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Epistemic trust (ET) refers to trust in communicated knowledge. This paper describes the development and validation of a new self-report questionnaire, the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ). We report on two studies (Study 1, n = 500; Study 2, n = 705) examining the psychometric properties of the ETMCQ and the relationship between EMTCQ scores (i.e., an individual’s epistemic stance) and exposure to adverse childhood experiences, mental health symptoms, attachment, mentalizing and general self-efficacy. The factor structure of the ETMCQ was examined using Exploratory and Confirmatory Factor Analyses, and its reliability and test-retest reliability were tested. Both studies yielded three correlated yet distinct factors–Trust, Mistrust and Credulity–and confirmed the reliability and validity of the ETMCQ. Preregistered hypotheses were confirmed and replicated across both studies. Main findings suggest intriguing links between the ETMCQ and developmental psychopathology constructs and are consistent with thinking on the role of epistemic stance in undermining adaptation and increasing the developmental risk of mental health problems. Mistrust and Credulity scores were associated with childhood adversity and higher scores on the global psychopathology severity index and both factors partially mediated the link between early adversity and mental health symptoms. Mistrust and Credulity were positively associated with difficulties in understanding mental states and insecure attachment styles. Post-hoc analysis identified that different attachment styles were associated with differences in epistemic stance. In addition, Trust was not associated with reduced levels of mental health symptoms and did not moderate the impact of childhood adversity–findings are congruent with the suggestion that the reduction of mistrust and credulity may be crucial common factors in promoting resilience and the effectiveness of psychotherapeutic interventions. This investigation and the ETMCQ provide an empirical measure of what until now has been largely a theoretical concept and open new avenues for future research.

Background: Presenting to peers is an effective practice to promote active learning. Assigned discussants ask prepared questions to spark meaningful dialogue among students. This project examined how students self-assessed the effects of using peer discussants on communication, engagement, and understanding of their presentations. Method: Students were provided with instructions about how to implement peer discussants for student presentations. Postcourse, students completed a six-item Likert-style survey assessing their engagement, understanding, and communication compared with no discussant role. Results: Sixty-seven students completed a postimplementation survey for a 40% response rate. All survey items were rated at least 2 on a 3-point Likert scale. Highest rated items included engagement and understanding (discussant role) and level of peer comments and questions (presenter role). Conclusion: The use of assigned discussants is an active teaching-learning strategy that realizes potential to support nursing students as they become professional nurses and lifelong learners.

Given the shortage of cost-of-illness studies in dementia outside of the Western population, the current study estimated the annual cost of dementia in Taiwan and assessed whether different categories of care costs vary by severity using multiple disease-severity measures. This study included 231 dementia patient-caregiver dyads in a dementia clinic at a national university hospital in southern Taiwan. Three disease measures including cognitive, functional, and behavioral disturbances were obtained from patients based on medical history. A societal perspective was used to estimate the total costs of dementia according to three cost sub-categories. The association between dementia severity and cost of care was examined through bivariate and multivariate analyses. Total costs of care for moderate dementia patient were 1.4 times the costs for mild dementia and doubled from mild to severe dementia among our community-dwelling dementia sample. Multivariate analysis indicated that functional declines had a greater impact on all cost outcomes as compared to behavioral disturbance, which showed no impact on any costs. Informal care costs accounted for the greatest share in total cost of care for both mild (42%) and severe (43%) dementia patients. Since the total costs of dementia increased with severity, providing care to delay disease progression, with a focus on maintaining patient physical function, may reduce the overall cost of dementia. The greater contribution of informal care to total costs as opposed to social care also suggests a need for more publicly-funded long-term care services to assist family caregivers of dementia patients in Taiwan.

The The Neonatal Nurse Practitioner program at The Ohio State University transitioned from a traditional face-to-face program to a distance-enhanced hybrid model providing course content online with campus visits for procedural skills and simulation in 2017. Although the 2020 COVID-19 pandemic necessitated cancellation of all in-person events across the university, the neonatal nurse practitioner students' learning needs remained the same. The onsite experience was redesigned for virtual delivery. Procedural content was accomplished through student-led small-group collaborative critical thinking activities surrounding procedural complications, and other faculty-led scenario discussions. Students collaborated for a Complications Rounds activity (1-day) that promoted learning about procedural skills from a global perspective including safe techniques, monitoring, risks, and troubleshooting complications. Procedural content can be achieved when in-person learning is not possible. The Complications Rounds approach can mitigate delays or gaps in practical experiences. Examining complications in-depth increases preparedness, promoting greater awareness of harm prevention when these present in future practice. [J Nurs Educ. 2020;59(12):692-696.].

Background Parkinson’s disease (PD) exerts a considerable burden on the elderly. Studies on long-term costs for Parkinson’s disease patients in Taiwan are not available. Objectives This study aims to examine the medical resource utilization and medical costs including drug costs for PD patients in Taiwan over up to 15 years of follow-up. Methods Incident PD patients and matched non-PD subjects were identified between 2003 and 2016 from the National Health Insurance (NHI) research database. Differences in annual healthcare utilization and costs between PD and non-PD subjects from 2003 to 2018 were predicted by generalized linear models. We performed analyses stratified by PD severity and also by age, gender, and duration of follow-up. Results We identified 50,290 PD cases and 201,153 non-PD subjects. From the payer’s perspective, the average total medical costs (drug costs) associated with PD and non-PD subjects were NT$631,080 (NT$222,810) and NT$480,880 (NT$140,120), respectively. Total medical and drug costs of PD after diagnosis remained high, from NT$138,487 per patient in the first year following diagnosis up to NT$154,676 per patient at year 15. The largest components of costs were for outpatient care (55% of total medical costs), and total drugs cost (35% of total medical costs). Patients with severe PD incurred higher total medical costs compared to those with moderate or mild PD, with outpatient and inpatient costs as well as drug costs rising with disease severity. Conclusions This is the first study of its kind in Taiwan that comprehensively analyzes long-term healthcare utilization and costs among PD patients. PD imposes a significant economic burden in Taiwan, with medical (drug) costs being 1.31 (1.59) times that of non-PD individuals and costs increasing substantially with PD severity. Our findings can aid health policymakers in understanding the healthcare needs and medical costs of PD patients, supporting effective policy formulation.

This article explores the epistemological aspects of dialogue through an engagement with the Danish existence thinker, Søren Kierkegaard. I argue that dialogue plays an integral role in the epistemic process tentatively sketched by Kierkegaard. To show this, I start by examining Kierkegaard’s criticism of non-dialogical approaches to knowing. Offering a corrective, Kierkegaard instead operates with a contact theory of knowledge analogising knowing and breathing to underline the importance of receptivity and relationality in the epistemic process. By placing Kierkegaard in conversation with his pseudonym Johannes Climacus, dialogue can be seen to play a crucial role in two ways. Firstly, Kierkegaard and Climacus creatively re-appropriate and reconstruct dialogical aporia textually to encourage receptivity and make the needed space for knowledge. Secondly, Kierkegaard’s and Climacus’s invocations of dialogue implicitly and explicitly centre the second-person perspective in different ways to emphasise the importance of “contact” and relation in knowing. I argue that although this perspective can ultimately be considered a second-order perspective, it points not only to receptivity, but also to relationality as both an object of knowledge and as part of the epistemic process itself.

Background To assess the prevalence of urban-rural disparity in lower extremities amputation (LEA) among patients with diabetes and to explore whether patient-related or physician-related factors might have contributed to such disparity. Methods This was a population-based study including patients with diabetes aged ≥55 years from 2009 to 2013. Among them, 9236 received LEA. Data were retrieved from Taiwan’s National Health Insurance (NHI) claims. A multiple Poisson regression model was also employed to assess the urban-rural difference in LEA prevalence by simultaneously taking into account socio-demographic variables and density of practicing physicians. Results Between 2009 and 2013, the annual prevalence of LEA declined from 30.4 to 20.5 per 10,000 patients. Compared to patients from urban areas, those who lived in sub-urban and rural areas suffered from a significantly elevated prevalence of LEA, with a prevalence rate ratio (PRR) of 1.47 (95% CI, 1.39–1.55) and 1.68 (95% CI, 1.56–1.82), respectively. The density of physicians who presumably provided diabetes care can barely explain the urban-rural disparity in LEA prevalence. Conclusions Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in LEA prevalence still exists in Taiwan after nearly two decades of the NHI program.

Since the 1970s, the emergence and expansion of novel methods for calcium ion (Ca2+) detection have found diverse applications in vitro and in vivo across a series of model animal systems. Matched with advances in fluorescence imaging techniques, the improvements in the functional range and stability of various calcium indicators have significantly enhanced more accurate study of intracellular Ca2+ dynamics and its effects on cell signaling, growth, differentiation, and regulation. Nonetheless, the current limitations broadly presented by organic calcium dyes, genetically encoded calcium indicators, and calcium-responsive nanoparticles suggest a potential path toward more rapid optimization by taking advantage of a synthetic biology approach. This engineering-oriented discipline applies principles of modularity and standardization to redesign and interrogate endogenous biological systems. This review will elucidate how novel synthetic biology technologies constructed for eukaryotic systems can offer a promising toolkit for interfacing with calcium signaling and overcoming barriers in order to accelerate the process of Ca2+ detection optimization.

Suami SIAGA, which translates literally as the ‘alert husband’, is a national campaign that was created in early 2000 to promote male participation in maternal and child health program in Indonesia. The purpose of this study was to identify the proportion of men who took part in Suami SIAGA and the factors associated with their participation using the 2012 Indonesia Demographic and Health Survey (IDHS). This study also examined the relationship between Suami SIAGA and the following results related to the national campaign: the presence of husbands at antenatal care (ANC) units and the place of delivery at health facilities. Data on the characteristics of husbands and wives, as well as other related factors, the perceived elements of Suami SIAGA, and the national campaign outcomes were obtained from a total of 1256 eligible male subjects, drawn from the matched couples’data set. The data was analysed using bivariate and multiple logistic regression to test the associations. This study found that 86% of the respondents were categorised as SIAGA husbands. After controlling all the variables, age and education of wife factors were significantly associated with Suami SIAGA, especially in the group of women aged 41–49 years old (OR = 2.4, 95% CI: 1.1–5.5) and women with a secondary level of education (OR = 1.8, 95% CI: 1.2–2.7) and higher (OR = 2.8, 95% CI: 1.4–5.6). SIAGA husbands were more likely to attend their wives’ANC (OR = 2.3; 95% CI: 1.4–3.7). This study provides evidence on the benefit of husband involvement in maternal health, especially to improve ANC attendance. Empowering women themselves should also be addressed in leveraging the impact of Suami SIAGA. Suami SIAGA, dont la traduction littérale veut dire «mari vigilant», est une campagne nationale initiée au début de l’année 2000 pour promouvoir la participation des hommes au programme de santé maternelle et infantile en Indonésie. Le but de cette étude était d’identifier la proportion d’hommes ayant participé à Suami SIAGA et les facteurs associés à leur engagement en utilisant l’Enquête démographique et sanitaire de 2012 en Indonésie. La présente étude se propose également d’examiner la corrélation entre Suami SIAGA et les résultats suivants liés à la campagne nationale: la présence des maris dans les unités de soins prénatals (ANC) et les maternités des formations sanitaires. Les données sur les caractéristiques des maris et des épouses, ainsi que d’autres facteurs connexes, les composantes de Suami SIAGA et les résultats de la campagne nationale ont été recueillis auprès d’un total de 1256 hommes admissibles, tirés de l’ensemble de données sur les couples. Les données ont été analysées en utilisant une régression logistique bivariée et multiple pour tester les associations. L’étude a révélé que 86% des personnes interrogées étaient classées dans la catégorie des maris SIAGA. Après avoir contrôlé toutes les variables, on a constaté que les facteurs d’âge et d’éducation de l’épouse avaient une corrélation significative avec Suami SIAGA, en particulier chez les femmes de 41 à 49 ans (OR=2,4, IC 95%: 1,1-5,5) et celles ayant un niveau d’éducation secondaire (OR=1,8, 95% CI: 1,2-2,7) ou supérieur (OR=2,8, 95% CI: 1,4-5,6). Les maris SIAGA étaient plus enclins à assister à l’accouchement de leur femme (OR=2,3, IC 95%: 1,4-3,7). L’étude fournit des données probantes sur les avantages de l’engagement du mari à la santé maternelle, en particulier pour une plus grande assiduité aux soins prénatals. L’autonomisation des femmes elles-mêmes doit également être prise en compte pour tirer parti de l’impact de la campagne Suami SIAGA. Suami SIAGA, 直译为“丈夫提醒”, 是印度尼西亚2000年初 启动的全国运动, 旨在促进男性参与孕产妇和儿童健康。本研 究的目的是了解参与Suami SIAGA项目的男性比例, 以及与他 们参与项目相关的因素, 数据来源是2012年印度尼西亚人口与 健康调查 （IDHS）。本研究还探讨Suami SIAGA与下列全国 运动结果的关系：丈夫在产前护理 （ANC） 和卫生机构中分 娩场所的陪伴。丈夫和妻子特征及其他相关因素, Suami SIAGA的感知要素, 以及全国运动结果的数据共包含1256个符 合条件的男性, 来自匹配夫妻数据集。采用双因素和多因素 Logistic回归进行数据分析和相关性检验。本研究发现, 86% 的应答者属于参与SIAGA的丈夫。控制所有其他因素后, 妻子 年龄和教育程度与丈夫参与SIAGA显著相关, 尤其是在41-49 岁年龄组 （OR=2.4, 95% CI： 1.1-5.5） 和中等、高等教育程 度组（OR=1.8, 95% CI： 1.2-2.7； OR=2.8, 95% CI： 1.4- 5.6） 。 SIAGA丈夫更有可能陪伴妻子进行产前护理 （OR=2.3, 95% CI： 1.4-3.7） 。 本研究证明了丈夫参与孕产 妇健康的益处, 尤其是在提高产前护理的使用方面。在利用 Suami SIAGA运动的影响时也应该赋予女性权利。 Suami SIAGA, que se traduce literalmente como el “esposo alerta”, es una campaña nacional que fue creada a principios de 2000 para promover la participación masculina en el programa de salud materna e infantil en Indonesia. El propósito de este estudio fue identificar la proporción de hombres que tomaron parte en Suami SIAGA y los factores asociados con su participación usando la Encuesta Demográfica y de Salud de Indonesia (EDSI) de 2012. Este estudio también examinó la relación entre Suami SIAGA y los siguientes resultados relacionados con la campaña nacional: la presencia de esposos en las unidades de atención prenatal (APN) y en el lugar de parto en las instalaciones de salud. Los datos sobre las características de los esposos y esposas, así como otros factores relacionados, los elementos percibidos de Suami SIAGA, y los resultados de la campaña nacional se obtuvieron de un total de 1256 sujetos masculinos elegibles, extraídos del conjunto de datos de parejas correspondientes. Los datos se analizaron mediante regresión logística bivariada y múltiple para probar las asociaciones. Este estudio encontró que el 86% de los encuestados se clasificaron como esposos SIAGA. Después de controlar todas las variables, los factores de la edad y la educación de la esposa se asociaron significativamente con Suami SIAGA, especialmente en el grupo de mujeres de 41-49 años de edad (OR=2.4, IC 95%: 1.1-5.5) y mujeres con nivel secundario de educación (OR=1.8, IC 95%: 1.2-2.7) y mayor (OR=2.8, IC 95%: 1.4-5.6). Los esposos SIAGA tenían más probabilidades de asistir a la APN de sus esposas (OR=2.3; IC 95%: 1.4-3.7). Este estudio proporciona las pruebas sobre el beneficio de la participación del esposo en la salud materna, especialmente para mejorar la asistencia a la APN. Empoderar a las mujeres también debería abordarse al aprovechar el impacto de Suami SIAGA.

This study aims to investigate the factors influencing the work status of retirees after retirement, especially focusing on self-employment and unpaid work. Data was taken and analyzed from the “Taiwan Health and Retirement Study,” a nationally representative sample of retired personnel aged 50–74 in 2015–2016. Four types of work status were classified after retirement: Fully retired, Paid work, Self-employment, and Unpaid work. Multinomial regression analysis was used to explore the factors related to participation in paid, self-employed, and unpaid work. Results show that pre-retirement occupation was significantly associated with paid work after retirement. For example, retirees in Taiwan who were employed by private enterprises or self-employed before retirement were more likely to engage in paid work after retirement than civil servants before retirement. Two other factors, namely pre-retirement job stress and work flexibility, prolong the careers of retired workers, especially in self-employment and unpaid work after retirement. Gender also significantly affects the choice of work after retirement. These findings can be used as a reference for future policies on the aging labor force.