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The aims of this cross-sectional survey study were to examine the association between sexual orientation microaggression and anxiety and depression among young adult lesbian, gay, and bisexual (LGB) individuals in Taiwan, as well as to examine the mediating effect of self-identity disturbance and the moderating effect of gender. In total, 1000 self-identified LGB individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, self-identity disturbance was assessed using the Self-Concept and Identity Measure, anxiety was assessed using the State subscale on the Chinese version of the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. Structural equation modeling (SEM) was used to examine relationships between the variables. The SEM results demonstrated that sexual orientation microaggression was directly associated with increased anxiety and depression, as well as being indirectly associated with increased anxiety and depression via the mediation of self-identity disturbance among young adult LGB individuals. Gender did not moderate the relationships between any of the variables. Both sexual orientation microaggression and self-identity disturbance warrant program interventions for enhancing mental health among LGB individuals.

Endometrial cancer incidence increases annually. Several risk factors, including high glucose intake, are associated with endometrial cancer. We investigated whether glucose affects lysine-specific demethylase 1 (LSD1) expression and the responsible molecular mechanisms. A high concentration of glucose stimulated p62 phosphorylation and increased LSD1 protein expression. Knockdown of p62 or treatment with mammalian target of rapamycin (mTOR), transforming growth factor-β activated kinase 1 (TAK1), casein kinase 1 (CK1), and protein kinase C (PKC) inhibitors abrogated glucose-regulated LSD1 expression. Unphosphorylated p62 and LSD1 formed a complex with Kelch-like ECH-associated protein 1 (KEAP1) and were degraded by the KEAP1-dependent proteasome. Phosphorylated p62 increased LSD1 protein expression by escaping the KEAP1 proteasome complex. LSD1 and KEAP1 interaction was enhanced in the presence of the nuclear factor erythroid 2-related factor 2 (NRF2) protein. LSD1 also participated in antioxidant gene regulation with NRF2. In diabetic mice, increasing LSD1and phospho-p62 expression was observed in uterine epithelial cells. Our results indicate that glucose induces p62 phosphorylation through mTOR, TAK1, CK1, and PKC kinases. Subsequently, phospho-p62 competitively interacts with KEAP1 and releases NRF2-LSD1 from the KEAP1 proteasome complex. Our findings may have public health implications for the prevention of endometrial cancer.

Experiences of sexual orientation microaggression (SOM) are prevalent in lesbian, gay, and bisexual (LGB) individuals. The aims of this quantitative cross-sectional survey study were to examine the factors, including demographics, sexual orientation characteristics, and perceived social support related to SOM, as well as the relationships of SOM with anxiety, depression, and suicidality among young adult LGB individuals in Taiwan. In total, 1000 self-identified young adult LGB individuals (500 men and 500 women) participated in this study. The experience of SOM was assessed using the Sexual Orientation Microaggression Inventory. We also collected demographic and sexual orientation characteristics; perceived general family support, using the Family APGAR Index; anxiety on the State-Trait Anxiety Inventory; depression on the Center for Epidemiological Studies-Depression Scale; and suicidality on the suicidality module of the Kiddie-SADS. The factors related to SOM and the associations of SOM with anxiety, depression, and suicidality were examined using multivariate linear regression analysis. The results indicated that males experienced greater SOM than females, and that younger age of identification of sexual orientation and perceived lower general family support were significantly associated with greater SOM. Greater SOM was significantly associated with greater anxiety, depression, and suicidality. The experiences of SOM in LGB individuals with mental health problems warrant assessment and intervention that take the related factors into account.

Background: Resolving the coronavirus disease 2019 (COVID-19) pandemic requires diagnostic testing to determine which individuals are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current gold standard is to perform reverse-transcription polymerase chain reaction (PCR) on nasopharyngeal samples. Best-in-class assays demonstrate a limit of detection (LoD) of approximately 100 copies of viral RNA per milliliter of transport media. However, LoDs of currently approved assays vary over 10,000-fold. Assays with higher LoDs will miss infected patients. However, the relative clinical sensitivity of these assays remains unknown., Methods: Here we model the clinical sensitivities of assays based on their LoD. Cycle threshold (Ct) values were obtained from 4700 first-time positive patients using the Abbott RealTime SARS-CoV-2 Emergency Use Authorization test. We derived viral loads from Ct based on PCR principles and empiric analysis. A sliding scale relationship for predicting clinical sensitivity was developed from analysis of viral load distribution relative to assay LoD., Results: Ct values were reliably repeatable over short time testing windows, providing support for use as a tool to estimate viral load. Viral load was found to be relatively evenly distributed across log10 bins of incremental viral load. Based on these data, each 10-fold increase in LoD is expected to lower assay sensitivity by approximately 13%., Conclusions: The assay LoD meaningfully impacts clinical performance of SARS-CoV-2 tests. The highest LoDs on the market will miss a majority of infected patients. Assays should therefore be benchmarked against a universal standard to allow cross-comparison of SARS-CoV-2 detection methods., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background: Stroke is a leading cause of long-term disability and is considered a major global health burden., Objectives: We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan., Methods: We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects., Results: A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains., Conclusion: Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: The differences in brain activity between patients with major depressive disorder (MDD) and healthy adults have been confirmed by functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and electroencephalography (EEG). The prefrontal lobe and posterior cingulate cortex (PCC) are related to emotional regulation in patients with MDD. However, the high cost and poor time resolution of fMRI and PET limit their clinical application. Recently, researchers have used high time resolution of standardized weighted low-resolution electromagnetic tomography (swLORETA) to investigate deep brain activity. This study aimed to convert raw EEG signals into swLORETA images and explore deep brain activity in patients with MDD and healthy adults., Methods: BrainMaster EEG equipment with a 19-channel EEG cap was used to collect resting EEG data with eyes closed for 5 min. NeuroGuide software was used to remove the EEG artifacts, and the swLORETA software was used to analyze 12,700 voxels of current source density (CSD) for 139 patients with MDD and co-morbid anxiety symptoms (mean age = 43.08, SD = 13.76; 28.78% were male) and 134 healthy adults (mean age = 40.60, SD = 13.52; 34.33% were male). Deep brain activity in the frontal lobe and PCC at different frequency bands was analyzed, including delta (1-4 Hz), theta (5-7 Hz), alpha (8-11 Hz), beta (12-24 Hz), beta1 (12-14 Hz), beta2 (15-17 Hz), beta3 (18-24 Hz), and high beta (25-29 Hz)., Results: There was lower delta and theta and higher beta, beta1, beta2, beta3, and high-beta activity at the prefrontal lobe (dorsal medial prefrontal cortex [dmPFC], ventral medial prefrontal cortex [vmPFC], and dorsal lateral prefrontal cortex [dlPFC], ventral lateral prefrontal cortex [vlPFC], orbital frontal cortex [OFC]) and PCC in MDD patients compared with healthy adults. There was no significant difference in alpha activity between the two groups., Conclusion: This study indicates brain hyperactivity in the right prefrontal lobe (dlPFC and vmPFC) and PCC in patients with MDD with co-morbid anxiety symptoms, and the dlPFC and PCC were also related to emotion regulation in MDD. Inhibiting high-beta activity or restoring delta and theta activity to the normal range in the right frontal lobe and PCC may be possible in z-score neurofeedback protocols for patients with MDD in future studies.

The present study aimed (1) to identify distinct latent classes of motivation to get vaccinated against coronavirus disease 2019 (COVID-19) and previous seasonal influenza vaccination among people in Taiwan and (2) to examine the roles of sources of information, risk perception, and cognitive appraisals of vaccination against COVID-19 in these classes. We recruited 1047 participants through a Facebook advertisement. The participants' motivation to get vaccinated against COVID-19, previous seasonal influenza vaccination, sources of information about COVID-19 vaccination, risk perception of COVID-19, and cognitive appraisals of vaccination against COVID-19 were determined. We examined the participants' motivation for COVID-19 vaccination and previous seasonal influenza vaccination through latent profile analysis. Four latent classes of motivation were identified: participants with high motivation for COVID-19 vaccination and high seasonal influenza vaccination, those with high motivation for COVID-19 vaccination but low seasonal influenza vaccination, those with low motivation for COVID-19 vaccination but high seasonal influenza vaccination, and those with low motivation for COVID-19 vaccination and low seasonal influenza vaccination. Compared with participants in the latent class of high motivation for COVID-19 vaccination and high seasonal influenza vaccination, those in the other three latent classes had lower levels of positive appraisals of COVID-19 vaccination; participants in the latent class of low motivation for COVID-19 vaccination and low seasonal influenza vaccination had lower risk perception of COVID-19 and were also less likely to obtain information about COVID-19 vaccination from the internet, friends, and family members. The various motivations and behaviors for vaccination, sources of information, risk perception, and cognitive appraisals of vaccination against COVID-19 should be considered in intervention programs aiming to increase people's motivation to get vaccinated against COVID-19.

The present study examined the factor structure and concurrent validity of the traditional Chinese version of the Sexual Orientation Microaggression Inventory (SOMI) among lesbian, gay, and bisexual (LGB) individuals in Taiwan. In total, 1000 self-identified LGB individuals completed the SOMI, HIV and Homosexuality Related Stigma Scale (HHRSS), and Acceptance and Action Questionnaire-II (AAQ). Different factor structures (including one-factor, four-factor, bifactor, and higher-order factor structures) were evaluated using confirmatory factor analysis. The bifactor structure significantly outperformed all others on the SOMI. The bifactor structure with one general factor and four trait factors was found to be measurement invariant across biological sex with satisfactory fit indices. The SOMI general factor was significantly associated with HHRSS-Homosexuality score and AAQ score. The findings indicate that the SOMI is a psychometrically sound instrument for Taiwan sexual minority groups. More specifically, SOMI can be used to accurately assess microaggression among LGB individuals. The measure on microaggression may also provide insights for healthcare providers about LGB individuals' sexuality-related stigma. Moreover, healthcare providers and relevant stakeholders can use the SOMI to understand how LGB individuals perceive and feel microaggression.

Objective : The Theory of Planned Behavior (TPB) is one of the most robust models in explaining health-related behavior. In this study, we tested the extended TPB to predict university students' intentions to uptake COVID-19 vaccination. Methods : An online cross-sectional survey was developed to investigate students' intention to uptake the COVID-19 vaccine based on the components of the TPB (i.e., attitude, subjective norms, and perceived behavioral control) and extended components (i.e., knowledge about COVID-19, risk perception of COVID-19, and past influenza vaccination behavior). Non-probability sampling was used to collect data from 3145 students from 43 universities in mainland China in January 2021. Structural equation modeling (SEM) was applied to examine the proposed model. Enrolled students were relatively young (mean age = 20.80 years; SD = 2.09), half of them are female (50.2%), and most of them were studying in undergraduate programs (n = 3026; 96.2%). Results : The results showed that students' knowledge of the COVID-19 vaccine and risk perception of COVID-19 positively influenced their attitude toward the uptake of a COVID-19 vaccine. Also, students' attitude toward COVID-19 vaccination uptake and their past influenza vaccination uptake behaviors were positively associated with the intention to uptake COVID-19 vaccination. Subjective norm and perceived behavioral control were not significant predictors for the intention to uptake COVID-19 vaccination (R 2  = 0.49). Conclusions : The present study demonstrated that the extended TPB appears to be an efficient model with the focus on attitude, knowledge, risk perception, and past influenza vaccination uptake behaviors in explaining students' intention for COVID-19 vaccination.

Craving is a core feature of heroin use disorder. Craving for heroin is a conscious cognitive process. Recently, implicit (i.e., an implicit attitude toward heroin use) cognitive processes have been thought to be precursors of cravings. This study aimed to explore the associations of craving and implicit attitude toward heroin use with the level of heroin use disorder and adherence to methadone maintenance treatment (MMT). This study recruited 213 intravenous heroin users (196 males and 17 females) from MMT clinics of two hospitals. The mean age of participants was 42.3 years. They provided details of their severity of heroin use disorder and craving for heroin via questionnaires and also completed a computerized test to assess implicit attitude toward heroin use. The relationships between implicit attitude, craving, age, heroin use disorder, and MMT adherence were examined using path analysis. Craving was positively related to heroin use disorder (beta = 0.4). Implicit attitude directly and indirectly positively contributed to heroin use disorder (betas: 0.1 and 0.3). Craving was positively related to MMT adherence (beta: 0.2), whereas implicit attitude had an indirect effect on MMT adherence (beta: 0.03). Age was negatively associated with craving but was not associated with implicit attitude toward heroin. Methadone dosage was negatively associated with craving. Craving is significantly associated with the levels of heroin use disorder and MMT adherence. Meanwhile, craving mediates the relationship between implicit attitude and heroin use disorder, as well as MMT adherence. Implicit attitude also contributes to the level of heroin use disorder directly. For reducing craving, adequate dosage may be necessary.

Vaccination appears to be one of the effective strategies to control the COVID-19 pandemic. However, the challenge of vaccine hesitancy may lower the uptake rate and affect overall vaccine efficacy. Being a low-risk group in terms of serious consequences of infection, university students may possess low motivation to get vaccinated. Therefore, an expanded Protection Motivation Theory (PMT) incorporating perceived knowledge, adaptive response, and maladaptive response was proposed to investigate the COVID-19 vaccination intention among Taiwanese university students. University students ( n = 924; 575 males; mean age = 25.29 years) completed an online survey during January to February 2021. The proposed expanded PMT model was examined using structural equation modeling (SEM). The results showed that perceived knowledge was significantly associated with coping appraisal (standardized coefficient (β) = 0.820; p < 0.001), and coping appraisal was significantly associated with adaptive response (β = 0.852; p < 0.001), maladaptive response (β = 0.300; p < 0.001) and intention (β = 0.533; p = 0.009). Moreover, maladaptive response (β = -0.173; p = 0.001) but not adaptive response (β = 0.148; p = 0.482) was significantly and negatively associated with intention. The present study's results demonstrated a positive path between perceived knowledge, coping appraisal, and intention among university students. Therefore, improving knowledge among this population may increase the intention to uptake the vaccine.

The coronavirus disease 2019 (COVID-19) pandemic has thrown out a challenge to caregivers of children with attention-deficit/hyperactivity disorder (ADHD). The present study examined the factors related to the poor general mental health state of the caregivers of children with ADHD during the COVID-19 pandemic, including (1) difficulties of caregivers in asking their child to adopt protective behaviors against COVID-19, (2) difficulties of caregivers in managing the child's daily performance, and (3) worsened psychological symptoms in children. In total, 161 caregivers completed an online questionnaire to provide data regarding their general mental health state and difficulties in asking their child with ADHD to adopt protective behaviors against COVID-19 and in managing the child's after-school learning, sleep routine, and internet use, as well as worsened psychological symptoms. The results of multivariate logistic regression analysis demonstrated that caregivers' difficulties in managing ADHD children's self-protective behaviors and after-school learning and the children's worsened emotional symptoms were significantly associated with poor caregiver general mental health state. An intervention that enhances the mental health of caregivers of children with ADHD during the COVID-19 pandemic by addressing their difficulties in managing the children's behaviors and psychological problems is warranted.

Estrogens can elicit rapid cellular responses via the G-protein-coupled receptor 30 (GPR30), followed by estrogen receptor α (ERα/ESR1)-mediated genomic effects. Here, we investigated whether rapid estrogen signaling via GRP30 may affect ESR1 expression, and we examined the underlying molecular mechanisms. The exposure of human endometrial cancer cells to 17β-estradiol promoted p62 phosphorylation and increased ESR1 protein expression. However, both a GPR30 antagonist and GPR30 silencing abrogated this phenomenon. GPR30 activation by 17β-estradiol elicited the SRC/EGFR/PI3K/Akt/mTOR signaling pathway. Intriguingly, unphosphorylated p62 and ESR1 were found to form an intracellular complex with the substrate adaptor protein KEAP1. Upon phosphorylation, p62 promoted ESR1 release from the complex, to increase its protein expression. Given the critical role played by p62 in autophagy, we also examined how this process affected ESR1 expression. The activation of autophagy by everolimus decreased ESR1 by promoting p62 degradation, whereas autophagy inhibition with chloroquine increased ESR1 expression. The treatment of female C57BL/6 mice with the autophagy inhibitor hydroxychloroquine-which promotes p62 expression-increased both phosphorylated p62 and ESR1 expression in uterine epithelial cells. Collectively, our results indicate that 17β-estradiol-mediated GPR30 activation elicits the SRC/EGFR/PI3K/Akt/mTOR signaling pathway and promotes p62 phosphorylation. In turn, phosphorylated p62 increased ESR1 expression by inducing its release from complexes that included KEAP1. Our findings may lead to novel pharmacological strategies aimed at decreasing ESR1 expression in estrogen-sensitive cells.

Ketamine use has become of increasing concern because it has spread in many parts of the world during the past few years. Substance users usually have depression and a lower quality of life (QoL). The aim of this study was to explore depression and QoL in ketamine users, and to further examine the role of gender in relation to differences in depression and QoL in ketamine users. This study recruited 204 current ketamine users, 102 abstinent ketamine users and 102 healthy controls. The demographic data, severity of depression and QoL were recorded. Analysis of Variance (ANOVA) was employed to compare the associations of ketamine use status with depression and QoL. Gender differences were examined by moderator analysis. The current ketamine users with and without ketamine use disorder, in addition to the abstinent ketamine users with ketamine use disorder, have more severe depression and a lower QoL than healthy controls. There were significant gender differences in depression and QoL in abstinent ketamine users with ketamine use disorder. Ketamine users have more severe depression and a lower QoL. In particular, depression and a lower QoL are still prominent in abstinent ketamine users. The gender differences in depression and QoL are significant in abstinent ketamine users.

This cross-sectional study investigated the mediating effects of emotional problems including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) symptoms on the association between bullying victimization and quality of life (QoL) among adolescents with ADHD in Taiwan. A total of 171 adolescents diagnosed as having ADHD participated in this study. Adolescents completed the School Bullying Experience Questionnaire, the Taiwanese Quality of Life Questionnaire for Adolescents, the Taiwanese version of the Children's Depression Inventory and the Multidimensional Anxiety Scale for Children. Caregivers completed the Chinese version of the Swanson, Nolan, and Pelham Version IV Scale. Structural equation modeling (SEM) was used to examine the relationships among the variables. The results of SEM revealed that bullying victimization indirectly correlated with QoL through the mediation of emotional problems in adolescents with ADHD, whereas ADHD and ODD symptoms did not mediate the association between bullying victimization and QoL. Bullying victimization should be actively prevented and intervened on to ensure better QoL in adolescents with ADHD. Moreover, emotional problems should be alleviated among adolescents with ADHD with bullying victimization experience to maintain their QoL.

The aims of this study were to examine the proportion of caregivers who were hesitant to vaccinate their children with attention-deficit/hyperactivity disorder (ADHD) against coronavirus disease 2019 (COVID-19) and the factors related to caregiver intentions to vaccinate their children against COVID-19. In total, 161 caregivers of children with ADHD were recruited in this study. The caregivers completed an online questionnaire to provide data regarding their intention to vaccinate their children against COVID-19, concerns about the effectiveness and safety of vaccines, unfavorable family attitudes toward vaccines, and children's medication use for ADHD and comorbid psychopathology. The factors related to caregiver intentions to vaccinate their child were examined using linear regression analysis. The results indicated that 25.5% of caregivers were hesitant to vaccinate their children with ADHD, and 11.8% refused to vaccinate their children against COVID-19. The caregivers' concerns about the safety of vaccines and children's regular use of medication for ADHD were negatively associated with caregiver intentions to vaccinate, whereas the children's comorbid conduct or oppositional defiant problems were positively associated with the caregiver intentions to vaccinate. An intervention that enhances caregiver intentions to vaccinate their children with ADHD against COVID-19 by addressing the related factors found in this study is warranted.

Affiliate stigma may increase the risks of negative parenting and psychological and depressive problems in caregivers of children with attention-deficit/hyperactivity disorder (ADHD). Evaluating affiliate stigma and determining how to reduce it are crucial to promoting mental health in caregivers and their children with ADHD. The aim of this study was to examine the associations of stress-coping orientations and parental child-rearing styles with the risk of high affiliate stigma in caregivers of children with ADHD in Taiwan. Affiliate stigma, stress-coping orientations, and parental child-rearing styles were assessed. The results of univariate logistic regression analysis indicated that caregivers' gender, depressive symptoms, four orientations of stress coping, and two parenting styles, and children's high severities of internalizing, externalizing, and ADHD symptoms were significantly associated with high affiliate stigma. The results of multivariate logistic regression analysis indicated that after controlling for caregivers' gender, depressive symptoms, and children's severity of internalizing, externalizing, and ADHD symptoms, caregivers with high orientation of seeking social support were less likely to have high affiliate stigma than those with low orientation of seeking social support; the caregivers with high care and affection parenting were less likely to have high affiliate stigma than those with low care and affection parenting, whereas the caregivers with high overprotection parenting were more likely to have high affiliate stigma than those with low overprotection parenting. Intervention programs targeting caregiver affiliate stigma must consider various coping orientations and parental child-rearing styles in their approach.

This 1-year follow-up study examined the predictive values of the demographics, depressive symptoms, stress-coping orientations, and perceived family support of caregivers as well as the internalizing, externalizing and ADHD symptoms of children with attention-deficit/hyperactivity disorder (ADHD) at baseline on the depressive symptoms of the caregivers after 1 year. A total of four hundred caregivers of children with ADHD were recruited. The baseline levels of the caregivers' depressive symptoms, stress-coping orientations, and perceived family support and the internalizing and externalizing problems of the children were assessed using the Center for Epidemiological Studies Depression Scale, the Coping Orientation to Problems Experienced, Family Adaptation, Partnership, Growth, Affection, Resolve Index, and the Child Behavior Checklist For Ages 6-18, respectively. Their predictions for the caregiver's depressive symptoms 1 year after the baseline were examined using linear regression analysis. In total, 382 caregivers of children with ADHD underwent the follow-up assessment 1 year from the baseline. A marital status of being separated or divorced, less effective coping and depressive symptoms orientation, and children with internalizing problems and ADHD symptoms at baseline were positively associated with the caregivers' depressive symptoms at follow-up, whereas the caregivers' perceived family support and an emotion-focused coping orientation at baseline were negatively associated with depressive symptoms at follow-up. Multiple characteristics of the caregivers and children with ADHD at baseline predicted the caregivers' depressive symptoms 1 year later.

Purpose of Review: During the coronavirus disease 2019 pandemic, when facing extraordinary infection prevention challenges, acute care settings have balanced routine patient safety needs while minimizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risk to patients and healthcare personnel (HCP). Mitigation strategies in acute care settings are based on a combination of basic science, environmental, and epidemiologic evidence. Here, we review the literature on SARS-CoV-2 transmission, how it has shaped infection prevention interventions in acute care settings, and the results of such measures to reduce transmission., Recent Findings: HCP adherence to transmission-based precautions in acute care settings, such as the use of personal protective equipment (PPE), is essential to mitigating SARS-CoV-2 spread. Although the SARS-CoV-2 virus has been isolated in nonrespiratory body sites, such exposure has not been shown to definitively cause transmission in humans. Epidemiologic evidence has demonstrated that implementation and adherence to infection prevention strategies reduces acute setting transmission., Summary: Given SARS-CoV-2 infection occurs primarily through respiratory transmission, preventing HCP acquisition requires fidelity to consistent PPE usage. Infection prevention strategies and implementation of transmission-based precautions have reduced spread and outbreaks. Epidemiologic studies of acute care outbreaks often include reports of PPE nonadherence and community exposure contributing to SARS-CoV-2 transmission within this setting., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Antimicrobial prescribing and the associated discipline of antimicrobial stewardship have inherent ethical and moral dimensions. We contend that the explicit, formal application of ethical principles and frameworks can strengthen and further justify the value of antimicrobial stewardship programs and their work. To illustrate the value of this process, we highlight 3 ethical scenarios that antimicrobial stewardship programs regularly encounter at the prescriber, institutional, and societal levels, and we analyze these scenarios using the Beauchamp and Childress biomedical ethics framework., Competing Interests: All authors report no conflicts of interest relevant to this article., (© The Author(s) 2021.)

Cadherin cell-cell adhesion proteins play key roles in tissue morphogenesis and wound healing. Cadherin ectodomains bind in two conformations, X-dimers and strand-swap dimers, with different adhesive properties. However, the mechanisms by which cells regulate ectodomain conformation are unknown. Cadherin intracellular regions associate with several actin-binding proteins including vinculin, which are believed to tune cell-cell adhesion by remodeling the actin cytoskeleton. Here, we show at the single-molecule level, that vinculin association with the cadherin cytoplasmic region allosterically converts weak X-dimers into strong strand-swap dimers and that this process is mediated by myosin II-dependent changes in cytoskeletal tension. We also show that in epithelial cells, ∼70% of apical cadherins exist as strand-swap dimers while the remaining form X-dimers, providing two cadherin pools with different adhesive properties. Our results demonstrate the inside-out regulation of cadherin conformation and establish a mechanistic role for vinculin in this process., Competing Interests: The authors declare no competing interest.

The aims of the present study were (1) to identify the variables related to denying the justification for vaccination during the coronavirus disease 2019 (COVID-19) pandemic in Taiwan and (2) to examine the associations of such denial with perceived risk of COVID-19 and the extrinsic and intrinsic intentions to get vaccinated against COVID-19. We recruited 1047 participants by using a Facebook advertisement. We investigated whether the participants denied justification for vaccination as well as their sociodemographic characteristics, mental health status, sources of information about COVID-19 vaccination, perceived risk of COVID-19, and extrinsic and intrinsic intentions to get vaccinated against COVID-19. The results indicated that 20.0% of the participants denied justification for vaccination. Participants who were older, had an educational level below college, were not health care workers, were in poor general mental health state, or did not obtain information about COVID-19 vaccination from the Internet were more likely to deny justification for vaccination. Denial was negatively associated with both extrinsic and intrinsic intentions to get vaccinated against COVID-19 but not associated with the perceived risk of COVID-19. Multiple variables related to denying the justification for vaccination; the denial was negatively associated with the intention to get vaccinated against COVID-19.

This study examined the relationships of cyberbullying and traditional bullying victimization and perpetration, perceived family function, frustration discomfort, and hostility with self-reported depressive symptoms and suicidality in adolescents diagnosed as having attention-deficit/hyperactivity disorder (ADHD). Both the self-reported severity of depressive symptoms on the Center for Epidemiological Studies Depression Scale and the occurrence of suicidal ideation or a suicide attempt on the suicidality module of the Kiddie Schedule for Affective Disorders and Schizophrenia were assessed in 195 adolescents with ADHD. The adolescents completed the Cyberbullying Experiences Questionnaire, Chinese version of the School Bullying Experience Questionnaire, Frustration-Discomfort Scale, Buss-Durkee Hostility Inventory, and Family APGAR Index. Caregivers completed the ADHD problems component of the Child Behavior Checklist for Ages 6-18. Multiple regression analyses were used to examine the correlates for each of self-reported depressive symptoms and suicidality. The results showed that after the effects of gender, age, ADHD symptoms, and family function were controlled, greater frustration discomfort and bullying perpetration significantly predicted self-reported depressive symptoms. Being cyberbullying victims and displaying hostility significantly predicted the risk of suicidality. Various types of bullying involvement, frustration intolerance, and hostility significantly predicted self-reported depressive symptoms and suicidality in adolescents with ADHD. By monitoring and intervening in these factors, we can reduce the risk of depression-related problems and suicidality in adolescents with ADHD.

In 829 hospital encounters for patients with COVID-19, 73.2% included orders for antibiotics; however, only 1.8% had respiratory cultures during the first 3 hospital days isolating bacteria. Case-control analysis of 30 patients and 96 controls found that each antibiotic day increased the risk of isolating multidrug-resistant gram-negative bacteria (MDR-GNB) in respiratory cultures by 6.5%., Competing Interests: All authors report no conflicts of interest relevant to this article., (© The Author(s) 2021.)

Background: COVID-19 continues to ravage the world with economies and life significantly and negatively affected. Fortunately, there has been significant progress in the production of vaccines to stem the infection. However, with controversies and myths surrounding vaccinations, it is timely to examine individuals' willingness to vaccinate. The present study adapted the Motors of Influenza Vaccination Acceptance Scale (MoVac-Flu Scale) into the Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) for validation and assessed the acceptance of COVID-19 vaccination utilizing the cognitive model of empowerment (CME)., Methods: A total of 3145 university students (mean age = 20.80 years; SD = 2.09) were recruited for the present study between January 5 and 16, 2021. Two MoVac-COVID19S scales (9-item and 12-item) were adapted from the MoVac-Flu Scale, an instrument developed using CME. Psychometric tests were conducted to ascertain reliability and validity properties., Results: The findings indicated that the MoVac-COVID19S had high internal consistency in both the 9-item version (ω = 0.921) and 12-item version (ω = 0.898). The factor structure of the MoVac-COVID19S (9-item and 12-item versions) corresponded well with CME theory. All the fit indices were satisfactory (comparative fit index = 0.984, Tucker-Lewis index = 0.971, root mean square error of approximation = 0.088, standardized root mean square residual = 0.058) but the 9-item MoVac-COVID had better fit indices than the 12-item MoVac-COVID due to the negative wording effects existing in the 12-item MoVac-COVID19S. The scale had satisfactory known-group validity in both 9-item and 12-item versions., Conclusions: The MoVac-COVID19S has promising psychometric properties based on internal consistency, factor structure, and known-group validity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The aim of this follow-up study was to examine the predictive values of caregivers' affiliate stigma at baseline for depression in caregivers and internalizing and externalizing symptoms in children with attention-deficit/hyperactivity disorder (ADHD) 1 year later. The Study on Affiliate Stigma in Caregivers of Children with ADHD surveyed the levels of affiliate stigma and depression in 400 caregivers and the behavioral problems of their children with ADHD. The levels of the caregivers' depression and children's behavioral problems were assessed 1 year later. The associations of caregivers' affiliate stigma at baseline with depression in caregivers and internalizing and externalizing symptoms in children with ADHD at follow-up were examined using stepwise multiple regression. The results indicated that before caregivers' depression and children's behavioral problems at baseline were controlled, caregivers' affiliate stigma at baseline positively predicted caregivers' depression and all children's behavioral problems. After caregivers' depression and children's behavioral problems at baseline were controlled, caregivers' affiliate stigma at baseline still positively predicted children's affective and somatic problems. Parenting training and cognitive behavioral therapy should be provided to caregivers with intense affiliate stigma to prevent emotional problems and difficulties in managing their children's behavioral problems.

The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through a Facebook advertisement. The participants' explicit and intrinsic intentions to receive COVID-19 vaccination and their risk perception of COVID-19 were measured. We discovered that sexual minority individuals had higher levels of explicit and intrinsic intention to receive vaccination relative to heterosexual individuals. Intrinsic intention was positively associated with explicit intention after the effects of demographic characteristics and risk perception of COVID-19 were controlled for. Sexual orientation did not moderate the association between explicit and intrinsic intentions. The present study determined the relationship between sexual orientation and intention to receive COVID-19 vaccination.

The present study aimed to identify the distinct classes of motivations to get vaccinated and to adopt preventive behaviors against the coronavirus disease 2019 (COVID-19) among people in Taiwan and to examine the roles of Protection Motivation Theory (PMT) cognitive constructs in these unique classes of motivations to get vaccinated and to adopt preventive behaviors. We recruited 1047 participants by using a Facebook advertisement. Participants' motivations to get vaccinated and to adopt preventive behaviors against COVID-19, PMT constructs of threat appraisal (perceived severity and perceived vulnerability), and PMT constructs of coping appraisal (self-efficacy, response efficacy, response cost, knowledge, and previous vaccination for seasonal influenza) were determined. We analyzed participants' motivations to get vaccinated and to adopt preventive behaviors against COVID-19 by using latent profile analysis. The present study identified three latent classes, including the participants with high motivation for vaccination and preventive behaviors (the class of Both High), those with low motivation for vaccination and preventive behaviors (the class of Both Low), and those with high motivation for vaccination but low motivation for preventive behaviors (the class of High Vaccination but Low Preventive Behaviors). Compared with the participants in the class of Both High, participants in the class of Both Low had lower levels of perceived vulnerability, perceived severity, self-efficacy to have vaccination, response efficacy of vaccination, knowledge about vaccination, and previous vaccination for seasonal influenza; participants in the class of High Vaccination but Low Preventive Behaviors had lower levels of perceived vulnerability and perceived severity but higher levels of response cost of vaccination. We concluded that varieties of motivations, threat, and coping appraisals should be considered in intervention programs aiming to increase motivation to adopt recommended protective behaviors against COVID-19.

Victimization and perpetration of cyberbullying and traditional bullying are prevalent among adolescents with attention-deficit/hyperactivity disorder (ADHD). This study examined the associations of impulsivity, frustration discomfort, and hostility with victimization and with the perpetration of cyberbullying and traditional bullying in adolescents with ADHD. Self-reported involvement in cyberbullying and traditional bullying was assessed in 195 adolescents with a clinical diagnosis of ADHD. Adolescents also completed questionnaires for impulsivity, frustration discomfort, and hostility. Caregivers completed the Child Behavior Checklist for adolescents' ADHD, internalization, oppositional defiance, and problems with conduct. The associations of impulsivity, frustration discomfort, and hostility with victimization and perpetration of cyberbullying and traditional bullying were examined using logistic regression analysis. The results demonstrated that after the effects of demographic characteristics and behavioral problems were controlled for, frustration intolerance increased the risks of being cyberbullying victims and perpetrators whereas hostility increased the risks of being the victims and perpetrators of traditional bullying. Impulsivity was not significantly associated with any type of bullying involvement. Prevention and intervention programs should alleviate frustration intolerance and hostility among adolescents with ADHD.

Background: Surgical site infection (SSI) is common in colorectal surgery patients and associated with morbidity and mortality. Guidelines recommend preoperative intravenous antimicrobial prophylaxis with aerobic and anaerobic coverage to reduce SSI risk. Cephalosporin based prophylaxis (CBP) regimens are recommended as first-line prophylaxis, and non-cephalosporin based are recommended as alternative prophylaxis (AP). We evaluate the efficacy of CBP versus AP in preventing surgical site infections in colorectal surgery patients., Methods: A systematic review and meta-analysis was conducted of studies published between 2005 and 2020 in MEDLINE and Web of Science. Studies were excluded if intravenous antimicrobial prophylaxis was not administered, or if oral and intravenous prophylaxis were routinely co-administered. Heterogeneity was reported using the Q-statistic and I 2 -statistic. Publication bias was evaluated using a funnel plot and Egger test for small study effects. Statistical significance was defined as a two-sided p  < 0.05., Results: 11 studies met inclusion criteria. AP was not associated with increased SSI risk at 30 days compared to CBP (OR 1.01, 95% CI 0.91, 1.13; OR < 1 favors AP). There was no effect size variability in subgroup analysis comparing higher-to lower-quality studies (I 2  = 99%, P  = 0.17). Subgroup analysis by publication year approached a significant difference in effect size between studies published prior to 2014 and later than 2014 (I 2  = 99%, P  = 0.06)., Conclusions: Meta-analysis of 11 studies of SSI risk in adult colorectal surgery patients suggest that SSI risk is similar for patients receiving CBP or AP, subgroup analysis of studies published since 2014 suggest increased SSI risk with AP compared to CBP., Competing Interests: None., (© 2021 The Authors.)

Background: Craving is considered a hallmark of substance use disorder and is one of the criteria of substance use disorder. The Desires for Drug Questionnaire (DDQ) is a widely used questionnaire to assess craving for heroin. This study aimed to examine the psychometric properties of the ketamine version of the DDQ (DDQ-K) and the associations between craving for ketamine as measured using the DDQ-K and clinical outcome indicators in individuals with ketamine use disorder. Methods: In total, 651 individuals with ketamine use disorder completed the DDQ-K and the Visual Analog Craving Scale (VACS). Demographic data, severity of ketamine use, money spent on ketamine, positive/negative aspects of ketamine use, and readiness to change ketamine use were also recorded. We examined the reliability (internal consistency), construct validity (factor structure), and concurrent validity of the DDQ-K. Multiple regression analysis was used to examine the relationships of craving measured using the DDQ-K with clinical outcome indicators, including money spent on ketamine, severity of ketamine use, positive/negative aspects of ketamine use, and readiness to change ketamine use. Results: The original three-factor model of the DDQ-K was acceptable for use in individuals with ketamine use disorder according to confirmatory factor analysis. The subscales of Desire and Intention and Negative Reinforcement of the DDQ-K, but not the subscale of Control, were of acceptable concurrent validity. The score on the Desire and Intention subscale was positively associated with the level of ketamine dependence, money spent on ketamine use, and positive/negative aspects of ketamine use and negatively associated with readiness to change ketamine use. Conclusion: This study supported the use of the Desire and Intention and Negative Reinforcement subscales of the DDQ-K to assess craving in patients with ketamine use., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wang, Lin, Liu, Hsu, Yang, Wu and Yen.)

Children with attention-deficit/hyperactivity disorder (ADHD) are commonly affected by medical illness. The aim of the present study was to explore the risks of contracting respiratory infectious diseases (RIDs), including upper and lower RIDs and influenza, in children with ADHD. We also examined whether methylphenidate has a protective effect regarding the risk of contracting RIDs among children with ADHD who have a history of methylphenidate treatment. Children in the Taiwan Maternal and Child Health Database from 2004 to 2016 were included in the present study. Upper and lower RIDs, influenza, ADHD, age, sex, and records of methylphenidate prescription were identified. A Cox proportional hazards regression model was used to estimate the significance of the risk of RIDs among children with ADHD in comparison with that among children without ADHD after adjustment for sex and age. The self-controlled case series analysis was conducted to examine the protective effect of methylphenidate treatment against RIDs. In total, 85,853 children with ADHD and 1,458,750 children without ADHD were included in the study. After controlling for sociodemographic variables, we observed that children with ADHD had significantly higher risks of upper RIDs, lower RIDs, and influenza infection than did those without ADHD. Among the children with ADHD who had a history of methylphenidate treatment, the risk of contracting RIDs was lower during the methylphenidate treatment period than during the nontreatment period. Children with ADHD had a higher RID risk than those without ADHD. Methylphenidate might reduce the risk of RIDs among children with ADHD who have a history of methylphenidate treatment.

Victimization and perpetration of cyberbullying and traditional bullying are prevalent among adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The aims of this study were to examine the role of social anxiety in victimization and perpetration of cyberbullying and traditional bullying in adolescents with ASD and ADHD in Taiwan. A total of 219 adolescents with ASD and 287 adolescents with ADHD aged 11-18 years and their caregivers were recruited from the child psychiatry outpatient clinics into this study. The associations of social anxiety with victimization and perpetration of cyberbullying and traditional bullying were examined using logistic regression analysis. The results indicated that after the effects of sex, age, and autistic social impairment were controlled, social anxiety increased the risk of being a victim of cyberbullying (Odds Ratios (OR) = 1.048; 95% Confidence Interval (CI): 1.013-1.084), a victim of traditional bullying (OR = 1.066; 95% CI: 1.036-1.097), and a perpetrator of traditional bullying (OR = 1.061; 95% CI: 1.027-1.096) in adolescents with ASD. After the effects of sex, age, and ADHD symptoms were controlled for, social anxiety increased the risk of being a victim of traditional bullying in adolescents with ADHD (OR = 1.067; 95% CI: 1.039-1.096). Social anxiety was significantly associated with several forms of bullying involvement in adolescents with ASD and ADHD and warrants being considered into prevention and intervention programs for bullying involvement.

Background: Vocational peer support (VPS) services are recovery-oriented interventions in modern psychiatric care for persons with schizophrenia. However, few VPS services are found in Taiwan. Hence, a pilot program of peer co-delivered vocational rehabilitation to support persons with schizophrenia in Taiwan was proposed and evaluated., Methods: Six peers were trained and were willing to co-lead and assist workplace problem-solving groups and care skills training in an extended vocational rehabilitation program from August 2017 to December 2018. The social support, mental health, psychiatric symptoms, and functioning of service users were assessed before and after peer co-delivered services, and the assessments were based on the following: Social Support Scale (SSS), Chinese Health Questionnaire-12 (CHQ-12), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF), and the Chinese version of the Social Functioning Scale (C-SFS)., Results: The recruited 46 service users were mostly middle-aged (49.1 ± 9.8), with 27 being male (58.7%). After interventions, 42 service users who completed the program had a significantly increased SSS score (149.1 ± 31.8 vs. 161.2 ± 35.0, df = 41, t = 2.70, p = 0.01) and subscale of friend-peer dimension (44.4 ± 12.0 vs. 53.2 ± 13.2, df = 41, t = 4.72, p < 0.001). The objective (GAF: 69.8 ± 9.8 vs. 72.6 ± 8.8, df = 41, t = 3.50, p = 0.001) and subjective social functional scores (C-SFS: 75.2 ± 8.8 vs. 78.1 ± 9.5, df = 41, t = 2.59, p = 0.01) both significantly increased. The weekly wage elevated significantly (37.5 ± 35.5 vs. 43.6 ± 38.0, df = 41, t = 2.57, p = 0.01) and the BPRS-18 score decreased significantly, too (31.2 ± 6.7 vs. 29.3 ± 5.0, df = 41, t = - 2.83, p = 0.007)., Conclusions: Peer co-delivered vocational rehabilitation services may enhance the social support received by persons with schizophrenia and improve their occupational outcomes. The pilot program proposed can thus be a model for non-Western countries with limited resources allocated by governments to support persons with schizophrenia., Trial Registration: ClinicalTrials NCT04767204, retrospectively registered on Feb 23, 2021.

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.

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: The aims of the present study were to examine the prediction of the threat and coping appraisal utilizing an extended protection motivation theory (PMT) for the motivation to have COVID-19 vaccination and the influence of various information sources on coping appraisal among university students in China., Methods: The sample comprised 3145 students from 43 universities in China who completed an online survey including PMT constructs as well as constructs added to PMT. The PMT constructs comprised motivation to have COVID-19 vaccination, threat appraisal, and coping appraisal. The extended PMT constructs comprised knowledge about mechanisms and information sources of COVID-19 vaccination., Results: Perceived severity of COVID-19 was positively associated with motivation to have COVID-19 vaccination. Receiving information concerning COVID-19 vaccination from medical personnel was associated with greater self-efficacy, response efficacy, and knowledge, whereas receiving information concerning COVID-19 vaccination from coworkers/colleagues was associated with less response efficacy and knowledge. Receiving online information concerning COVID-19 vaccination was associated with greater response cost of vaccination efficacy and less knowledge., Conclusions: This study supported the prediction of perceived severity in the PMT for motivation to have COVID-19 vaccination among university students in China. Vaccination information sources have different effects on students' coping appraisal of COVID-19 vaccination.

This study examined parent-adolescent agreement on the callous, uncaring, and unemotional dimensions of callous-unemotional (CU) traits and the differences in adolescent-reported and parent-reported CU traits among 126 adolescents with autism spectrum disorder (ASD), 207 adolescents with attention-deficit/hyperactivity disorder (ADHD), and 203 typically developing (TD) adolescents. Adolescent-reported and parent-reported CU traits on the three dimensions of the Inventory of Callous and Unemotional Traits were obtained. The strength of CU traits and the differences between adolescent-reported and parent-reported traits were compared among the three groups using analysis of covariance. Parent-adolescent agreement was examined using intraclass correlation. The results reveal that both adolescent-reported and parent-reported callousness and uncaring traits in the ASD and ADHD groups were significantly stronger than those in the TD group. Parent-adolescent agreement on the uncaring trait was fair across the three groups, whereas that on callousness was poor across all three groups. Parent-adolescent agreement on unemotionality was fair in the TD group but poor in the ADHD and ASD groups. ASD and ADHD groups had significantly greater differences in scores reported by parents and adolescents on the callousness trait than the TD group. The parent-adolescent score differences in the uncaring trait were also larger in the ASD group than in the TD group. Thus, these results support the application of a multi-informant approach in CU trait assessment, especially for adolescents with ASD or ADHD.

Background/purpose: Public debates on legalization of same-sex marriage occurred in Taiwan since the latter half of 2016. Taiwanese people voted on same-sex marriage referendums on November 24, 2018. The aim of this Facebook online study was to examine the changes in rates of poor mental health status among Taiwanese people during the 23-month period of public debates on and referendums for legalizing same-sex marriage., Methods: A two-wave internet survey was conducted using Facebook to gather information regarding mental health and attitudes toward same-sex marriage among 3286 participants (1456 heterosexual and 1830 nonheterosexul) in Wave 1 (one week after the first reading of the Marriage Equality Bill) and 1370 participants (540 heterosexual and 830 nonheterosexul) in Wave 2 survey (one week after the referendum of same-sex marriage). The five-item Brief Symptom Rating Scale was used for assessing mental health status., Results: The rate of poor mental health status significantly increased from the Wave 1 to Wave 2 surveys in heterosexual, lesbian, gay and bisexual (LGB) participants. In nonherterosexual groups, the rates of poor mental health status increased in LGB and female and male nonheterosexual participants of all age. The rates of poor mental health status also increased in heterosexual participants who were female, were young, and supported same-sex marriage., Conclusion: The rates of poor mental health status increased in both heterosexual and nonheterosexual people during the period of public debates on and the referendums for same-sex marriage. Heterosexual people who were female, were young, and supported same-sex marriage had also increased rates of poor mental health state during the same period., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Children with attention deficit/hyperactivity disorder (ADHD) are vulnerable to traumatic injuries. Parents of children with ADHD experience undesirable impacts more frequently than parents of children without ADHD. The aim of this study was to evaluate whether traumatic injuries are more prevalent in parents of children with ADHD than in parents of children without ADHD. We compared the prevalence of traumatic injuries between parents of children with and without ADHD by using data from the Taiwan Maternal and Child Health Database from 2004 to 2017. The Cox proportional-hazards regression model was used to examine differences in burn injury, fracture, and traumatic brain injury between parents of children with and without ADHD after adjustment for age, urbanicity, and income level. In total, 81,401 fathers and 87,549 mothers who had at least one offspring with ADHD and 1,646,100 fathers and 1,730,941 mothers with no offspring with ADHD were included in the analysis. The results indicated that both fathers and mothers of children with ADHD had higher risks of burn injury, fracture, and traumatic brain injury than fathers and mothers of children without ADHD. Mothers of children with ADHD had higher risks for all kinds of traumatic events than fathers of children with ADHD.

The purpose of this study is to understand the functional status distribution and to explore the factors associated with changes in functional status and social participation in people with depression using two-year follow-up data. Subjects were selected from the Taiwan Databank of Persons with Disabilities (TDPD) if they had an evaluation date between July 2012 and 31 December 2017. We used data for 1138 individuals with multiple evaluation records and who were diagnosed with depression. The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was the primary functional status measure. Other factors selected from the TDPD included social demographic data, living situation, employment status, economic status, and educational level. The results show scores in all dimensions of the WHODAS 2.0 declined over two years, especially in the domains of cognition, household activities, social participation, and total WHODAS 2.0 score. Aging groups showed poor recovery in cognition, getting along with others, and household activities. People living in suburban areas showed poorer recovery than people living in rural and urban areas in cognition, self-care, and general function (total score of WHODAS 2.0). Employment was also strongly associated with functional recovery in household activities, social participation, and general function. The original scores for cognition and getting along with others showed a significant negative relationship with social participation improvement. Our results can be used by policy makers to provide resources and conduct investigations, and by clinicians when making rehabilitation plans.

This study aimed to compare the level of attitudes toward homosexuality among nurses in Taiwan between 2005 and 2017 and with various demographic characteristics, as well as the roles of demographic characteristics in the changing trend of attitudes toward homosexuality between 2005 and 2017. This survey study recruited nurses from three hospitals in 2005 (Survey 2005, N = 1176) and 2017 (Survey 2017, N = 1519). Participants' four dimensions of attitudes toward homosexuality, including condemnation, immorality, avoiding contact, and stereotypes, were assessed using the Taiwanese version of the Attitudes Toward Homosexuality Questionnaire. The results demonstrated that nurses in 2017 exhibited lower levels of avoiding contact with lesbian and gay patients and stereotypes toward homosexuality but higher levels of condemnation of gay and lesbian individuals and perceptions of gay and lesbian individuals as immoral than did nurses in 2005. Age moderated changes in some dimensions of attitudes toward homosexuality from 2005 to 2017. The need to develop training programs aimed at improving not only the quality of nursing skills but also their negative attitudes regarding homosexuality is urgent.

The impacts of novel coronavirus disease-2019 (COVID-19) on human life continue to be serious. To control the spread of COVID-19, the production of effective vaccines is likely to be one of the best solutions. However, vaccination hesitancy may decrease individuals' willingness to get vaccinated. The Drivers of COVID-19 Vaccination Acceptance Scale (DrVac-COVID19S) was recently developed to help healthcare professionals and researchers better understand vaccination acceptance. The present study examined whether DrVac-COVID19S is measurement invariant across different subgroups (Taiwanese vs. mainland Chinese university students; males vs. females; and health-related program majors vs. non-health-related program majors). Taiwanese ( n = 761; mean age = 25.51 years; standard deviation (SD) = 6.42; 63.5% females) and mainland Chinese university students ( n = 3145; mean age = 20.72 years; SD = 2.06; 50.2% females) were recruited using an online survey between 5 January and 21 February 2021. Factor structure and measurement invariance of the two DrVac-COVID19S scales (nine-item and 12-item) were tested using confirmatory factor analysis (CFA). The findings indicated that the DrVac-COVID19S had a four-factor structure and was measurement invariant across the subgroups. The DrVac-COVID19S's four-factor structure was supported by the CFA results is a practical and valid instrument to quickly capture university students' willingness to get COVID-19 vaccination. Moreover, the DrVac-COVID19S can be used to compare university students' underlying reasons to get COVID-19 vaccination among different subgroups.

The aims of this online survey study were to examine the associations of demographic characteristics (gender, age, and sexual orientation), mental health status, and point in time of the survey (i.e., the beginning of the social debates on legalizing same-sex marriage vs. the end of the social debates) with people's perception of the attitudes of the general population in Taiwan toward homosexuality. A two-wave internet survey was conducted using Facebook to gather information regarding people's perception of the population's attitudes toward homosexuality among 4562 participants. The five-item Brief Symptom Rating Scale was used for assessing mental health status. The results indicated that participants perceived the population as having a lower acceptance at the end of the social debates on legalizing same-sex marriage than at the beginning of the social debates; gender moderated the decline in perceived acceptance. The results also indicated that poor mental health and heterosexual orientation were significantly associated with a lower perception of the population's homosexuality acceptance in both waves of the survey. The factors related to perceived homosexuality acceptance need to be considered in developing programs to increase the population's homosexuality acceptance.

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.

Coronavirus disease 2019 (COVID-19) is a novel infectious disease which has had a great impact on the public. Further investigations are, therefore, needed to investigate how the public copes with COVID-19. This study aimed to develop a model to estimate the mediating effects of risk perception and confidence on the association between perceived social support and active coping with the COVID-19 pandemic among people in Taiwan. The data of 1970 participants recruited from a Facebook advertisement were analyzed. Perceived social support, active coping with COVID-19, risk perception and confidence were evaluated using self-administered questionnaires. Structural equation modeling was used to verify the direct and indirect effects between variables. The mediation model demonstrated that lower perceived social support was significantly associated with a higher level of active coping with COVID-19, and this was mediated by a higher level of risk perception. The present study identified the importance of risk perception on the public's coping strategies during the COVID-19 pandemic.