HIV-positive status in a family-oriented Taiwanese society is a complex process and different by the modes of transmission.

Disturbed eating behaviors in Taiwanese adolescents with type 1 diabetes mellitus: a comparative study

Objectives:  This study aimed to (i) compare disturbed eating behaviors in adolescents with type 1 diabetes mellitus (T1D) with a matched group of adolescents in Taiwan and (ii) examine the relationships of disturbed eating behaviors to body mass index (BMI) and metabolic control among adolescents with T1D.

Febrile Convulsions: Development and Validation of a Questionnaire to Measure Parental Knowledge, Attitudes, Concerns and Practices

BACKGROUND The best medicine for febrile convulsions (FCs) is not prescription medications but effective communication of related information to parents. Therefore, a quick assessment tool for obtaining information about parental responses to FCs is essential for educating parents, clinical practice and research. This paper describes the development and psychometric testing of a questionnaire on parental knowledge, attitudes, concerns and practices (KACP) toward FC. METHODS Questionnaire items were created via literature review, interview, and expert consultation. Ten parents were interviewed to develop the questionnaire contents. Nine experts and seven parents were consulted to review the content and face validity of the questionnaire. Of the 326 parents of children with FC visiting 11 emergency departments in southern Taiwan, 216 parents completed the questionnaire, and 64 completed the questionnaire again 2 weeks later. Content validity, internal consistency, test-retest reliability, and item analysis were evaluated. RESULTS Cronbachs alpha exceeded 0.72 for the knowledge, attitudes and concerns domains. The item-total correlations in the knowledge and concerns domains ranged from 0.40 to 0.73, but were lower in the attitudes domain (only 4 in 10 items were within 0.40-0.70). The intraclass correlation coefficients (ICC) for the test-retest reliability of the knowledge, attitudes and concerns domains were 0.65, 0.68 and 0.58, respectively. The correlation coefficients between KACP domains were tested and significantly supported the theoretical basis of the questionnaire. CONCLUSION For research purposes, the KACP questionnaire measures parental responses with a moderate level of reliability and validity. Cross-cultural investigation of the questionnaire is needed to facilitate its use in other countries.

Parental Knowledge, Concerns, and Management of Childhood Fever in Taiwan

Background: Childhood fever is a commonly treated condition in medical settings. Many studies around the world have reported on the phenomenon of parental fever phobia. Studies of parental knowledge regarding childhood fever are lacking in Taiwan. Purpose: This study explores parental knowledge, concerns, and management of childhood fever and their correlates in Taiwan. Methods: This study used a cross-sectional survey and self-administered questionnaire. Six hundred forty-nine parents were recruited as participants from pediatric clinics and kindergartens in southern Taiwan. Results: Nearly half (47.2%) of participants incompletely understood the healthcare information about childhood fever provided by physicians and nurses. Furthermore, 41.6% of parents were dissatisfied with the information provided. The median score of parental knowledge was 10 (interquartile range [IQR] = [8, 12] out of a maximum of 23). Parent gender, religion, education level, and occupation were independent predictors of knowledge scores. Parents who were never or sometimes concerned about childhood fever had significantly higher knowledge scores than those who were always concerned about childhood fever (median knowledge score: 11, IQR = [9, 13] vs. 10, IQR = [8, 11]). Most parents followed Western medical advice to manage childhood fever; however, 31.1% of parents combined this with traditional folk treatments. Levels of concern among parents included 86.6% ofparents who frequently or always worried about their children’s fever. Fever-induced anxiety was reported by 68.8% of the parents. Conclusions/Implications for Practice: Participants’ lack of fever-related knowledge was because, in part, of either their not understanding or their dissatisfaction with provided information. The higher level of concern compared with other countries and studies indicates that parents in Taiwan need appropriate information about fever management to alleviate their concerns and guide them in caring for their febrile children.

IJEPA Gray Area for Health Policy and International Nurse Migration

Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country’s adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country’s own participation in a bilateral trade and investment agreement, known as the Indonesia–Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia–Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia–Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia–Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.

Newborn Screening: Should Explicit Parental Consent Be Required?

Newborn screening, the first population-based metabolic screening program has been universally conducted for several decades. With the advent of genetic technologies, many genetic/metabolic disorders can be detected pre-symptomatically but might be untreatable. Since the benefits and risks of screening tests on newborns are not fully known, newborn screening programs confront both legal and ethical challenges. This article aims to explore the following questions: (1) Is explicit parental consent required? (2) What level of consent should be sought? and (3) Is screening in the absence of explicit consent legally defensible? This article considers: (1) the introduction of newborn screening, (2) the conditions under which it is conducted (voluntary vs. mandatory), (3) the argument over whether explicit parental consent is required, (4) the conditions under which implied consent may be assumed, and (5) the principles of informing parents. This article concludes that implied consent is not acceptable except for traditional routine screening. Healthcare professionals should provide information about the known benefits and risks of testing and recognize the parental right of refusal. Finally, since the absence of explicit parental consent to newborn screening is not legally defensible, childrens advocates should lobby for legislation permitting it in the absence of explicit consent in specific circumstances.

Cultural competence course for nursing students in Taiwan: A longitudinal study

BACKGROUND Culturally competent care is an essential ability for nursing students. However, little is known about the effects of educational intervention on attitudes or behavior changes with regard to cultural competence in Taiwan. PURPOSE This study evaluates the effects of a cultural competence course for nursing students. METHODS Using a longitudinal study design, 105 participants were assigned to an experiment group (51 participants) and control group (54 participants) based on the school they attended. Students in the experiment group received a two-credit course on cultural competence care. Using the Cultural Competence Assessment Instrument-Chinese Version (CCA-CV), data were collected between 2012 and 2013 at three points in time: before and after the course and again 6 to 8 months after the two groups (experiment and control) had completed the clinical practicum. RESULTS The results of a generalized estimating equation (GEE) analysis indicate that the cultural competence of all participants had improved at the posttest assessment, with the experiment group showing a significantly better improvement over the control group. However, the overall effectiveness of the training diminished with time. This study supports that taking a cultural competence course effectively enhances the cultural competence of nursing students for a limited period of time immediately following the course. CONCLUSIONS AND APPLICATIONS These results support that the benefits of incorporating a cultural competence course in clinical practice should be considered in the future. Furthermore, healthcare institutions should be encouraged to provide greater support and consideration to cultural competence issues in the nursing workplace in order to reinforce and extend the benefits of cultural competence courses provided at nursing schools.