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Background: Many therapies are available to treat low-risk superficial basal cell carcinoma (lr-sBCC), which may complicate the shared decision-making (SDM) process. Objective: To assess the SDM process of patients and physicians when deciding lr-sBCC therapy as well as the factors that may influence the SDM process. Methods: A prospective, multicenter cohort study was conducted over 18 months, from October 2018 to April 2020, in 3 tertiary university hospitals and 1 private hospital. Results: This study included 107 patients. There was a weak positive correlation between Shared Decision-Making Questionnaire-Patient version (SDM-Q-9) and Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) (Spearman’s correlation coefficient [rs] [105] = 0.21; P = .03). Most patients (71%) chose a nonsurgical treatment after the SDM process. Patients with higher satisfaction with the SDM had lower decisional conflict and decisional regret (P 80 years had higher rates of significant decisional conflict. When evaluating treatment decisions, the highest median score for decisional conflict (22, IQR [16]; P = .01) was observed among patients who chose a surgical excision. Limitations: Patients may have self-selected to participate. Conclusion: This study suggests that some patients may prefer less invasive therapies for lr-sBCC. The SDM process may reduce decisional conflict and decisional regret.

Objective:. The aim of this study is to identify risk factors for readmission after elective esophagogastric cancer surgery and characterize the impact of readmission on long-term survival. The study will also identify whether the location of readmission to either the hospital that performed the primary surgery (index hospital) or another institution (nonindex hospital) has an impact on postoperative mortality. Background:. Over the past decade, the center-volume relationship has driven the centralization of major cancer surgery, which has led to improvements in perioperative mortality. However, the impact of readmission, especially to nonindex centers, on long-term mortality remains unclear. Methods:. This was a national population-based cohort study using Hospital Episode Statistics of adult patients undergoing esophagectomy and gastrectomy in England between January 2008 and December 2019. Results:. This study included 27,592 patients, of which overall readmission rates were 25.1% (index 15.3% and nonindex 9.8%). The primary cause of readmission to an index hospital was surgical in 45.2% and 23.7% in nonindex readmissions. Patients with no readmissions had significantly longer survival than those with readmissions (median: 4.5 vs 3.8 years; P < 0.001). Patients readmitted to their index hospital had significantly improved survival as compared to nonindex readmissions (median: 3.3 vs 4.7 years; P < 0.001). Minimally invasive surgery and surgery performed in high-volume centers had improved 90-day mortality (odds ratio, 0.75; P < 0.001; odds ratio, 0.60; P < 0.001). Conclusion:. Patients requiring readmission to the hospital after surgery have an increased risk of mortality, which is worsened by readmission to a nonindex institution. Patients requiring readmission to the hospital should be assessed and admitted, if required, to their index institution.

Andrzej Cudo,1 Natalia Kopi&sacute;-Posiej,1,2 Mark D Griffiths3 1Department of Experimental Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland; 2Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland; 3International Gaming Research Unit, Nottingham Trent University, Nottingham, UKCorrespondence: Andrzej Cudo, Department of Experimental Psychology, The John Paul II Catholic University of Lublin, Al. Rac&lstrok;awickie 14, Lublin, 20-950, Poland, Tel +48 663 817 805, Email andrew.cudo@gmail.comIntroduction: Gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. Current research primarily highlights single types of factors. Consequently, the present study simultaneously analyzed the role of individual factors, such as self-control dimensions and motives for gaming, and gaming-related factors, such as game genres, and gaming platforms in GD among female and male gamers. Additionally, the study provides a comprehensive analysis of these factors in relation to GD both cross-sectionally (Study 1) and longitudinally (Study 2).Methods: Study 1 comprised 620 active gamers (M=22.16 years; SD=2.99), and Study 2 comprised 405 active gamers (M=28.05 years; SD=4.51). The instruments used in the studies included the Gaming Disorder Test, the nine-item Internet Gaming Disorder Short-Form (IGDS9-SF), Motives for Online Gaming Questionnaire, Video Game Questionnaire, and Self-Knowledge New Sheet.Results: The results showed that GD was associated with (i) self-control deficits associated with difficulties in implementation control and taking actions related to goals without unnecessary delay, (ii) retaining information about intentions and long-term plans, (iii) refraining from immediate, impulsive behavior, and (iv) inhibiting emotional reactions. GD was also associated primarily with escape, coping, and competition motives for gaming. However, the longitudinal study showed that social, fantasy, and skill-development motives were also related to GD development over time. The action game genres associated with GD but were not very important for GD over time. The cross-sectional study results indicated a negative relationship between GD and tablets and consoles used as gaming platforms. However, the longitudinal study showed that desktop computers and consoles use as gaming platforms were associated with the GD over time. Moreover, gaming-related factors explained only 9% of the variance in the GD model among female gamers and only 10% of the variance in the GD model among male gamers in cross-sectional study. In contrast, individual factors such as self-control dimensions and gaming motivation explained 32% of the variance in the GD model among both female and male gamers.Conclusion: Individual factors, such as self-control dimensions and motives for gaming, were more important in explaining GD than gaming-related factors, such as game genres and gaming platforms. Moreover, self-control deficits and motivation related to escape, coping and competence can be important factors to consider in the prevention and treatment of GD.Keywords: gaming disorder, self-control dimensions, game motivation, game genre, game platforms

Mohsen Saffari,1,2,&ast; I-Hua Chen,3,&ast; Po-Ching Huang,4 Kerry S O’Brien,5 Yi-Ping Hsieh,6 Ji-Kang Chen,7 Yun-Hsuan Chang,8– 11 Xingyong Jiang,12 Nadia Bevan,5 Yen-Ling Chang,13 Jung-Sheng Chen,14 Ching-Chung Tsai,15,16 Mark D Griffiths,17 Chung-Ying Lin4,18– 20 1Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran; 3Chinese Academy of Education Big Data, Qufu Normal University, Qufu, People’s Republic of China; 4Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5School of Social Sciences, Monash University, Melbourne, Australia; 6Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND, USA; 7Department of Social Work, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; 8Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 10Department of Psychology, National Cheng Kung University, Tainan, Taiwan; 11Institute of Genomics and Bioinformatics, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan; 12Yangan Primary School of Qionglai City, Qionglai, People’s Republic of China; 13Department of Family Medicine, Cardinal Tien Hospital, New Taipei, Taiwan; 14Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; 15Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; 16School of Medicine, I-Shou University, Kaohsiung, Taiwan; 17International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 18Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 19Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 20Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chung-Ying Lin, Institute of Allied Health Sciences, Department of Occupational Therapy, Department of Public Health, Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701401, Taiwan, Tel +886 6 2353535 ext. 5106, Fax +886 6 2367981, Email cylin36933@gmail.com Ching-Chung Tsai, Department of Pediatrics, E-Da Hospital, School of Medicine, I-Shou University, 1 Yi-Da Road, Kaohsiung, 824005, Taiwan, Email u101130@gmail.comIntroduction: Preventative factors in young people’s physical inactivity require further understanding, including related psychosocial factors (eg, body image and weight stigma). The Tendency to Avoid Physical Activity and Sport Scale (TAPAS) is a recently developed instrument to address this issue and the present study examined its psychometric properties among Chinese university students particularly in relation to patterns across sex, physical activity (PA) level, and weight status.Methods: Using a convenience sample of 3142 students (mean age = 19.8 years; 56% female) in mainland China, data were collected using an online survey between August and October 2022. Psychometric instruments including the Weight Bias Internalization Scale, 21-item Depression, Anxiety and Stress Scale, and International Physical Activity Questionnaire Short Form were administered along with the TAPAS to assess convergent and discriminant validity. Multi-group confirmatory factor analysis (CFA) assessed the measurement invariance across specific groups.Results: The unidimensional structure of the scale was confirmed through CFA (CFI=0.995; RMSEA=0.046). All configural, metric and scalar models of invariance indicated that the scale was invariant across sex, PA level, and weight status. Acceptable convergent and discriminant validity for the scale were found.Conclusion: The TAPAS is a suitable instrument to assess body image and weight stigma concerns for avoiding physical activity and sport among Chinese university students.Keywords: confirmatory factor analysis, factor structure, psychometrics, weight stigma, young adults, China

Shun-Hua Chen,1 Po-Jen Chen,2 Chiu-Hsiang Lee,3,4 Yu-Ping Wu,3,4 Daniel Kwasi Ahorsu,5,6 Mark D Griffiths,7 Chung-Ying Lin8 1School of Nursing, Fooyin University, Kaohsiung, 83102, Taiwan; 2Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung, 824005, Taiwan; 3Department of Nursing, Chung Shan Medical University, Taichung, Taiwan; 4Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan; 5Mental Health Research Centre, the Hong Kong Polytechnic University, Hung Hom, Hong Kong; 6Department of Special Education and Counselling, the Education University of Hong Kong, Tai Po, Hong Kong; 7International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 8Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, TaiwanCorrespondence: Chiu-Hsiang Lee, Department of Nursing, Chung Shan Medical University, Department of Nursing, Chung Shan Medical University Hospital, 1253F, Jengshin Hall, Taichung, 402, Taiwan, Tel +886-4-24730022 ext. 12216, Email csha528@gmail.com Daniel Kwasi Ahorsu, Department of Special Education and Counselling, The Education University of Hong Kong, B4-1/F-13, Tai Po, Hong Kong, Email daniel.ahorsu@connect.polyu.hkPurpose: Resilience continues to be an important concept in the nursing profession due to its significant role in personal healthcare, patients’ healthcare, and leadership. The present study examined the mediating role of perceived stress in the association between mindfulness and resilience among registered nurses in order to understand their importance among those in the Taiwanese nursing profession.Materials and Methods: Between October and November 2021, a total of 816 registered nurses participated in a cross-sectional survey including psychometric measures assessing perceived stress (Chinese Perceived Stress Scale-10), mindfulness (Chinese Mindful Attention Awareness Scale), and resilience (Chinese Questionnaire of Resilience).Results: Results indicated that perceived stress mediated the association between mindfulness and resilience (standardized coefficient = 0.251, p< 0.001), although there was no significant association between mindfulness and resilience (standardized coefficient = 0.042, p=0.16). This suggests that perceived stress may function as both distress and eustress because mindfulness was not directly associated with resilience but indirectly via perceived stress.Conclusion: Nurses and their administrators should focus on different ways of coping with stress so that they become more resilient in facing other stressors. Future studies may be conducted to examine the mediating role of perceived stress in the association between other coping strategies and resilience among registered nurses.Keywords: coping, healthcare, Taiwan, cross-sectional survey, mediation analysis, mindfulness, resilience

Yin-Han Wang,1 Tsung-Ming Yang,2,3 Ming-Szu Hung,2– 4 Yu-Ching Lin,2– 4 Tien-Pei Fang,1,3 Tzu-Tzu Kuo,5,&ast; Mark D Griffiths,6 Chung-Ying Lin7– 10,&ast; 1Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chiayi, Taiwan; 2Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; 3Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; 4Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 5Division of Respiratory Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan; 6International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 7Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 8Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 10Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chung-Ying Lin, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Tel +886-6-2353535 ext. 5106, Fax +886-6-2367981, Email cylin36933@gmail.com Tzu-Tzu Kuo, Division of Respiratory Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan, Email ed101231@gmail.comPurpose: Inhaled medication adherence is an important issue for patients with chronic obstructive pulmonary disease (COPD) because adhering to inhaled medications could substantially improve their health. However, patients with COPD may not be always adhere to the prescribed inhaled medications. Therefore, understanding the underlying reasons for patients with COPD adhering to inhaled medications is important. The present study used Theory of Planned Behavior (TPB) as a theoretical framework to develop the Intention of Inhaled Medication Adherence Scale (IMAS) and assess its psychometric properties.Patients and Methods: After reviewing papers using the TPB to design psychometric scales and the TPB scale development guidelines, 28 items were generated for expert evaluation. Eight experts reported that the 28 items all had good content validity (content validity index ranged from 0.88 to 1.00 at item-level; and from 0.981 to 0.987 at scale-level) comprising four factors. Following initial development, 235 patients with COPD (mean age 73.12 years; 93.6% males) completed the IMAS via interview with a respiratory therapist and a research assistant. The four-factor structure of the IMAS was evaluated using confirmatory factor analysis (CFA).Results: Nine IMAS items were removed because of low factor loadings or offending estimates. The 19-item IMAS was confirmed as having a four-factor structure supported by the CFA results (comparative fit index=1.00; Tucker-Lewis index=1.00; root mean square error of approximation=0.00; standardized root mean square residual=0.06).Conclusion: The 19-item IMAS had satisfactory psychometric properties in construct validity. The 19-item IMAS is an instrument that could help healthcare providers understand potential factors associated with adherence to inhaled medications among people with COPD.Keywords: adherence, confirmatory factor analysis, COPD, psychometrics

Background: Ventricular assist device (VAD) use for failed stage II palliation (S2P) is increasing with limited data on outcomes. Methods: To address this knowledge gap, we conducted a multicenter retrospective review of the Advanced Cardiac Therapies Improving Outcomes Network registry. We leveraged the registry to analyze data on the clinical course, complications, and survival of systemic VADs (SVAD) after S2P. Results: We identified 34 patients from 15 centers between 2012 and 2022 implanted at median age of 1.8 years [interquartile range (IQR) 0.9-2.7]; 85% had systemic right ventricles and all patients underwent at least one sternotomy. Preimplant, all but 1 patient had an Interagency Registry for Mechanically Assisted Circulatory Support profile of 1-2, with 62% being on ≥2 inotropes, 50% total parenteral nutrition dependent, 38% mechanically ventilated, and 20% on extracorporeal membrane oxygenation in the week preceding implant. Device strategy was variable with 70% being on continuous flow devices and the remaining on pulsatile support. Multiple device strategies were utilized in 32% of patients. Median time on VAD support was 74 days [IQR 30-186]. Adverse events were frequent and included infection (47%), strokes (29%), bleeding (26%), dialysis (15%), and respiratory failure (9%). Bleeding complications (p = 0.0004), respiratory failure (p = 0.04), and multiple inotropes preimplant (p = 0.046) were associated with in-hospital mortality. Overall survival to transplant/recovery was seen in 76% and to 1-year postexplant in 56%. Conclusion: Encouraging clinical outcomes are seen with SVAD use for failed S2P even in the face of frequent adverse events and wide center variability in device strategy. Ongoing multi-institutional collaboration is required to better understand optimal SVAD support strategies.

Kuo Zhang,1 Peiyu Li,1 Ying Zhao,2 Mark D Griffiths,3 Jingxin Wang,4 Meng Xuan Zhang5 1Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, 300350, People’s Republic of China; 2Mental Health Education Center, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China; 3International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, NG1 4FQ, UK; 4Academy of Psychology and Behavior, Faculty of Psychology, Tianjin Normal University, Tianjin, People’s Republic of China; 5Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, Jiangsu, 211189, People’s Republic of ChinaCorrespondence: Meng Xuan Zhang, Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, Jiangsu, 211189, People’s Republic of China, Email zhangmengxuan@seu.edu.cnIntroduction: The increased research examining social media addiction with its negative consequences has raised concerns over the past decade. However, little research has investigated the association between social media addiction and executive functioning as well as the mechanisms underlying this relationship.Methods: Using a survey, the present study examined the association between social media addiction and executive functioning via emotional disturbance and sleep quality among 1051 Chinese young adults, aged 18 to 27 years old (M=21.02 years [SD=1.89]; 34.41% male).Results: The results showed that social media addiction had a significant negative association with executive functioning but positive associations with emotional disturbance and poor sleep quality. Structural equation modeling suggested that there was a significant direct effect between social media addiction and executive functioning. Indirect effects via two paths (ie, emotional disturbance alone, and both emotional disturbance and sleep quality) were also statistically significant.Discussion: The findings indicate that both emotional disturbance and poor sleep quality are risk-enhancing mediators in the relationship between social media addiction and executive functioning. Intervention programs (eg, emotional regulation strategies) should be considered to reduce the adverse effects of social media addiction on cognitive impairment among young adults.Keywords: social media addiction, executive functioning, emotional disturbance, sleep quality, young adults

Yu-Ching Lin,1,2,&ast; Chung-Ying Lin,3– 6,&ast; Chia-Wei Fan,7 Chieh-Hsiu Liu,8 Daniel Kwasi Ahorsu,9 Duan-Rung Chen,10 Hui-Ching Weng,3,11 Mark D Griffiths12 1Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Occupational Therapy, AdventHealth University, Orlando, FL, USA; 8Department of Geriatrics and Gerontology, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 10Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan; 11Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 12International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK&ast;These authors contributed equally to this workCorrespondence: Hui-Ching Weng, Institute of Allied Health Sciences and Institute of Gerontology, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 70101, Taiwan, Tel +886-6-2353535 ext. 5986, Fax +886-6-3028175, Email hc6127@mail.ncku.edu.twPurpose: The present study compared two nationally representative cohort datasets concerning Taiwan residents’ healthy behaviors, subjective health outcomes, generalized trust, and accessibility to health promotion resources.Patients and Methods: The Taiwan Social Change Survey (TSCS) was conducted in two waves ten years apart: 2011 cohort (n = 1021; 48.4% males) and 2021 cohort (n = 1425; 47.4%) cohorts. Descriptive statistics were calculated to compare the two TSCS datasets. Then, multiple regression models were constructed with health outcome as the dependent variable, and demographics and other key components as independent variables.Results: The 2011 TSCS cohort showed higher prevalence for cigarette smoking (30.8% vs 25.2%; p=0.002), alcohol drinking (52.5% vs 24.3%; p< 0.001), exercise habits (52.7% vs 48.0%; p=0.02), and better fruit and vegetable accessibility (Mean=3.91 vs 3.82; p=0.04). The 2021 TSCS cohort reported higher body mass index (Mean=24.20 vs 23.63; p< 0.001), less residency in urban areas (22.4% vs 31.1%; p< 0.001), better jogging accessibility (4.14 vs 4.05; p=0.006), higher generalized trust (2.26 vs 2.17; p=0.001), and greater internet usage (3.43 vs 2.89; p< 0.001). The regression model showed that exercise habits (standardized coefficient=0.20 and 0.10; p< 0.001) and generalized trust (standardized coefficient=0.11 and 0.11; p=0.004 and < 0.001) were consistently associated with health outcomes in both cohorts. Additionally, internet use (standardized coefficient=− 0.07; p=0.026) and alcohol drinking behaviors (standardized coefficient=− 0.07; p=0.0022) were negatively associated with health outcomes in the 2021 cohort.Conclusion: The present study demonstrated the trends and changes over 10 years regarding multiple health-related components among Taiwan residents. The study’s findings provide insight into education promotion programs to reduce unhealthy behaviors as well as enhancing generalized trust building and developing healthy behaviors for Taiwan residents.Keywords: health behavior, health promotion, COVID-19, Taiwan, trust

Po-Ching Huang,1 Ching-Hsia Hung,1,2 Guan-Wei Chen,3 Ciaran Cashin,3 Mark D Griffiths,4 Wen-Chi Yang5,6 &ast;, Hsiao-Wen Wang3 &ast;, Chung-Ying Lin1,7– 9&ast;, Nai-Ying Ko10 1Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Hydraulic and Ocean Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan; 4International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 5Division of Hematology and Medical Oncology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan; 6Faculty of School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 7Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 8Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 10Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chung-Ying Lin, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701, Taiwan, Tel +886 6-2353535 ext. 5106, Fax +886 6-2367981, Email cylin36933@gmail.comPurpose: The duties related to COVID-19 control and prevention may have caused psychological stress for the individuals in charge (eg, frontline government workers) and have reportedly led to mental health issues, such as insomnia and post-traumatic stress disorder (PTSD). However, the prevalence of these COVID-19-related disorders and their associated factors remain unclear. Therefore, the purpose of the present study was to investigate the prevalence rates of insomnia, PTSD, COVID-19-related self-stigma, and smartphone addiction, along with the identification of risk factors and protective factors for Taiwan frontline government workers with COVID-19 pandemic control duties.Methods: The survey was carried out with 151 participants between September and October 2021. All participants completed the Fear of COVID-19 Scale (assessing fear of COVID-19), Self-Stigma Scale (assessing self-stigma during the COVID-19 pandemic), Smartphone Application-Based Addiction Scale (assessing the risk of smartphone addiction), Insomnia Severity Index (assessing insomnia), Impacts of Event Scale-6 (assessing PTSD), and a self-designed set of questions assessing trait resilience.Results: The results showed that the prevalence rate was 31.1% for insomnia and 33.8% for PTSD. Furthermore, service duration (adjusted odds ratio [AOR] = 0.93; 95% confidence interval [CI] = 0.86, 0.999) and trait resilience (AOR = 0.19; 95% CI = 0.08, 0.46) were protective factors and fear of COVID-19 (AOR = 1.91; 95% CI = 1.02, 3.57) was a risk factor for insomnia. Fear of COVID-19 (AOR = 2.63; 95% CI = 1.35, 5.14), self-stigma (AOR = 3.62; 95% CI = 1.19, 11.02), and smartphone addiction (AOR = 1.09, 95% CI = 1.001, 1.19) were risk factors, and trait resilience was a protective factor (AOR = 0.58; 95% CI = 0.29, 1.17) for PTSD.Conclusion: The findings demonstrated a high prevalence of insomnia and PTSD. Risk-reducing strategies and protective factor promotion strategies are recommended to help reduce the symptoms of insomnia and PTSD among Taiwan frontline government workers.Keywords: mental health, insomnia, post-traumatic stress disorder, smartphone addiction, village officer

Iqbal Pramukti,1,&ast; Carol Strong,2 I-Hua Chen,3 Cheng-Fang Yen,4– 6 Ahmad Rifai,7 Kusman Ibrahim,8 Moses Glorino Rumambo Pandin,9 Hema Subramaniam,10 Mark D Griffiths,11 Chung-Ying Lin,2,12– 14,&ast; Nai-Ying Ko7,&ast; 1Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Chinese Academy of Education Big Data, Qufu Normal University, Qufu City, Shandong, People’s Republic of China; 4Department of Psychiatry, School of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, 802, Taiwan; 5Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 802, Taiwan; 6College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, 91201, Taiwan; 7Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 8Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia; 9Faculty of Humanities, Universitas Airlangga, Gubeng, East Java, Indonesia; 10Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia; 11International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 12Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 13Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan; 14Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan&ast;These authors contributed equally to this workCorrespondence: Iqbal Pramukti, Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Jl. Raya Bandung-Sumedang Km.21, Jatinangor, Sumedang, West Java, Indonesia, Tel +6222-779-5596, Fax +6222-779-5596, Email iqbal.pramukti@unpad.ac.id Chung-Ying Lin, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Tel +886-6-2353535-5106, Fax +886-6-2367981, Email cylin36933@gmail.comBackground: As the number of COVID-19 cases grows worldwide, one solution to the global pandemic is vaccination. Unfortunately, the hesitancy of receiving vaccines is still high, particularly among younger age groups (eg, students). Because the hesitancy of receiving vaccines is an important issue, instruments have been developed to assess vaccine hesitancy. Moreover, the use of these instruments among specific groups such as students is of critical importance.Aim: The present study examined the psychometric properties of the nine-item MoVac-COVID19S (also known as the DrVac-COVID19S) including its measurement invariance among university students in three different countries (ie, Taiwan, Indonesia, and Malaysia).Methods: A multi-country, web-based cross-sectional survey study was conducted among 1809 university students, recruited from the three countries from May to September 2021. The nine-item scale was translated into Traditional Chinese, Bahasa Indonesian, and Malay.Results: The results of the confirmatory factor analysis indicated that the one-factor structure of the MoVac-COVID19S was fully supported among Indonesian and Malay participants (comparative fit index [CFI] = 0.991 and 0.998; Tucker-Lewis index [TLI] = 0.997 and 0.987; root mean sqaure error of approximation [RMSEA] = 0.040 and 0.071; and standardized root mean square residual [SRMR] = 0.014 and 0.039). Moreover, the four-factor structure was supported among Indonesian, Malay, and Taiwanese participants (CFI = 0.998, 0.998, and 0.985; TLI = 0.997, 0.996, and 0.973; RMSEA = 0.044, 0.038, and 0.091; and SRMR = 0.013, 0.018, and 0.049).Conclusion: The MoVac-COVID19S has good construct validity among university students from three different countries (ie, Taiwan, Indonesia, and Malaysia). The four-factor structure of the MoVac-COVID19S was supported. Therefore, health-care providers may want to assess the four underlying constructs to better understand why a university student accepts or declines COVID-19 vaccine uptake in the three countries. Using the findings, government policymakers and health-care authorities can design appropriate programs to help decrease vaccine hesitancy.Keywords: construct validity, COVID-19, factor analysis, measurement invariance, vaccine acceptance

Zainab Alimoradi,1,&ast; Chung-Ying Lin,2– 5,&ast; Irfan Ullah,6 Mark D Griffiths,7 Amir H Pakpour8 1Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran; 2Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Kabir Medical College, Gandhara University, Peshawar, Pakistan; 7International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 8Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden&ast;These authors contributed equally to this workCorrespondence: Irfan Ullah, Kabir Medical College, Gandhara University, Peshawar, Pakistan, Email irfanullahecp2@gmail.com Amir H Pakpour, Department of Nursing, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, 55111, Sweden, Email amir.pakpour@ju.seBackground: The COVID-19 pandemic is still ongoing and is not yet under control. Evidence regarding the impacts of COVID-19 on psychological distress has been widely reported worldwide, and one of the primary concerns regarding psychological distress is fear (ie, fear of COVID-19). Therefore, having a robust instrument for assessing fear of COVID-19 is important. The present systematic review aimed to synthesize the psychometric evidence evaluated using item response theory (IRT) on the Fear of COVID-19 Scale (FCV-19S).Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four academic databases (Scopus, PubMed Central, ProQuest, and ISI Web of Knowledge) were used to search target papers. Keywords used for search were “Fear of COVID-19 Scale” and its abbreviation (ie, “FCV-19S”) and IRT-related terms. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was then applied to evaluate the methodological quality of the reviewed papers. Moreover, psychometric properties using IRT methods were synthesized using a qualitative method.Results: The initial search resulted in 552 papers (73 duplicates) and 479 were screened based on their titles and abstracts. Finally, 16 papers were included for review regarding their methodological quality (via COSMIN) to synthesize the psychometric evidence for FCV-19S. The 16 papers included 21 countries with 16 language versions of FCV-19S.Conclusion: All the psychometric evidence indicated that the seven items in the FCV-19S fit with the concept of fear. The FCV-19S is a strong and valid instrument for assessing fear across different languages. The seven items in the FCV-19S appear to be unidimensional in assessing fear, which indicates that all items are necessary in the FCV-19S.Keywords: COVID-19, fear, item response theory, psychometrics, Rasch, review

I-Hua Chen,1,&ast; Pei-Ling Wu,2,3,&ast; Cheng-Fang Yen,4– 6,&ast; Irfan Ullah,7 Sheikh Shoib,8 Shafi Ullah Zahid,9 Aadil Bashir,10 Naved Iqbal,11 Frimpong-Manso Addo,12 Emma Sethina Adjaottor,12 Gifty Boakye Amankwaah,12 Daniel Kwasi Ahorsu,13 Mark D Griffiths,14 Chung-Ying Lin,15– 18 Amir H Pakpour19 1Chinese Academy of Education Big Data, Qufu Normal University, Qufu City, Shandong, People’s Republic of China; 2School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 3Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan; 4Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; 5Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan; 6College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, 91201, Taiwan; 7Kabir Medical College, Gandhara University, Peshawar, Pakistan; 8Sheikh Shoib Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, India; 9Department of Neurosurgery, Jamhuriat hospital, Kabul, Afghanistan; 10Department of Social Work, University of Kashmir, Kashmir, India; 11Department of Psychology, Jamia Millia Islamia, New Delhi, India; 12Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 13Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 14International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 15Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 16Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 17Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 18Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 19Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden&ast;These authors contributed equally to this workCorrespondence: Emma Sethina Adjaottor; Chung-Ying Lin, Tel +233 20 816 85080 ; +886-6-2353535-5106, Fax + 886-6-2367981, Email eadjaottor.chs@knust.edu.gh; cylin36933@gmail.comPurpose: The percentage of individuals who were fully vaccinated against COVID-19 was 53% worldwide, 62% in Asia, and 11% in Africa at the time of writing (February 9, 2022). In addition to administrative issues, vaccine hesitancy is an important factor contributing to the relatively low rate of vaccination. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) was developed to assess COVID-19 vaccination acceptance levels. However, it has only been tested among Taiwanese, mainland Chinese, and Ghanaian populations (Chen et al, 2021; Fan et al, 2021; Yeh et al, 2021). Therefore, the present study examined the construct validity and measurement invariance of the MoVac-COVID19S among individuals from five countries (ie, Taiwan, mainland China, India, Ghana, and Afghanistan).Participants and Methods: A cross-sectional survey study recruited 6053 participants across five countries who completed the survey between January and March 2021. Confirmatory factor analysis (CFA) fit indices were used to examine factor structure and measurement invariance across the five countries.Results: The fit indices of the CFA were relatively good across the countries except for the root mean square error of approximation (RMSEA). Moreover, the four-factor structure (either nine or 12 items) had a better fit than the one-factor structure. However, the four-factor model using nine MoVac-COVID19S items was the only model that had measurement invariance support for both factor loadings and item intercepts across the five countries.Conclusion: The present study confirmed that the MoVac-COVID19S has acceptable psychometric properties and can be used to assess an individual’s willingness to get COVID-19 vaccination.Keywords: factor structure, vaccine hesitancy, young adults

Daniel Kwasi Ahorsu,1,&ast; Iqbal Pramukti,2,&ast; Carol Strong,3 Hsiao-Wen Wang,4 Mark D Griffiths,5 Chung-Ying Lin,3,6– 8 Nai-Ying Ko9 1Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 2Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia; 3Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Hydraulic and Ocean Engineering, National Cheng Kung University, Tainan, 701, Taiwan; 5International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 6Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 8Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chung-Ying LinInstitute of Allied Health Sciences and Departments of Occupational Therapy and Public Health, Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, TaiwanTel +886-6-2353535-5106Fax +886-6-2367981Email cylin36933@gmail.comCorrespondence: Nai-Ying KoDepartment of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, TaiwanTel +886-6-2353535-5838Fax +886-6-2377550Email nyko@mail.ncku.edu.twPurpose: The present study examined the differences between international and local university students in Taiwan regarding COVID-19-related variables, anxiety, and suicidal ideation.Participants and Methods: An online cross-sectional survey (sent via an online link in an email) was carried out comprising university students (n=529). The students were assessed on measures (including validated psychometric instruments) of perceived susceptibility to COVID-19, perceived sufficiency of resources, sources of COVID-19 information, perceived satisfaction with support, anxiety and suicidal ideation.Results: Local students had higher susceptibility to COVID-19 (p< 0.001) but decreased sufficiency with resources (p< 0.001) and anxiety (p< 0.001) compared with international students. Staying with family members, satisfaction with support, and information seeking were the factors that predicted anxiety among international students (all p-values< 0.05), while information seeking predicted local students’ anxiety (p< 0.001). Furthermore, staying with family members, susceptibility to COVID-19, and sufficiency with resources were the factors that predicted suicidal ideation among international students (all p-values< 0.05), while being a male and satisfaction with support predicted suicidal ideation among local students (all p-values< 0.05).Conclusion: International students displayed different COVID-19-related challenges compared with local students. More specifically, international students as compared with local students had lower susceptibility to COVID-19 and higher anxiety. Therefore, healthcare providers should pay more attention to international students’ psychological health and awareness regarding impacts of COVID-19 on health.Keywords: anxiety, COVID-19, university students, suicidal ideation, Taiwan

Objective:. This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice. Background:. Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally. Methods:. This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume. Results:. In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks. Conclusions:. Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks.

Israt Jahan,1,2 Ismail Hosen,3,4 Firoj al Mamun,3,4 Mark Mohan Kaggwa,5 Mark D Griffiths,6 Mohammed A Mamun3,4 1Ministry of Health and Family Welfare, Government of People’s Republic of Bangladesh, Dhaka, Bangladesh; 2Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 3CHINTA Research Bangladesh, Dhaka, 1342, Bangladesh; 4Department of Public Health and Informatics, Jahangirnagar University, Dhaka, 1342, Bangladesh; 5Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 6Psychology Department, Nottingham Trent University, Nottingham, NG1 4FQ, UKCorrespondence: Mohammed A MamunCHINTA Research Bangladesh, Savar, Dhaka, 1342, BangladeshTel +88-1738592653Email mamunphi46@gmail.comBackground: The COVID-19 pandemic-related “stay-at-home” and confinement orders has led individuals to be more engaged with technology use (eg, internet use). For a minority of individuals, excessive use can become problematic and addictive. However, the investigation of problematic internet use in the COVID-19 context is only just emerging. Therefore, the present study investigated the changes in internet use behaviors and addiction rates in comparison with prior Bangladeshi studies.Methods: An online cross-sectional study was carried out among a total of 601 Bangladeshi students between October 7 and November 2, 2020. The survey included questions relating to socio-demographic, behavioral health, online use behaviors, and psychopathological variables.Results: A quarter of the participants (26%) reported having low levels of internet addiction, whereas 58.6% were classed as having moderate internet addiction and 13% severe internet addiction. A total of 4% of the sample were classed as being at risk of severe internet dependency (ie, scoring over ≥ 80 on IAT). Risk factors for internet addiction included smartphone addiction, Facebook addiction, depression, and anxiety. However, the final hierarchical regression model comprising all variables explained a total of 70.6% variance of problematic internet use.Conclusion: Based on the present findings, it is concluded that individuals are at elevated risk of problematic internet use like other psychological impacts that have been reported during the COVID-19 pandemic. Therefore, risk-reducing measures and healthy control use strategies should be implemented for vulnerable individuals.Keywords: COVID-19 and internet addiction, problematic internet use, online use behaviors, smartphone and Facebook addiction, depression, anxiety, Bangladeshi students

Luca Cerniglia,1,2 Mark D Griffiths,2,3 Silvia Cimino,2,4 Valeria De Palo,2,5 Lucia Monacis,2,5 Maria Sinatra,2,6 Renata Tambelli41Department of Psychology, International Telematic University Uninettuno, Rome, Italy; 2Centre for Advanced Studies on Cyberpsychology and Ethics (ASPEN), University of Bari, Bari, Italy; 3International Gaming Research Unit, Division of Psychology, Nottingham Trent University, Nottingham, UK; 4Department of Dynamic and Clinical Psychology, University of Rome “la Sapienza”, Rome, Italy; 5Department of Humanities, University of Foggia, Foggia, Italy; 6Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, Bari, ItalyBackground: For a small minority of individuals, the overuse of digital technologies has been associated with negative factors, including psychological distress and psychopathological symptoms. Two technology-based addictions – internet gaming disorder (IGD) and social media addiction (SMA) – have been found to be related to comorbid disorders and impulsivity especially in adolescents and emerging adults’ populations, but results in this field are inconclusivePurpose: Using the latent profile analysis (LPA), this study identified different profiles of adolescents characterized by unique patterns of psychopathological risks, and similar levels of impulsivity, IGD, and SMA.Participants and methods: A total of 643 participants (312 males; Mage =16.02 years) were divided into three age groups (early, mid-, and late adolescence). They completed a battery of scales comprising: Internet Gaming Disorder Scale–Short Form, Bergen Social Media Addiction Scale, Barratt Impulsiveness Scale for Adolescents, and Symptom Checklist-90-R.Results: LPAs revealed distinct profiles across early, mid- and late adolescence with regards to the psychopathological variables taken into account. Specifically, only two profiles were identified in the 14–15 year age group, whereas three profiles emerged in the 16–17 year age group.Conclusion: This study highlighted that the profiles identified in each age group differed in terms of psychopathological risk (low, medium and high), showing instead similar (and non-clinical) scores in technology-based addictions and impulsivity. Results could be useful in designing prevention and intervention programs in youth showing similar patterns for technology-based addictions, but different levels of psychopathological symptoms.Keywords: internet gaming disorder, gaming addiction, social media addiction, online addictions, impulsivity, psychopathology