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Since government-provided annual cervical cytology testing for all Taiwanese women aged 30 years or older became available in 1995, both cervical cancer incidence and death have decreased significantly. However, with the 2018 introduction of the national immunization program for human papillomavirus (HPV) vaccination in all schoolgirls aged 13–15 years old, the positive predictive value of cytology testing is expected to decrease with rising vaccination rates, and therefore a transition to more sensitive HPV-based testing may be needed. This position paper, derived from discussions by a panel of experts in cervical cancer screening, provides short-, medium-, and long-term policy recommendations to manage the transition between cervical screening methods for Taiwan. The recommendations include concrete suggestions regarding testing procedures, standards, accreditation, monitoring, promotion, and implementation. It is hoped that comprehensive preparation and management of this transition will enable Taiwan to repeat the previous successes of the cervical cytology testing program. [ABSTRACT FROM AUTHOR]

Background: Shortened cervical length is one of the primary predictors for spontaneous preterm deliveries in twin pregnancies. However, there is lack of consensus regarding cut-off values. Recent evidence highlights that established cut-offs for cervical length screening might not always apply across different populations. This study aims to present the distribution of cervical length in Taiwanese twin pregnancies and to assess its predictive value for spontaneous preterm birth during mid-trimester screening. Materials and methods: This retrospective analysis of cervical length screening in Taiwan evaluated 469 twin pregnancies between 20–24 weeks of gestation. Outcome data were obtained directly from the medical records of the delivery hospital. The study explored the predictive value of cervical length screening for spontaneous preterm birth and the characteristics of cervical length distribution in Taiwanese twin pregnancies. Results: The average gestational age at screening was 22.7 weeks. Cervical length values displayed a non-normal distribution (p-value <0.001). The median, 5th and 95th centiles were 37.5 mm 25.1 mm, and 47.9 mm, respectively. Various cut-off values were assessed using different methods, yielding positive [negative] likelihood ratios for spontaneous preterm births between 32–37 weeks of gestational age (GA) (1.3–30.1 and [0.51–0.92]) and for very preterm births between 28–32 weeks GA (5.6–51.1 and [0.45–0.64]). Conclusions: The findings from our analysis of Taiwanese twin pregnancies uphold the moderate predictive potential of cervical length screening, consistent with prior investigations. The presented likelihood ratios for predicting preterm birth at different gestational ages equip clinicians with valuable tools to enhance their diagnostic rationale and resource utilization. By fine-tuning screening parameters according to the spontaneous preterm birth prevalence and clinical priorities of the particular population, healthcare providers can enhance patient care. Our data implies that a cervical length below 20 mm might provide an optimal balance between minimizing false negatives and managing false positives when predicting spontaneous preterm birth. [ABSTRACT FROM AUTHOR]

Objective: The aims of this cross-sectional study were to examine the associations of various types of school bullying involvement experiences with different dimensions of anxiety symptoms on the Multidimensional Anxiety Scale for Children (MASC) and to examine the moderating effects of gender and age on the associations in Taiwanese adolescent students aged at 11-18. Method: Involvement in passive and physical bullying and belongings snatch and multiple dimensions of anxiety symptoms in 5537 adolescents were determined through use of the self-reported Chinese version of the School Bullying Experience Questionnaire (C-SBEQ) and the Taiwanese version of the MASC, respectively. The associations between four types of bullying involvement and four dimensions of anxiety symptoms and the moderating effects of gender and age were examined using linear mixed model analysis. Results: The results indicated that except for the non-significant association between victimization by verbal and relational bullying and harm avoidance, both victims of verbal and relational bullying and physical bullying and belongings snatch reported more severe anxiety symptoms on all four dimensions of MASC-T than non-bullied subjects. While the perpetrators of verbal and relational bullying reported more severe physical symptoms and social anxiety than did non-perpetrators of verbal and relational bullying, the perpetrators of physical bullying and belongings snatch reported less harm avoidance, social anxiety and separation/panic than did non-perpetrators of physical bullying and belongings snatch. Perpetrator-victims of verbal and relational bullying showed more physical symptoms than those who were pure victims or perpetrators of verbal and relational bullying. Perpetrator-victims of physical bullying and belongings snatch had more social anxiety than those who were pure victims or perpetrators. This study also found that gender and age had the moderating effect on the association between some forms of bullying involvement and some dimensions of anxiety symptoms. Conclusions: The results of this study support the necessity to apply the multi-dimensional scale to evaluate anxiety symptoms in adolescents who are involved in bullying and to take the different directions of association into consideration when developing prevention and intervention programs. (Contains 5 tables.)

Background: No single assessment method can successfully evaluate the clinical ability of medical students in psychiatric clerkships; however, few studies have examined the efficacy of multiple assessments, especially in psychiatry. The aim of this study was to examine the relationship among different types of assessments of medical students' clinical ability in psychiatric clerkships and whether it is reasonable to use multiple assessments. Method: A group of 196 students were enrolled during their psychiatric clerkship between September 2008 and May 2009 in Kaohsiung, Taiwan. The mini-clinical evaluation exercise (mini-CEX) and standardized patient (SP)-based test were used to evaluate "does" and "show how" in psychiatric clinical ability. A multiple-choice examination was used to evaluate knowledge of psychiatry. Results: There were statistically significant but weak correlations among the scores on the multiple-choice examination, SP-based test, and overall clinical competence domain on the mini-CEX. Conclusion: A blended assessment composed of a multiple-choice examination, mini-CEX, and SP-based test can evaluate different dimensions of clinical ability. It is reasonable to use multiple methods to assess medical students' competency in psychiatric clerkships.

This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of "experiencing suicide ideation" and "attempting suicide" in the past year among 500 gay or bisexual men was examined. The participants' time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support. [ABSTRACT FROM AUTHOR]

Purpose: The goal of the current study is to determine the risk of subsequent development of epithelial ovarian cancer (EOC) in women after ovarian surgery for benign ovarian tumors. Patients and Methods: We conducted the nationwide population-based historic cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan. Eleven thousand six hundred twenty women who underwent ovarian surgery for ovarian benign diseases were analyzed. The collected data included age, types of ovarian surgery, medical history by Charlson comorbidity index (CCI), infertility (yes/no), pelvic inflammatory disease (PID) (yes/no), tubal ligation (yes/no), total/subtotal hysterectomy (TH/STH) (yes/no), and endometrioma (yes/no). We used the Kaplan–Meier method and the Log-rank test to evaluate the risk factors. Cox proportional hazard methods were used to evaluate risk factors for the subsequent development of EOC. Multivariate analysis using Cox stepwise forward regression was conducted for the covariate selected in univariate analysis. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Wald test. Results: Subsequent EOC incidence rate (IR, incidence per 10,000 person-years) of women after ovarian surgery for benign ovarian tumors was 2.98. Separating into four groups based on different age, IR of EOC was 1.57 (< 30 years), 4.71 (30– 39 years), 3.59 (40– 49 years) and 0.94 (≥ 50 years), respectively. Univariate and multivariate analyses identified only high level of CCI (≥ 2 or more) as an independent risk factor for subsequent development of EOC in women after ovarian surgery for benign ovarian tumors (HR 59.17, 95% CI 7.50– 466.80 in women with CCI level of 2 and HR 190.68, 95% CI 24.33– 2494.19, in women with CCI level ≥ 3, respectively). Conclusion: Our results, if confirmed, suggest that women with other comorbidities (CCI) should be well informed that they may have a higher risk of subsequent development of EOC when ovarian surgery is planned even though the final pathology showed a benign ovarian tumor. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) has become a global pandemic since its outbreak in December 2019, which posed a threat to the safety and well-being of people on a global scale. Cancer patients are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and their critical morbidity and case fatality rates are high. The ablation expert committee of the Chinese Society of Clinical Oncology compiled corresponding expert recommendations. These recommendations summarize the preventive measures and management of tumor ablation treatment in medical institutions, including outpatient clinics, oncology wards, ablation operation room, and postablation follow-ups in accordance with the guidelines and protocols imposed by the National Health Commission of the People's Republic of China and the experience in management and prevention according to various hospitals. This consensus aims to reduce and prevent the spread of SARS-CoV-2 and its cross-infection between cancer patients in hospitals and provide regulatory advice and guidelines for medical personnel. [ABSTRACT FROM AUTHOR]

This study aimed to compare the severities of psychopathologies and the level of self-esteem among 219 adolescents with high-functioning autism spectrum disorder (ASD) who were classified into pure perpetrators, pure victims, perpetrator-victims, and neutrals in Taiwan. The experiences of school bullying involvement in the previous 1 year were measured using the Chinese version of the School Bullying Experience Questionnaire. The severities of depression, anxiety, and suicidality were measured using the Center for Epidemiological Studies Depression Scale, the Multidimensional Anxiety Scale for Children, and the 5-item questionnaire from the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. The level of self-esteem was measured using the Rosenberg Self-Esteem Scale. The results indicated that compared with the self-reported neutrals, the self-reported perpetrator-victims and pure victims had more severe depression and anxiety. No difference in depression, suicidality, anxiety, and self-esteem was found among the four groups of various parent-reported bullying involvement experiences. Mental health problems in adolescents with ASD who experienced bullying victimization should be routinely surveyed. [ABSTRACT FROM AUTHOR]

Objective: To examine the differences in the levels of intention to care for gay and lesbian patients and knowledge regarding homosexuality among Taiwanese nurses between 2005 and 2017 and the moderators of these differences. Design and Sample: This two‐wave survey study was conducted on nurses in 2005 (N = 1,176; Survey 2005) and 2017 (N = 1,519; Survey 2017) recruited from three hospitals. Measurements: An anonymous self‐report questionnaire was used. Results: In Survey 2017, the nurses expressed both a higher intention to care for gay and lesbian patients and degree of knowledge regarding homosexuality than did those in Survey 2005. The experience of providing care for gay or lesbian patients moderated the association between the time of the survey and intention to care for gay and lesbian patients. Moreover, having gay or lesbian friends or relatives moderated the association between the time of the survey and knowledge about homosexuality. Conclusions: Nurses' intention to care for gay and lesbian patients and knowledge regarding homosexuality in Taiwan significantly increased from 2005 to 2017. The experience of providing care for gay and lesbian patients and having gay or lesbian friends or relatives moderated the increase of nurses' intention to care and knowledge. [ABSTRACT FROM AUTHOR]

Introduction: Depression might affect women with cervical cancer and can deteriorate their quality of life or even their compliance with cancer treatments. The aim of this study was to investigate the incidence of depression and risk factors for developing depression among women with cervical cancer in Taiwan. Patients and methods: This study enrolled patients with newly diagnosed cervical cancer from the National Health Insurance Research Database in Taiwan. From a population of 21,400,826 residents, each cervical cancer patient was matched with one subject without cervical cancer according to sex, age, and comorbidities with the same diagnostic index. The International Classification of Diseases, Ninth Revision, code 180.9 was used to identify patients with cervical cancer, and 296.0X–296.1X, 296.4X–296.8X, 296.2X–296.3X, 300.4, and 311.X codes were used to identify those with depressive disorders. Results: In total, 19,316 newly diagnosed cervical cancer patients were enrolled from January 2000 to December 2005, and the median follow-up period was 5.23 years (1.75–8.48 years). The prevalence of depressive disorder was 4.21% (813 of 19,316) in the cervical cancer cohort, and it was 3.85% (744 of 19,316) in the control cohort. The incidence risk ratio of depressive disorders was 1.35 (95% CI =1.22–1.49, P<0.001) among these cervical cancer patients. Cervical cancer, as an independent risk factor, was associated with developing subsequent depressive disorder. In addition, being older (≥65 years old) and the comorbidities of diabetes mellitus, ischemic heart disease, and cerebrovascular disease were also risk factors for predicting depressive disorder in cervical cancer patients. Discussion: Cervical cancer is a prominent risk factor for the development of depression in women with cervical cancer in Taiwan. The patients with comorbidities, including diabetes mellitus, ischemic heart disease, and cerebrovascular disease, have higher risks of developing depression. However, there were no significant differences among the cervical cancer treatment modalities. In conclusion, these patients require early psychological support and intervention. [ABSTRACT FROM AUTHOR]

Purpose: This study examined associations between callous-unemotional (CU) traits and involvement in school bullying among 613 Taiwanese adolescents.Methods: CU traits were determined using the self-reported Chinese versions of the Inventory of Callous and Unemotional Traits (C-ICUT) and the School Bullying Experience Questionnaire (C-SBEQ). The study used logistic regression analysis to assess associations between CU traits and types of involvement in school bullying, with controls for the effect of age, sex, and residential background.Results: Higher levels of the callous trait were positively associated with greater risk of being a victim of physical bullying and belongings snatch, or a perpetrator of verbal, relational and physical bullying and belongings snatch. Higher levels of the unemotional trait were positively associated with greater risk of being a victim of verbal and relational bullying. The uncaring trait had no significant associations with any type of bullying involvement.Conclusion: The role played by CU traits should, therefore, be examined when developing programs to detect and prevent school bullying. [ABSTRACT FROM AUTHOR]

Background/purpose: Screening of dementia can help to initiate proper management of the disorder. The use of the Ascertain Dementia 8-item Questionnaire (AD8) in screening has been promoted in Taiwan recently. The purpose of this study was to compare the psychometric properties and appropriateness of informant-reported and self-rated AD8 in cognitive impairment screening in Taiwan.Methods: The AD8 were administered to 153 participants and their informants recruited from two neurology out-patient clinics. The discriminative abilities for early cognitive impairment [Clinical Dementia Rating scale (CDR) 0.5 and 1] of informant-based and self-rating AD8 were determined and compared with their areas under the receiver operating curve. κ coefficients representing the agreement between self-rated and informant-reported AD8 scores were also calculated.Results: Participants and their informants were aged 76.9 years and 56.0 years on average, respectively. Only informant-reported AD8 was significantly associated with CDR level (Spearman ρ=0.469, p<0.001) and Cognitive Abilities Screening Instrument score (Spearman ρ=-0.458, p<0.001). The item-by-item agreements between self-rated and informant-reported AD8 were poor (κ coefficients: -0.030 to 0.206). The area under the receiver-operator characteristic curve was 0.59 for self-rated AD8 scores, and 0.77 for informant-reported AD8 scores, indicating that the discriminating ability of AD8 scores between CDR 0 and CDR 0.5 or greater is better when reported by informant than when rated by self.Conclusion: Informant-rated AD8 gave more accurate screening results than self-reported AD8 in an out-patient clinic setting. [ABSTRACT FROM AUTHOR]

An important role of genetic factors in the development of breast cancer (BC) or ovarian cancer (OC) in Taiwanese (ethnic Chinese) patients has been suggested. However, other than germline BRCA1 or BRCA2 mutations, which are related to hereditary breast-ovarian cancer (HBOC), cancer-predisposition genes have not been well studied in this population. The aim of the present study was to more accurately summarize the prevalence of genetic mutations in HBOC patients using various gene panels ranging in size from BRCA1/2 alone to multi-gene panels. Among 272 HBOC patients analyzed, the prevalence of BRCA1, BRCA2 and non-BRCA1/2 pathogenic mutations was 7.7% (21/272), 6.8% (16/236) and 8.2% (13/159), respectively. The total mutation rate was 18.4% (50/272). Although no founder mutations were identified in this study, two recurrent mutations, BRCA1 (c.3607C>T) and BRCA2 (c.5164_5165 delAG), were found. The main pathogenic/likely pathogenic mutations in non-BRCA1/2 genes included ATM, BRIP1, FANCI, MSH2, MUYTH, RAD50, RAD51C and TP53. The prevalence rate of gene mutations in HBOC patients did not differ with respect to whether BC or OC was the first diagnosis or they presented a family history of the disease or their age at diagnosis. HBOC patients with both BC and OC exhibited a higher prevalence rate of mutations (50.0%) than patients with OC (25.0%) or BC (8.6%) alone. In conclusion, evaluation of hereditary cancer risk in Taiwan HBOC patients, particularly individuals with double cancer, is strongly encouraged. Panel testing can yield additional genomic information, and widespread and well-designed panel testing will help in assessing more accurate mutational prevalence of risk genes. [ABSTRACT FROM AUTHOR]

Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities. [ABSTRACT FROM AUTHOR]

Objectives:Caregivers’ perceived stress and reactions to patients’ memory and behavior problems have been commonly regarded as outcomes in caregiving research; however, these variables may also serve as predictors of caregivers’ depressive symptoms. The current study investigated the relationship between perceived stress and reactions to patients’ problems and depression among the family caregivers of persons with Alzheimer’s disease. Additionally, we examined caregiving self-efficacy and sleep quality as possible mediators in the relationship between perceived stress and reactions to patients’ memory and problem behaviors and depression. Methods:This study is a cross-sectional study. The study sample consisted of 72 family members caring for a loved one with Alzheimer’s disease who completed a set of questionnaires that included the Perceived Stress Scale, the Chinese Pittsburg Sleep Quality Index, the Revised Scale for Caregiving Self-efficacy, and the Revised Memory and Behavior Checklist (RMBPC). Results:The results indicated that both higher perceived stress and RMBPC reaction scores were directly and indirectly associated with higher depressive symptoms. A specific domain of caregivers’ self-efficacy and sleep quality mediated the indirect path. Conclusion:These findings suggest that caregiving self-efficacy and sleep quality may function as mechanisms through which perceived stress and reactions influence depressive symptoms and that this mechanism may be domain specific. [ABSTRACT FROM AUTHOR]

Background and Objectives: Prevailing literature explains how depression, compulsion, and mindfulness affect heroin use; however, there is no comprehensive framework that explains their overall relationships. We therefore proposed and examined a hypothetical depression-compulsion-heroin use and mindfulness (DCHm) model.Methods: We recruited 234 male heroin users. Self-reported levels of depression, mindfulness, compulsion to use, and severity of heroin use were measured. Structural equation modeling was used to examine the proposed DCHm model.Results: Compulsion was a mediator between depression and heroin use. In addition, the DCHm model had satisfactory model fit indices. Depression indirectly affected heroin use through compulsion to use. The moderating effects of mindfulness in the two competing models were compared between the high- and low-mindfulness groups. The DCHm model in the high-mindfulness group had more favorable model fit indices than it did in the low-mindfulness group.Conclusions: Through learned emotional regulation strategies, addicted people with higher mindfulness were less likely to compulsively take drugs because of a depressive mood than were those with lower mindfulness. Furthermore, effective emotion-regulation strategies should be developed and examined in future studies.Scientific Significance: These results raise questions about the effect of compulsion on heroin use disorders. Mindfulness-based approaches to emotional regulatory strategies should be developed based on these findings. Further experimentation and prospective studies are needed to more fully examine the moderating role of mindfulness on depression and compulsion. [ABSTRACT FROM AUTHOR]

A gamma-ray station has been established recently along the Longitudinal Valley in eastern Taiwan, which is a suture zone with NNE-striking on the boundary between Eurasia plate and Philippine Sea plate. Stresses arise in the crust in accordance with crustal deformations due to plate motions and geodynamic processes. Gamma-ray emission associated with the radioactive decay of radon, which is discharged into surface from deep source area, is continuously recorded in the station. Fluctuations of gamma-ray data are found to show a clear inverse correlation with atmospheric temperature. Based on the linear regression method, possible temperature effects can be removed and the corrected data can be obtained. Anomalous variations in the gamma-ray counting rate may appear as precursors a few days before some local earthquakes in eastern Taiwan. It is noted that there are two significant increases in the gamma-ray counting rate during the periods from March 20 to 26 and from April 22 to May 1, 2014. These increases are observed about one week before two earthquake swarms from March 26 to 27 and from May 3 to 5, 2014. Furthermore, a progressive anomaly with a continuous increase (∼8%) in gamma-ray count was recorded two weeks before the Fanglin Earthquake ( M L = 5.9, May 21, 2014) occurring in the Longitudinal Valley area. A continuous monitoring on the gamma-ray data can improve our understanding of the possible relationship between the observed gamma-ray variations and the earthquakes in the study area. [ABSTRACT FROM AUTHOR]

Aim This paper describes a 1-year follow-up of post-traumatic stress disorder ( PTSD) symptomatology and depression in an elderly minority population who experienced Typhoon Morakot in Taiwan. Methods The PTSD Symptom Scale - Interview and the 10-item short form Center for Epidemiological Studies Depression Scale were used to examine PTSD symptomatology and depression in 120 victims at 3-6 months and in 88 victims (73.3% reinterview rate) at 11-12 months after the disaster. Further, we looked for associations between stress, prognosis, and development of PTSD symptomatology and depression. Results The prevalence of PTSD symptomatology decreased from 29.2% (35/120) at 3-6 months to 15.9% (14/88) at 11-12 months. The prevalence of depression, however, increased from 43.3% (52/120) to 46.6% (41/88). No factor was associated with follow-up PTSD symptomatology, and only the level of education was related to follow-up depression. Generally, the risk factors of age, sex, symptomatology of PTSD and depression at baseline, and stressor of unemployment predicted new-onset or chronic PTSD symptomatology and depression. Delayed-onset depression 48.0% (24/50) was more common than delayed-onset PTSD symptomatology 11.3% (7/62). Chronic and delayed-onset PTSD symptomatology were more easily developed with depression. Conclusion Although PTSD and depression were separate consequences of trauma, they emerged and affected mental health together. We documented the courses of PTSD and depression among elderly aboriginal people, and the possible effects of demographic, symptomatology, and adverse life stressors were discussed. [ABSTRACT FROM AUTHOR]

The aims of this intervention study were to examine the effects of individual cognitive-behavioral therapy (CBT) based on the modified Coping Cat Program on improving anxiety symptoms and behavioral problems in Taiwanese children with anxiety disorders and parenting stress perceived by their mothers. A total of 24 children with anxiety disorders in the treatment group completed the 17-session individual CBT based on the modified Coping Cat Program, and 26 children in the control group received the treatment as usual intervention. The Taiwanese version of the MASC (MASC-T), the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and the Chinese version of the Parenting Stress Index (C-PSI) were applied to assess the severities of anxiety symptoms, behavioral problems and parenting stress, respectively. The effects of CBT on improving anxiety symptoms, behavioral problems and parenting stress were examined by using linear mixed-effect model with maximum likelihood estimation. The results indicated that the CBT significantly improved the severities of MASC-T Physical Symptoms and Social Anxiety subscales, CBCL/6-18 DSM-oriented Anxiety Problem subscale, and C-PSI Child domains Mood and Adaptability subscales. Individual CBT based on the modified Coping Cat Program can potentially improve anxiety symptoms in Taiwanese children with anxiety disorders and some child domains of parenting stress perceived by their mothers. [ABSTRACT FROM AUTHOR]

Background: Melioidosis is a severe bacterial infection caused by Burkholderia pseudomallei with a high case-fatality rate. Epidemiological and animal studies show the possibility of inhalation transmission. However, no B. pseudomallei concentrations in ambient air have been researched. Here, we developed a method to quantify ambient B. pseudomallei and then measured concentrations of ambient B. pseudomallei during the typhoon season and the non-typhoon season to determine the factors influencing ambient B. pseudomallei levels. Methods: We quantified ambient B. pseudomallei by using a filter/real-time qPCR method in the Zoynan Region in Kaohsiung, southern Taiwan. Twenty-four hour samples were collected at a sampling rate of 20 L/min every day from June 11 to December 21, 2012 including during the typhoon season (June to September) and reference season (October to December). Results: We successfully developed a filtration/real-time qPCR method to quantify ambient B. pseudomallei. To our knowledge, this is the first report describing concentrations of ambient B. pseudomallei. Ambient B. pseudomallei were only detected during the typhoon season when compared to the reference season. For the typhoons affecting the Zoynan Region, the positive rates of ambient B. pseudomallei were very high at 80% to 100%. During June to December, rainfall was positively correlated with ambient B. pseudomallei with a statistical significance. Sediment at a nearby pond significantly influenced the concentration of ambient B. pseudomallei. During the typhoon month, the typhoon was positively correlated with ambient B. pseudomallei whereas wind speed was reversely correlated with ambient B. pseudomallei. Conclusions: Our data suggest the possibility of transmission of B. pseudomallei via inhalation during the typhoon season. Author Summary: Melioidosis is a severe bacterial infection caused by Burkholderia pseudomallei with a high case-fatality rate. Epidemiological and animal studies show the possibility of inhalation transmission. However, no B. pseudomallei concentrations in ambient air have been researched. Here, we successfully developed a method to quantify ambient B. pseudomallei by using a filter/real-time qPCR method. Twenty-four hour samples were collected every day from June 11 to December 21, 2012 including during the typhoon season (June to September) and reference season (October to December) in the Zoynan Region in Kaohsiung, southern Taiwan. To our knowledge, this is the first report describing concentrations of B. pseudomallei in ambient air. For the typhoons affecting the Zoynan Region, the positive rates of ambient B. pseudomallei were very high. Our data imply the possibility of air transmission of Melioidosis during the typhoon season. In addition, ambient B. pseudomallei aerosolized from sediment of a nearby lake should be a concern as an important source of transmission. Our results could provide deeper insight into Melioidosis transmissibility and infection control. [ABSTRACT FROM AUTHOR]

Aim The objective of the study was to investigate the potential effects of daily energy expenditure on the academic performance ( AP) of elementary schoolchildren, the results of which will be used as the basis of planning physical activity ( PA) for children in the future. Methods Participants were collected from 4th to 6th grade children at an elementary school in southern Taiwan. The effective sample data size was 1065 (79.8%; 528 boys and 537 girls). Daily mean energy expenditure was obtained using the 3 Day Physical Activity Recall (3- DPAR), and the intensive activities degrees of physical activity were categorized into lowest PA, middle PA, and highest PA group, and academic performance assessed with weighted academic score. Results The significant effect on the academic performance of schoolchildren was only in energy expenditure but not for sexes and tutorials attended. All students in the middle PA group performed better academically than those in the highest PA group. After controlling sexes, male students in the middle PA group performed better than other groups; female students in the lowest PA group performed better than other groups. Conclusion These results may be consulted by schools, academic faculties, and parents in setting up exercise plans for children. [ABSTRACT FROM AUTHOR]

Objective:We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD).Methods:For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD–FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs’ neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs’ distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale – Short Form, and sleep disturbance by the General Sleep Disturbance Scale.Results:FCGs’ most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs’ sleep disturbance was predicted by their physical fatigue, their depressive symptoms, and the synergistic effect of physical fatigue and depressive symptoms in the final model, explaining 57.8% of the variance.Conclusions:This study supports the model that development of caregivers’ sleep problems may depend on their depression, fatigue, and the synergistic effects of these two variables. These findings suggest that clinicians should educate FCGs about self-care and offer strategies for dealing with a cluster of symptoms when maintaining sleep hygiene. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Advanced maternal age (AMA) is the most frequent indication for amniocentesis in predicting balanced reciprocal translocations, and abnormal ultrasound findings are indications in predicting unbalanced reciprocal translocations; however, to date, no studies have focused on Robertsonian translocations. Methods: A retrospective review was conducted on 16,749 pregnant women who underwent midtrimester amniocentesis between January 1981 and December 2010. Robertsonian translocations were identified in 39 cases. Results: The percentage of Robertsonian translocations in all amniocentesis cases was 0.23% (39/16,749); 31 were balanced and eight were unbalanced. De novo abnormality occurred in 17 cases, or in 43.6% of all Robertsonian translocations. The two major indications for amniocentesis with a diagnosis of Robertsonian translocations were AMA (41.0%, n = 16) and a parent with abnormal karyotypes (18.0%, n = 7). The highest percentage of Robertsonian translocations was found in parents with abnormal karyotypes (2.8%, 7/252), but neither of the indications were clearly superior for detecting de novo Robertsonian translocations. Conclusion: Although AMA is an indication for amniocentesis in approximately two-fifths of cases with Robertsonian translocations, the indication of parent with abnormal karyotypes was more likely to lead to the detection of non-de novo Robertsonian translocations, suggesting that parents with abnormal karyotypes need careful prenatal consultation. [Copyright &y& Elsevier]

Abstract: Background: Reciprocal translocation is the most common type of translocation; however, there are only a few studies that address the indications for reciprocal translocation in amniocentesis. Here we share our data, based on 30 years'' experience in a single tertiary center, to investigate the rates and indications for amniocentesis in cases of reciprocal translocations. Methods: A retrospective review of 16,749 pregnant women, who underwent midtrimester amniocentesis between January 1981 and December 2010, was conducted. Seventy-four cases of reciprocal translocation were identified. Results: The percentage of reciprocal translocations in all amniocentesis cases was 0.44% (74/16,749); of these 74 cases, 56 were balanced and 18 unbalanced. De novo abnormality occurred in 23 cases, which constituted 31.1% of all reciprocal translocations. The three major indications for amniocentesis with a diagnosis of reciprocal translocation included advanced maternal age (AMA, 52.7%), a parent with an abnormal karyotype (17.6%), and abnormal biochemical markers in the maternal serum (12.2%). For individual types of reciprocal translocations (balanced and unbalanced), except for the presence of abnormal biochemical markers in maternal serum, both AMA and a parent with an abnormal karyotype were primary indications for amniocentesis. However, the highest percentage of reciprocal translocations in all amniocentesis cases was found in cases involving a parent with an abnormal karyotype (5.16%, 13/252). Conclusion: Patients with a parent who carries an abnormal karyotype should be encouraged to undergo amniocentesis in prenatal consultation, since the risk of a diagnosis of reciprocal translocation can be particularly high. [Copyright &y& Elsevier]

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The aim of this cross-sectional study was to examine the individual (demographic characteristics, substance-using behaviors, emotional status, and negative outcome expectancy) and peer factors associated with ketamine use in Taiwanese adolescents. A total of 9,860 adolescents completed the self-report questionnaires without omission. Demographic characteristics, substance-using behaviors, emotional status, negative outcome expectancy, and peer factors were compared between the ketamine users and non-users using the Mann-Whitney U test and the Chi-square test, and then significant factors were further selected for stepwise logistic regression analysis to examine the associated factors of ketamine use. Sixty-nine (0.7 %) participants reported having used ketamine in the past year. The results of logistic regression analysis indicated that ketamine users were more likely to use marijuana, smoke cigarettes, have peers using illicit drugs, and have a lower level of negative outcome expectancy regarding using ketamine than ketamine non-users. The associated factors found in this study should be taken into consideration when developing prevention and intervention programs for ketamine use in adolescents. [ABSTRACT FROM AUTHOR]

Background: A good quality of life (QOL) is associated with successful treatment in patients with opioid dependence. Therefore, it is of clinical benefit to examine what factors can predict a change in QOL among heroin users in the course of a methadone maintenance treatment (MMT) program. Objectives: This longitudinal study aimed to examine the patterns and predictors of change in QOL among heroin users during the period of an 18-month MMT program. Methods: A total of 368 intravenous heroin users receiving MMT in southern Taiwan between 2007 and 2008 were interviewed using the Taiwan version of the Brief Version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF) at baseline and after 3, 6, 9, 12, 15, and 18 months of treatment. Demographic and substance-use characteristics, severity of heroin use, HIV serostatus, criminal record, and family function data were collected during baseline interviews. Data on methadone dosage at each follow-up point and the duration of retention in the MMT program were also collected. Results: Improvement in QOL was rapid during the first 3 months after initiation of MMT and slowed beyond the 3-month point. A higher dosage of methadone predicted a better QOL. In addition, longer retention in the program may be associated with a better QOL. Conclusions: The results supported the hypothesis that, regarding QOL, heroin users can benefit rapidly and continuously from a MMT. A higher dose of methadone and longer treatment may predict improvement in QOL. Scientific significance: Efforts are needed to amend the modifiable factors related to poor QOL for heroin users in MMT programs. [ABSTRACT FROM AUTHOR]

To examine the rates and factors associated with alcohol consumption after the recognition of pregnancy among indigenous pregnant women, as well as the rates and factors associated with continuing alcohol consumption after the recognition of pregnancy among indigenous pregnant women who drank alcohol before the recognition of pregnancy in 10 hospitals in southern and eastern Taiwan. A total of 806 indigenous women who had just given birth in 10 hospitals in southern and eastern Taiwan were recruited. They were interviewed to collect their substance use information, demographic characteristics, psychological health status, history of physical abuse, and pregnancy history. The rates of alcohol consumption after the recognition of pregnancy in all indigenous pregnant women and the rates of continuing alcohol consumption after the recognition of pregnancy among those who drank alcohol before the recognition of pregnancy were calculated. The factors relating to alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were examined using logistic regression analyses. The results of this study found that 26.6% of indigenous pregnant women drank alcohol at any stage after the recognition of pregnancy, and 52.5% of indigenous pregnant women who drank alcohol before the recognition of pregnancy persisted in drinking alcohol after the recognition of pregnancy. Multiple parities, smoking or chewing betel quid after the recognition of pregnancy, and a higher frequency of drinking alcohol before the recognition of pregnancy were significantly associated with alcohol consumption and continuing alcohol consumption after the recognition of pregnancy. Meanwhile, being single or divorced, and intimate partner violence after the recognition of pregnancy were significantly associated with alcohol consumption after the recognition of pregnancy. High prevalence rates of alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were found among indigenous pregnant women in Taiwan. Early detection of alcohol consumption and effective intervention for alcohol consumption during pregnancy are needed. [ABSTRACT FROM AUTHOR]

chang y., wang p.-c., li h.-h. & liu y.-c. (2011) Journal of Nursing Management 19, 769-776 Relations among depression, self-efficacy and optimism in a sample of nurses in Taiwan Aims The present study investigated the level of depression among hospital nurses, to examine personality contributions to depression and to offer managers relevant organizational strategies to reduce levels of depression. Background The World Health Organization's Global Burden of Disease Study estimates that major depression is the leading cause of disability among women in the world today. It is surprising that there is a relative dearth of research investigating depression among nursing staff. Method A cross-sectional survey of 314 staff nurses in a general hospital in Taiwan. Participants completed a set of questionnaires and a demographic information form. A number of statistical methods were used including descriptive statistics, product-moment correlations and multiple regression analysis. Results In all, 52.5% of nurses reported mild-to-moderate depressive symptoms. Self-efficacy and optimism were significant buffers against depression. Conclusions The results of the present study confirm the importance of self-efficacy and optimism. Nurses with positive evaluation and expectation towards their self and others tend to report lower depression levels. Implications for Nursing Management The results of the present study indicate that there is an immediate need to pay further attention to nurses' depression issues. It is therefore suggested that Nursing Managers take an empowering approach to strengthen nurses' self-efficacy and optimism levels to prevent depression in this profession. [ABSTRACT FROM AUTHOR]

This study aimed to compare the differences in motivation to receive a COVID-19 vaccination between frontline physicians and nurses and the Taiwanese public. The associations of threat and coping appraisals, as described in Protection Motivation Theory (PMT), with motivation to receive COVID-19 vaccination were compared between these groups, too. We recruited 279 frontline physicians and nurses and 768 members of the public by a Facebook advertisement. Participants' motivation to receive COVID-19 vaccination, perceived severity of and vulnerability to COVID-19, self-efficacy and response efficacy of COVID-19 vaccination, response cost of COVID-19 vaccination, and knowledge about the mechanism of COVID-19 vaccination in light of PMT were determined. The results demonstrated that frontline health workers had higher motivation to receive COVID-19 vaccination than the public. Response efficacy and knowledge of COVID-19 vaccination were positively associated with motivation to receive COVID-19 vaccination in both frontline health workers and the public, whereas perceived vulnerability, perceived severity, and response cost of COVID-19 vaccination were positively associated with motivation in the public but not in frontline physicians and nurses. The factors related to motivation to receive COVID-19 vaccination should be considered when designing programs to increase motivation to receive COVID-19 vaccination among frontline health workers and the public. [ABSTRACT FROM AUTHOR]

Sleep problems are common in Taiwan. Poor sleep may be associated with many illnesses, including substance use disorders. Ketamine use disorder has significantly increased in Taiwan in recent years and may lead to physical and cognitive problems. Craving for ketamine is a risk factor for ketamine use and relapse, and poor sleep quality may increase craving. This study aimed to explore the mediating effects of craving on the relationship between poor sleep quality and ketamine use. Demographic data, sleep quality, severity of dependence and craving were recorded for current ketamine users and abstinent ketamine users. Mediation analysis was used to examine the mediating effect of craving on the relationship between poor sleep and ketamine use. This study enrolled 414 current ketamine users with ketamine use disorder, 238 current ketamine users without ketamine use disorder, and 102 abstinent ketamine users with ketamine use disorder. Compared with healthy controls, all ketamine users had poor sleep quality. Poor sleep quality was associated with the initiation of and dependence on ketamine use. Craving can mediate the relationship between poor sleep quality and ketamine use. Poor sleep quality remains a problem for those abstaining from ketamine use. Poor sleep quality in ketamine users is an important issue because it is directly and indirectly through craving associated with ketamine use. [ABSTRACT FROM AUTHOR]

Background: People obtain information on the coronavirus disease (COVID-19) from the internet and other sources. Understanding the factors related to such information sources aids health professionals in educating individuals.Objective: This study used data collected from the online survey study on COVID-19 in Taiwan to examine what major COVID-19 information sources are available and which sources are significantly related to the self-confidence of people in coping with COVID-19 in Taiwan.Methods: A total of 1904 participants (1270 non-health-care workers and 634 health care workers) were recruited from the Facebook advertisement. Their major sources of information about COVID-19, the relationships between the sources and demographic factors, and the relationships between the sources and the self-confidence in coping with COVID-19 were surveyed.Results: Most Taiwanese people relied on the internet for COVID-19 information. Many respondents also used a variety of sources of information on COVID-19; such variety was associated with sex, age, and the level of worry toward COVID-19, as well as if one was a health care worker. For health care workers, the use of formal lessons as an information source was significantly associated with better self-confidence in coping with COVID-19. The significant association between receiving information from more sources and greater self-confidence was found only in health care workers but not in non-health-care workers.Conclusions: Medical professionals should consider subgroups of the population when establishing various means to deliver information on COVID-19. [ABSTRACT FROM AUTHOR]

Background: This study investigated the prevalence of major depressive disorder (MDD) among Taiwanese patients with type 2 diabetes mellitus (T2DM).Methods: We enrolled patients with at least one service claim for ambulatory or inpatient care with a principal diagnosis of MDD and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2DM, as listed in Taiwan's National Health Insurance database.Results: We enrolled 715,756 people from the general population (GP), 61,589 patients with T2DM but without MDD, and 778 patients with both T2DM and MDD. The prevalence of MDD increased from 0.70% to 1.25% in the patients with T2DM, whereas it increased from 0.25% to 0.67% in the GP from 2000 to 2010. The higher prevalence of MDD was associated with the female sex, residing in the southern regions of Taiwan, and having comorbidities of cerebrovascular disease and anxiety disorder as well as higher comorbidity severity (Charlson comorbidity index, 1-2 and > 2).Limitations: One limitation is the use of secondary data on diagnoses of MDD and T2DM. Another limitation is that we could not access some crucial related variables.Conclusions: The prevalence of MDD was higher in the patients with T2DM than in the GP. In this study, the prevalence of MDD in the patients with T2DM was lower than that reported in Western countries. [ABSTRACT FROM AUTHOR]

Objective To improve the understanding of primary fallopian tube carcinoma (PFTC) through an analysis of possible clinical and pathologic determinants of prognosis. Methods A retrospective review of the database of a tertiary hospital in Taiwan for 1978–2007 was conducted to identify patients with a diagnosis of PFTC and to evaluate the clinicopathologic features associated with PFTC outcome. Results Fifty-eight patients (mean age 62.5 years) had a diagnosis of PFTC. Stage III/IV disease (55%) and poorly differentiated tumors (52%) were most common. The median follow-up was 93 months (range, 11–333 months). The 5-year disease-free survival rate was 59%, and the overall survival rate was 64%. Factors important in disease-free and overall survival in univariate analysis included the presence of pelvic and/or para-aortic lymph node metastases, International Federation of Gynecology and Obstetrics stage, high preoperative carbohydrate antigen 125 serum level, completion of optimal debulking surgery, and the use of paclitaxel-based chemotherapy; however, only patients with optimal cytoreduction had a decreased hazard of recurrence (hazard ratio [HR] 0.06; 95% confidence interval [CI] 0.01–0.23) and mortality (HR 0.08; 95% CI, 0.02–0.31) in multivariate analysis. Conclusion Advanced tumor stage, in particular the presence of lymph node metastases, worsened the prognosis of patients with PFTC. However, optimal debulking surgery significantly improved the prognosis, emphasizing the importance of the treatment strategy. [ABSTRACT FROM AUTHOR]

Abstract: The DSM-5 proposed the diagnostic criteria of Internet gaming disorder (IGD) and suggested that more evidence is necessary before it is included as a standard disorder in the DSM system. The aims of this study were to: 1) evaluate the diagnostic validity of individual criteria of IGD in the DSM-5 and the criteria of craving and irritability; 2) determine the optimal cut-off point for the IGD criteria in the DSM-5. We recruited 75 subjects with IGD, 75 without IGD, and 75 in remission from IGD based on the Diagnostic Criteria of Internet Addiction for College Students (DC-IA-C). All participants underwent a diagnostic interview based on the diagnostic criteria of IGD in the DSM-5 and completed the CIAS and QGU-B. Except for the “deceiving” and “escape” criteria, all criteria of IGD had diagnostic accuracy ranging from 77.3% to 94.7% to differentiate university students with IGD from remitted students. The criterion of craving had diagnostic accuracy of 88% and the criteria of irritability had an accuracy of 68.7%. Fulfilling 5 or more criteria of IGD in the DSM-5 was the best cut-off point to differentiate young adults with IGD from healthy or remitted users. [Copyright &y& Elsevier]

• For the public, receiving information sources from medical staff and the Internet was associated with better and poorer psychological well-being, respectively. • For health care workers, attending formal lessons was significantly associated with better psychological well-being in coping with COVID-19. • People used a variety of sources of information on COVID-19, where Internet and traditional media were the most common used sources. [ABSTRACT FROM AUTHOR]

Aims: The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan., Methods: Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up., Results: In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender ( p  = .003), who perceived greater levels of microaggression ( p  < .001), and who had greater levels of problematic Internet use at baseline ( p  = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up ( p  = .023)., Conclusion: Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.

Background: The burden of nonalcoholic fatty liver disease (NAFLD) is growing in patients with chronic hepatitis B (CHB). NAFLD is typically associated with obesity, however, it is increasingly being identified in non-obese patients. This study aimed to investigate disease severity and antiviral response in non-obese patients with CHB with NAFLD (CHB + NAFLD)., Methods: A total of 809 patients with CHB + NAFLD were prospectively recruited and followed up for 3 years. NAFLD was diagnosed by transient elastography and defined as controlled attenuation parameter ≥248 dB/m, in the absence of excessive alcohol intake. Obesity status was defined by the Asian body mass index (BMI) cutoff of 25 kg/m 2 . Metabolic abnormality was defined by the presence of dyslipidemia, hypertension or diabetes. Fibrosis staging was defined according to the EASL-ALEH guidelines, with fibrosis progression defined as ≥1-stage increment., Results: In the total cohort (median age 40 years, 59.0% antiviral-treated), 33.3% were non-obese. Non-obese patients were less metabolically abnormal than obese patients (60.2% vs 72.0%, P = 0.003). After 3-year follow up, the rate of fibrosis progression was comparable between non-obese and obese patients (17.5% vs 21.9% in the total cohort, P = 0.145; 15.7% vs 14.6% in antiviral-treated cohort with persistent viral suppression, P = 0.795). No significant differences in virological and biochemical responses were observed between non-obese and obese patients (P >0.05 for all)., Conclusion: Approximately one third of CHB + NAFLD patients were non-obese. Non-obese patients, while less metabolically abnormal, had a similar risk for fibrosis progression as obese patients. Obesity status did not impact the efficiency of antiviral therapy., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

A significant decline in both incidence and prevalence of cervical cancers after widespread-introducing cervical screening strategy by Papanicolau test (Pap test) has been found in the world, but cervical cancer is still one of the most common female cancers, reporting the fourth prevalence and also one of the leading causes to result in main women-associated morbidity and mortality, particularly for those women living in low- and middle-income countries. Cervical cancer is one of the most important health concerns directly destroying the global health-care system, partly because of not only increasing the disability either secondary to diseases themselves of victims or mediated by treatment-related adverse events to the survivors but also acting as a leading cause of death of diseased patients worldwide, alarming the urgent need to do something to minimize the catastrophic diseases-related heavy socioeconomic burden. It is fortunate that cervical cancer is a preventable disease, based on its strong association with human papillomavirus (HPV) infection (more than 95%), particularly for those high-risk HPV (HR-HPV) and its high possibility by detecting HPV infection before the development of cervical cancer as well as an effective prevention by HPV vaccination. That is why WHO (World Health Organization) considers cervical cancer as a public problem and attempts to accelerate the elimination of cervical cancer program by three-pillar approach (90:70:90% targets), including (1) 90% of girls are fully vaccinated with HPV vaccine by 15 years of age; (2) 70% of women are screened with a high-performance test by 35 and 45 years of age and precancerous lesions are treated early; and (3) 90% of women identified with cervical diseases receive appropriate and adequate treatment. Herein, this review focuses on the HPV vaccination as Part I, including global recommendations and Taiwan government's policy for HPV vaccination., Competing Interests: Declaration of competing interest Dr. Peng-Hui Wang and Dr. Szu-Ting Yang, editorial board members at Taiwanese Journal of Obstetrics and Gynecology, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2024. Published by Elsevier B.V.)

Endometrial cancer (EC) has become one of rapidly increasing women's cancers, contributing to the most common cancer of the female genital tract in high- and middle-incomed countries, including Taiwan. In general, EC is believed its favorable outcome; however, high-grade endometrial cancers have a tendency to recur and also have a high risk to be presented as an advanced stage or accompanied with metastatic lesions, which result in a biggest therapeutic challenge. The standard therapy includes complete staging surgery (sentinel node sampling)/optimal debulking surgery, and subsequent adjuvant therapy, by either radiotherapy locally or systemic therapy as chemotherapy or targeted therapy, or in combination or in subsequential strategy is made based on the risk stratification using clinicopathological prognostic factors. All efforts are made to minimize the risk of recurrence and possible therapeutic failure. In this part I, we would like to overview the general background knowledge (basic concept) about the cancer of uterine corpus, and discuss the recent transformation to patients-tailored therapy based on modern molecular technology as the optimal strategy to balance the therapeutic efficacy and treatment-related toxicity. Optimally, it is possible to reach the best benefits., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Methadone maintenance treatment (MMT) can alleviate opioid dependence. However, MMT possibly increases the risk of motor vehicle collisions. The current study investigated preliminary estimation of motor vehicle collision incidence rates. Furthermore, in this population-based retrospective cohort study with frequency-matched controls, opiate adults receiving MMT (cases) and those not receiving MMT (controls) were identified at a 1:2 ratio by linking data from several nationwide administrative registry databases. From 2009 to 2016, the crude incidence rate of motor vehicle collisions was the lowest in the general adult population, followed by that in opiate adults, and it was the highest in adults receiving MMT. The incidence rates of motor vehicle collisions were significantly higher in opiate users receiving MMT than in those not receiving MMT. Kaplan-Meier curves of the incidence of motor vehicle collisions differed significantly between groups, with a significant increased risk during the first 90 days of follow-up. In conclusion, drivers receiving MMT have higher motor vehicle collision risk than those not receiving MMT in opiate users, and it is worthy of noticing road safety in such drivers, particularly during the first 90 days of MMT., Competing Interests: YY, PH, TW, PW, CL, JT, YG, HC No competing interests declared, (© 2021, Yang et al.)

Objective: Fatigue, a painful and unpleasant subjective experience, is common in perimenopausal women. Therefore, an effective tool to evaluate the fatigue-precipitating factor is important for perimenopausal women prone to fatigue syndrome., Materials and Methods: This study was surveyed by short-term perimenopausal fatigue scale. The enrollment period was from November 2019 to January 2020. The subjects were perimenopausal women prone to perimenopausal fatigue. The differences between the fatigue-precipitating factors and the degrees of fatigue and disturbance were determined by one-way ANOVA and t test., Results: A total of 220 perimenopausal women with mean age of 51.3 years were included. Among these, 64.1% did not have a habit of regular exercise and 55.5% had chronic diseases. Fatigue syndrome was found in 64.1% of subjects, who were mainly presented by shoulder and neck pain and sleep problems. There were significant differences between "perimenopausal fatigue" and "duration" (p < 0.001); "with and without regular exercise" (p = 0.05); and "with and without chronic diseases" (p = 0.03)., Conclusions: Our study showed the perimenopausal fatigue syndrome is more frequently found in perimenopausal women who have a co-morbidity (chronic illness) and do not have a habit of regular exercise. An early identification and prompt intervention may help perimenopausal women to deal with their fatigue syndrome. The short questionnaire perimenopausal fatigue scale seems to be useful for screening perimenopausal women prone to fatigue syndrome., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2021. Published by Elsevier B.V.)

During the COVID-19 pandemic, the number of hospital visits and attendance at scheduled appointments have dropped significantly. We used the health belief model (in three dimensions) to examine the determinants of non-attendance of scheduled appointments in outpatient clinics due to the COVID-19 pandemic. Participants in Taiwan ( n = 1954) completed an online survey from 10 April 10 to 23 April 2020, which assessed how people perceived and responded to the outbreak of a fast-spreading infectious disease. We performed both univariate and multivariate logistic regression to examine the roles of cognitive, affective, and behavioral health belief constructs in nonattendance at scheduled appointments. The results indicated that individuals who perceived high confidence in coping with COVID-19 were less likely to miss or cancel their doctor's appointments, whereas individuals who reported high anxiety and practiced more preventive health behaviors, including avoiding crowded places, washing hands more often, and wearing a mask more often, were more likely to miss or cancel their appointments due to the COVID-19 pandemic. Non-heterosexual participants had a lower rate of nonattendance at scheduled appointments compared with heterosexual ones. The study results increase our understanding of the patients' cognitive health beliefs, psychological distress, and health behaviors when assessing adherence to medical appointments during a pandemic.

Background: Patients with coronary heart disease (CHD) who quit smoking exhibit lower rates of heart attack recurrence and mortality than their peers who continue smoking. However, most male patients with CHD resume smoking after hospital discharge., Purpose: To explore the effectiveness of motivational interventions and mobile social network support on smoking cessation and other predictors of smoking cessation in male patients with CHD., Methods: An experimental design was used, and a convenience sample was recruited from a cardiology ward of a hospital in northern Taiwan. The participants were randomly assigned to the experimental group (n = 57) and control group (n = 64). During hospitalization, each participant completed a questionnaire after undergoing cardiac catheterization. The questionnaire included a demographic datasheet, the Fagerström Test for Nicotine Dependence, and the contemplation ladder. Afterward, the experimental group received motivational interventions, filled out a self-efficacy scale and the contemplation ladder, and joined an online mobile social group (LINE) for three months. The control group received regular care and a smoking cessation booklet, and then filled out the self-efficacy scale and contemplation ladder. An intention-to-treat analysis was adopted to evaluate smoke cessation status. Information on post-discharge smoking status was collected from the participants via the Line communications app or phone calls at three-months after hospital discharge and was further confirmed using urinary cotinine levels., Results: The results revealed that both groups registered improvements in motivation to quit smoking. This motivation was relatively higher in the experimental group after the intervention than in the control group. The smoking cessation rate in the experimental group (35.09%) was higher than that in the control group (17.19%). However, the intergroup difference in the cessation rate only approached statistical significance (OR: 2.34; p = .055) after controlling for the baseline difference between the two groups. Controlling for the effects of the intervention, age of smoking initiation, first diagnosis of CHD, and self-efficacy were identified as predictors of smoking cessation., Conclusions / Implications for Practice: Healthcare providers are encouraged to provide motivational interviews to enhance the motivation of their patients to quit smoking as well as to incorporate self-efficacy into related interventions to increase the smoking cessation rate.

The present study aimed to identify the distinct levels of risk perception and preventive behaviors during the coronavirus disease 2019 (COVID-19) outbreak among people in Taiwan and to examine the roles of information sources in various levels of risk perception and preventive behavior. The online survey recruited 1984 participants through a Facebook advertisement. Their self-reported risk perception, adopted preventive behaviors and COVID-19-related information were collected. We analyzed individuals' risk perception and adopted preventive behaviors by using latent profile analysis and conducted multinomial logistic regression of latent class membership on COVID-19-related information sources. Four latent classes were identified, including the risk neutrals with high preventive behaviors, the risk exaggerators with high preventive behaviors, the risk deniers with moderate preventive behaviors, and the risk deniers with low preventive behaviors. Compared with the risk neutrals, the risk exaggerators with high preventive behaviors were more likely to obtain COVID-19 information from multiple sources, whereas the risk deniers with moderate preventive behaviors and risk deniers with low preventive behaviors were less likely to obtain COVID-19 information compared with the risk neutrals. Governments and health professions should take the variety of risk perception and adopted preventive behaviors into consideration when disseminating information on COVID-19 to the general public.