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Dian-Jeng Li,1– 3 Agata Chudzicka-Czupa&lstrok;a,4 Mateusz Paliga,5 Nadiya Hapon,6 Liudmyla Karamushka,7 Marta &Zdot;ywio&lstrok;ek-Szeja,4 Roger S McIntyre,8– 10 Soon-Kiat Chiang,11 Yi-Lung Chen,12,13 Cheng-Fang Yen,1,14,15 Roger Ho Chun Man16,17 1Graduate Institute of Medicine and School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; 2Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, 80276, Taiwan; 3Department of Nursing, Meiho University, Pingtung, 91200, Taiwan; 4Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland; 5Faculty of Social Sciences, Institute of Psychology, University of Silesia in Katowice, Katowice, Poland; 6Department of Psychology, Faculty of Philosophy, Ivan Franko National University in Lviv, Lviv, Ukraine; 7G. S. Kostiuk Institute of Psychology, National Academy of Educational Sciences of Ukraine, Kyiv, Ukraine; 8Department of Psychiatry University of Toronto, Toronto, Canada; 9Department of Pharmacology, University of Toronto, Toronto, Canada; 10Brain and Cognition Discovery Foundation, Toronto, Canada; 11Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 12Department of Psychology, Asia University, Taichung, Taiwan; 13Department of Healthcare Administration, Asia University, Taichung, Taiwan; 14Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 15College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan; 16Department of Psychological Medicine, National University of Singapore, Singapore, Singapore; 17Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, SingaporeCorrespondence: Cheng-Fang Yen, Department of Psychiatry, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, Tel +886-7-3121101 ext. 6822, Fax +886-7-3134761, Email chfaye@cc.kmu.edu.tw Yi-Lung Chen, Department of Healthcare Administration, Asia University, No. 500, Lioufeng Road, Wufeng, Taichung, 41354, Taiwan, Tel +886-4-23323456&num;20106, Fax +886-4-23321206, Email elong@asia.edu.twBackground: The Russo-Ukrainian War has resulted in massive social, economic, and psychological burdens worldwide. This study aimed to investigate the associations between time spent on the war-related news and psychological distress, including depression, anxiety, and post-traumatic stress disorder (PTSD) and the mediating effects of rumination on the associations in people residing in Poland and Ukraine.Methods: This cross-sectional study recruited 1438 internet users in Poland and Ukraine, and collected data on levels of rumination, psychological distress, and the amount of time spent on and sources of the news of the Russo-Ukrainian War. Structural equation modeling with bootstrapping methods was used to evaluate the mediation effect. Multivariate linear regression was used to identify predictive effect of the source of the war-related news on psychological distress and rumination.Results: The results showed a mediating effect of rumination on the association between the amount of time spent on the war-related news and psychological distress among participants in Poland (β = 0.16, p < 0.001) and Ukraine (β = 0.15, p < 0.001). Approaching the news from television was associated with rumination (β = 0.607, p < 0.001) and PTSD symptoms in Poland (β = 2.475, p = 0.009), while approaching news from the internet was associated with rumination in Poland (β = 0.616, p = 0.001).Conclusion: The study identified the mediating effect of rumination and the associations of approaching the war-related news from television and the internet with mental health.Keywords: Russo-Ukrainian war, rumination, psychological distress, mediation, time spent on the news of war

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

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

Wei-Hsin Lu,1 Yu-Ping Chang,2 Chien-Ho Lin,3 Cheng-Fang Yen4,51Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; 2School of Nursing, The State University of New York, University at Buffalo, New York, USA; 3Department of Psychiatry, Chimei Medical Center, Tainan, Taiwan; 4Graduate Institute of Medicine, Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanPurpose: To examine the prevalence of negative Facebook (FB) experiences among gay and bisexual men in emerging adulthood in Taiwan and their association with traditional harassment victimization and quality of life (QOL).Materials and methods: In total, 302 gay or bisexual men aged 20–25 years old with experience of FB use in the preceding year were recruited. We measured the types, severities, and prevalence of negative FB experiences by self-report questionnaires. Traditional harassment victimization experiences were assessed using the adapted form of Chinese-version School Bullying Experience Questionnaire (C-SBEQ). QOL was evaluated by The World Health Organization (WHO) Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). Regression analysis was used to assess respective associations.Results: Among the study participants, 26.5% reported having negative FB experiences in the preceding year. Negative FB experiences were significantly associated with victimization of verbal ridicule and relational exclusion, but not physical aggression or theft of belongings. Negative FB experiences were also significantly associated with unsatisfactory QOL in all domains except social relationships, even the effects of traditional bullying victimization were controlled.Conclusion: Negative FB experiences are closely associated with both real life victimization and QOL in gay and bisexual men. Subjective experiences on social networking sites require consideration in conception of measures to reduce bullying victimization as well as improve QOL in this population.Keywords: bullying, social networking sites, sexual minorities, well-being, negative online experiences

Dian-Jeng Li,1,2 Kuan-Shang Chung,1 Hung-Chi Wu,1 Chih-Yao Hsu,1 Cheng-Fang Yen2,3 1Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Introduction: Sleep disturbance is a major health concern for heroin users receiving methadone maintenance treatment (MMT). The present study was aimed to investigate the predictors for new-onset clinically predominant sleep disturbance (CPSD) among heroin users receiving MMT. Methods: This 2-year retrospective study included 152 individuals (127 males and 25 females) with heroin use disorder who visited our MMT clinics for the first time. A univariate Cox proportional hazards regression model (Cox model) was used to estimate the potential factors of subsequent CPSD, followed by a multivariate Cox model to identify significant predictors of CPSD after adjusting for other covariates.Results: Twenty-nine (19.1%) participants developed CPSD during the 2-year period. After forward selection in the Cox model, earlier age at onset of heroin exposure (OR=0.95; P=0.044), lower attendance rate (OR =0.04; P=0.03), greater maximum dose of methadone (OR =1.01; P=0.022), and shorter time to maximum methadone dose (OR =0.98; P=0.007) were significantly associated with new-onset CPSD.Conclusion: We identified predictors that were significantly associated with new-onset CPSD, and clinicians should be aware of sleep disturbance in heroin users receiving MMT with these risk factors. Future studies are necessary to verify our findings and extend the applicability. Keywords: MMT, new-onset sleep disturbance, heroin, CPSD

Chien-Chuan Wang,1,2 Huang-Chi Lin,2,3 Mu-Hong Chen,4,5 Nai-Ying Ko,6,7 Yu-Ping Chang,8 I-Mei Lin,9 Cheng-Fang Yen2,3 1Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Department of Psychiatry, Graduate Institute of Medicine and Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Division of Child and Adolescent Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; 5Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; 6Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Nursing Department and Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; 8School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA; 9Department of Psychology, College of Humanities and Social Science, Kaohsiung Medical University, Kaohsiung, Taiwan Objective: This study examined the differences in the current levels of depression, anxiety, and physical pain in emerging adulthood among gay and bisexual men with various experiences of traditional and cyber homophobic bullying based on gender role nonconformity and sexual orientation and the moderating effects of family and peer support.Methods: A total of 500 gay or bisexual men (age 20–25 years) in Taiwan were recruited from August 2015 to July 2017. The levels of depression, anxiety, and physical pain among gay or bisexual men who had experienced both traditional and cyber homophobic bullying (n=109), only traditional or cyber bullying (n=173), and neither traditional nor cyber bullying during childhood (n=218) were compared. The moderating effects of family and peer support on the effects of homophobic bullying victimization on depression, anxiety, and physical pain were also examined.Results: Victims of any type of homophobic bullying in childhood had more severe depression, anxiety, and physical pain in emerging adulthood than nonvictims. Victims of both traditional and cyber homophobic bullying had more severe anxiety in adulthood than victims of only traditional or cyber homophobic bullying. Family but not peer support in childhood moderated the effects of homophobic bullying victimization on current levels of anxiety and physical pain in emerging adulthood among gay and bisexual men.Conclusion: The results of the present study support that early prevention and intervention for homophobic bullying and enhancement of family support are essential to reduce mental health problems in emergent adults among gay and bisexual men. Keywords: sexual minority, homophobia, harassment, gender role nonconformity, sexual orientation

Liang-Jen Wang,1,2 Miao-Chun Chou,1 Wen-Jiun Chou,1 Min-Jing Lee,1 Sheng-Yu Lee,3,4 Pao-Yen Lin,5 Yi-Hsuan Lee,1 Yi-Hsin Yang,6 Cheng-Fang Yen2,7 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 2Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, 3Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, 4Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, 5Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 6School of Pharmacy, Kaohsiung Medical University Hospital, 7Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Objective: Both prenatal testosterone (T) exposure and postnatal T levels have been associated with developing neural circuitry and behavioral systems. This study examined the potential correlation between pre- and postnatal T levels and behavioral and neurocognitive profiles of children with attention-deficit/hyperactivity disorder (ADHD).Methods: Two hundred ADHD patients with a mean age of 8.7±2.0 years (158 boys and 42 girls) were recruited. The ratio of the length of the right index finger (2D) to that of the right ring finger (4D) (2D/4D ratio) served as a surrogate of prenatal T exposure, and postnatal T was determined using salivary T concentration. Behavioral symptoms were evaluated using the Swanson, Nolan, and Pelham – Version IV Scale for ADHD (SNAP-IV). Neurocognitive function was assessed using the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) and Conners’ Continuous Performance Test (CPT).Results: Lower 2D/4D ratios were associated with comorbid disruptive behavior disorders (t=2.15, P=0.033) in all participants. Among the boys with ADHD, neither 2D/4D ratios nor salivary T levels were associated with behavioral symptoms or neurocognitive function. Among the girls with ADHD, the salivary T level was positively correlated with the Perceptual Reasoning Index of the WISC-IV (r=0.48, P=0.001) and the Confidence Index (r=0.37, P=0.017) and Omission Errors of the CPT (r=0.62, P

The aims of this study were to compare the levels of concern over weight and dieting (COWD) among adolescents with different body weight status, gender, and age, and to examine the associations of COWD with multidimensional characteristics. Nine thousand eighty-seven adolescents completed the questionnaires. The levels of COWD were compared among the groups with different body weight status, gender, and age. The correlates of COWD in gender- and age-specified groups were examined. The results indicated that the levels of COWD varied across the groups of adolescents with different body weight status, gender, and age. Being overweight or obese, depression, and low self-esteem were associated with high COWD in all gender- and age-specified groups. A variety of socio-demographic, personal, family, peer, and school characteristics were also associated with high COWD in adolescents with specified gender and age. Gender- and age-specified intervention programs targeting adolescents with the correlates of high COWD should be considered. [ABSTRACT FROM AUTHOR]

The aims of this prospective study were to examine the predictive values of self-stigma, insight, and perceived adverse effects of medication for remission of depressive symptoms, suicidal risk, and medication adherence in patients with depressive disorders over a 1-year follow-up period. One hundred seventy-four participants who were in a state of obvious depression underwent an index interview to determine their degree of self-stigma, insight, and perceived adverse effects of medication. One year later, they were reassessed to determine the severity of their depressive symptoms, suicidal risk, and the level of the medication adherence, and their associations with the 3 possible predictors at the index interview were examined. The results of this study indicated that perceiving more severe adverse effects of medication at the index interview increased the risks of the nonremission of depressive symptoms, occurrence of suicidal ideation or attempt, and medication nonadherence in patients with depressive disorders in the 1-year period. However, the degrees of self-stigma and insight did not predict the severity of depressive symptoms, suicidal risk, or the level of the medication adherence. Based on the results of this study, we suggest that it is important for clinicians to prevent the occurrence of and to help patients manage the adverse effects of medication. We also suggest that further prospective studies are needed to examine the predictive values of self-stigma and insight for clinical outcomes and medication adherence. [ABSTRACT FROM AUTHOR]

In patients with agenesis of the vagina and cervix but with a functional endometrium, the traditional treatment is hysterectomy with construction of a neovagina. We report successful treatment by laparoscopically assisted full thickness skin graft for reconstruction in a patient with congenital agenesis of the vagina and uterine cervix concomitant with haematometra and ovarian endometrioma in a 12 year old girl. Postoperatively, the vaginal skin graft healed well, and menstruation first appeared 4 weeks later. In our opinion, a combined laparoscopic and vaginal procedure with full thickness skin graft is an efficacious alternative in managing such genital defects. [ABSTRACT FROM PUBLISHER]

Objective: This study examined the predictors of self-efficacy in reducing risky injection behaviors among heroin users receiving methadone maintenance treatment (MMT).Method: The Methadone Maintenance Treatment Outcome Study was an 18-month prospective study from March 2007 to July 2008. Data collection was conducted in the substance use disorders treatment outpatient clinics of three hospitals in southern Taiwan. A total of 368 opioid-dependent heroin users (13.6% women) were interviewed at baseline and at 3-, 6-, 9-, 12-, 15- and 18-month follow-ups. The level of self-efficacy in reducing risky injection behaviors was repeatedly assessed using the Self-Efficacy Scale for HIV Risk Behaviors. Demographic and substance use characteristics, HIV serostatus, family function, depression, and pros and cons of heroin use were collected at baseline, and methadone dosage at each follow-up interview and the duration of retention in the MMT program were also recorded.Results: The results of the generalized estimating equation indicated that a lower educational level, concurrent methamphetamine use, a younger age at first heroin use, a lower methadone dosage, a higher level of depression, and a shorter duration of retention in the MMT program were predictive of a lower level of self-efficacy in reducing risky injection behaviors.Conclusions: This study found that personal and MMT-related factors were predictive of a lower level of self-efficacy among heroin users receiving MMT. Programs implemented to promote a higher level of self-efficacy should be provided to heroin users in the MMT program. [ABSTRACT FROM AUTHOR]

A proportion of gay and bisexual men (GBM) experience worse mental health when they encounter stress from problems within the gay community. This qualitative study examined the dominant standards held in the gay community in Taiwan, the intraminority-community stress experienced by GBM, and the strategies that GBM adopt to cope with such stress. Data from open and in-depth interviews with 26 GBM were subject to reflexive thematic analysis. The results found that appearance, sexual satisfaction, wealth and social status, being a member of gay groups, and youth were valued in the gay community in Taiwan. These standards resulted in a variety of stress responses, including concerns about not fitting in, diminished self-confidence, feelings of frustration due to unattainable standards and challenges in interpersonal relationships. The strategies adopted to cope with such stress involved acceptance and adherence, passive acceptance, rational thinking and critique, mental resilience, mutual support, and efforts to question and challenge norms. Our findings can provide mental health professionals with key insights into the intraminority gay community stress and coping responses in GBM.

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

Background: The role of combination therapies for serious methicillin-resistant Staphylococcus aureus (MRSA) infections is widely debated., Methods: This retrospective cohort study included adults with MRSA bacteraemia treated between January 1, 2013, to December 31, 2022. Patients receiving combination therapy with vancomycin and ceftaroline were matched in a 2:1 ratio with those on vancomycin monotherapy based on bacteraemia source and illness severity. The primary outcome was frequency of bacteraemia recurrence. Secondary outcomes were all cause 30/90-day mortality, recurrence or mortality at 30/90 days and in hospital length of stay., Results: Of 57 patients included, 37 (65%) were in the combination group. The overall intensive care unit admission rate was 63.2% (36/57) and the Pitt Bacteraemia Score was 1 [0-4] at the time of diagnosis. The most common source of infection was endovascular/endocarditis (n = 36, 63.2%). Demographic and clinical characteristics were similar between the monotherapy and combination group of patients, except for higher body mass index (32.5 [25.5-36.4] vs. 24.4 [20.9-29], p = 0.004) and a greater immunosuppression prevalence (3 (15%) vs. 0 (0%), p = 0.039) in monotherapy group. There was no significant difference in bacteraemia recurrence (3 (15%) vs. 4 (10.8%), p = 0.7) or all-cause 30-day mortality (3 (15%) vs. 4 (10.8%), p = 0.7) between the two groups., Conclusion: The results of this study are limited by a retrospective observational design; however, combination of vancomycin and ceftaroline for MRSA bacteraemia was not associated with lower bacteraemia recurrence or mortality compared to vancomycin monotherapy., (© 2024. The Author(s).)

Exposure to war is a severe traumatic experience with disastrous mental health effects. This study examined the mental health among 5,560 residents in 11 countries worldwide at different geographic distances from the epicenter of the Russian-Ukrainian War (RUW). An online questionnaire assessed war-related variables (e.g., personal experiences with RUW, perceived concern and threat), previous life stress experiences, and mental health (i.e., resilience, anxiety, depression, perceived stress, ICD-11 PTSD, and CPTSD). Results showed regional differences. Ukrainians had the worst mental health indices, followed by participants in the bordering countries, and then by those in the distal ones. War-related variables were associated with worse mental health. The common predictors for PTSD and CPTSD were previous mental disorder, anxiety, and perceived stress, whereas unique predictors were also found (PTSD: female gender and impact of news on mental health; CPTSD: being single, overall impact of war on mental health, sum of lifetime traumatic experiences, resilience (inversely), and depression). Given the continuing uncertainty about the threat of war for many of the nations in this study, findings suggest the need for practitioners to support concerned populations., Competing Interests: Declaration of competing interest The authors have nothing to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Long COVID symptoms (i.e., experiencing symptoms of COVID-19 for 3 months post-COVID-19) affect individuals' health and their quality of life (QoL). However, the pathways through which it does so are not fully known., Aim: The present study examined the mediating roles of sleep quality, psychological distress, and self-stigma in the associations between long COVID symptoms and QoL among individuals with mental illness., Method: Individuals with mental illness (n = 333) were recruited from a psychiatric center in southern Taiwan to participate in the study. Data were collected regarding sleep quality, psychological distress, self-stigma, and QoL. Independent t-tests, Pearson correlations, and regression with Hayes' Process Macro were used to compare groups, examine relationships, and parallel mediation models, respectively., Results: Participants with long COVID symptoms had significantly worse sleep quality, psychological distress, physical QoL, and psychological QoL compared to those without symptoms. There were significant relationships between sleep quality, psychological distress, self-stigma, and QoL. Sleep quality significantly mediated the associations between long COVID symptoms and physical and social QoL. Psychological distress significantly mediated the associations between long COVID symptoms and all domains of QoL, but not self-stigma., Conclusion: There are alternative pathways (e.g., sleep quality and psychological distress) through which long COVID symptoms may affect the QoL of individuals with mental illness. The findings suggest that individuals with long COVID symptoms have a higher chance of having poor QoL. Therefore, there may be the need for counseling and possible therapy for those who contract COVID-19, especially among individuals who already have mental illness., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background: Taiwan had high cesarean rate which exceeded the recommended threshold (15%), set by WHO. However, there have not a comprehensive study to discuss the long-term offspring consequences of cesarean section (CS). This study aimed to show whether allergy disorders, obesity and respiratory infection of children are associated with modes of delivery, using the National Health Insurance Research Database (NHIRD) of Taiwan., Methods: This study used the maternal and child health database of NHIRD. We included the children who birth between 2004 and 2013 and inter-linked the database of the mother and children. The participants were followed until 2018/12/31. We performed a Cox proportional hazards model to identify the association of CS with respiratory tract infection, allergy disorder, and obesity diagnosed in childhood., Results: CS significantly increased the risk of developed childhood asthma (adjusted hazard ratio [aHR] = 1.03; 95% confidence interval [CI]: 1.02-1.03), allergy rhinitis (aHR = 1.04; 95% CI: 1.04-1.05), atopic dermatitis (aHR = 1.05; 95% CI: 1.04-1.06), respiratory tract infection (aHR = 1.07; 95% CI: 1.06-1.07) and overweight (aHR = 1.29; 95% CI: 1.18-1.40) even after adjusting with confounding factor. Development of food allergy (aHR = 1.13; 95% CI: 0.87-1.47) was not associated with cesarean section., Conclusion: This study indicated that children delivered by CS more commonly developed respiratory tract infections, asthma, allergic rhinitis, atopic dermatitis, obesity than children delivered vaginally. Among these, obesity have a stronger association with cesarean section., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Purpose: This study examined the associations of passive and active online sexual risk behaviors with perceived family relationships, impulsivity, and attention-deficit/hyperactivity disorder (ADHD)., Participants and Methods: A total of 176 adolescents with ADHD and 173 adolescents without ADHD participated in this study. The participants' parents rated their parenting style on the Parental Bonding Instrument. The adolescents self-reported their lifelong experiences of passive and active online sexual risk behaviors, perceived family relationship quality on the family domain of the Taiwanese Quality of Life Questionnaire for Adolescents, and three domains of impulsivity on the Barratt Impulsiveness Scale version 11. Multivariable logistic regression was used to examine the associations of online sexual risk behaviors with perceived family relationships, impulsivity, and ADHD., Results: Overall, 114 participants (32.7%) reported passive forms of online sexual risk behaviors, and 49 (14.0%) reported active online sexual risk behaviors. Lack of foresight and self-control was significantly associated with passive online sexual risk behaviors ( p = 0.003). Good family relationship was significantly associated with a decreased risk of active online sexual risk behaviors ( p = 0.011), whereas seeking novelty and making decisions hastily was significantly associated with an increased risk of active online sexual risk behaviors ( p = 0.048). ADHD diagnosis and inability to plan were not significantly associated with online sexual risk behaviors ( p > 0.05)., Conclusion: A high proportion of Taiwanese adolescents reported exhibiting online sexual risk behaviors. The factors related to the manifestation of these behaviors should be considered when designing relevant intervention programs.

Background: To evaluate the association between maternal MVCs during pregnancy and neurodevelopmental disorders (NDDs, including intellectual disability, ADHD, ASD, and infantile cerebral palsy) in children., Methods: This population-based cohort of live births in Taiwan was analyzed, comparing children born to mothers involved in MVCs during pregnancy with those without such exposure. Children were linked to the insurance database to identify the possible diagnosis of NDDs. The Cox proportional hazards regression model was used to estimate the relative hazards., Results: A total of 19,277 children with maternal MVCs and 76,015 children without exposure were included. Children exposed to maternal MVCs during the first two trimesters or whose mothers sustained mild to severe injuries showed a higher risk of intellectual disability. Severe maternal injuries also increased the risk of infantile cerebral palsy (aHR = 3.86; 1.27-11.78). MVCs in the third trimester, or mild maternal injuries, were associated with a higher risk of ASD (third trimester: aHR = 1.40; 1.04-1.87; mild injuries: aHR = 1.38; 1.09-1.74)., Conclusion: Children exposed to maternal MVCs with severe injuries had a higher risk of intellectual disability and cerebral palsy. Third-trimester exposure may increase the risk of ASD. However, these findings should be interpreted cautiously as genetic factors may contribute to the observed association., Impact: There is some evidence linking maternal MVCs during pregnancy to the development of neurodevelopmental disorders in children. Children of mothers with severely injured were more likely to suffer from infantile cerebral palsy and intellectual disability. The risk of autism spectrum disorder is higher in children whose mothers are involved in MVCs during the late stage of pregnancy, and there is also an increased risk of intellectual disability during the first two trimesters., Competing Interests: Competing interests The authors declare no competing interests. Ethics approval and consent to participate This study was approved by the Institutional Review Board of the National Cheng Kung University Hospital (No. B-ER-109-088)., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Objective: In this population-based cohort study, we compared the risks of incident hyperopia, myopia, astigmatism, and strabismus between children with autism spectrum disorder (ASD) and children without ASD., Methods: This study included children who were born in Taiwan at any time between 2004 and 2017. Data were collected from the Taiwan Maternal and Child Health Database. We included 20,688 children with ASD and 2,062,120 matched controls to estimate the risks of incident hyperopia, myopia, astigmatism, and strabismus. Cox proportional hazards regression models were constructed for risk assessment. The models were adjusted for sex, calendar year of birth, and gestational age at birth. Statistical significance was determined by calculating adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs)., Results: Children with ASD had higher risks of incident hyperopia (aHR: 1.78; 95% CI: 1.70-1.86), myopia (aHR: 1.27; 95% CI: 1.24-1.30), astigmatism (aHR: 1.51; 95% CI: 1.46-1.56), and strabismus (aHR: 2.18; 95% CI: 2.05-2.32) than did those without it., Conclusion: Clinicians should screen children with ASD for potential ophthalmic conditions. Further studies are required to elucidate the mechanisms underlying the associations between ASD and ophthalmic diseases. The roles of types and severities of ASD symptoms in detecting ophthalmic disease also requires further study., Competing Interests: The authors report no conflicts of interest.

Background: Higher functional connectivity within the default mode network (DMN) has been found in functional magnetic resonance imaging (fMRI) studies of major depressive disorder (MDD). We used electroencephalogram (EEG) coherence as an index of functional connectivity to examine group differences in DMN between the MDD and healthy control (HC) groups during the resting state., Methods: MDD patients with comorbid anxiety symptoms (n = 154) and healthy controls (n = 165) completed the questionnaires of depression, anxiety, and rumination. A 19-channel EEG recording was measured under resting state for all participants. EEG coherences of the delta, theta, alpha, beta, and high beta in the anterior DMN (aDMN), posterior DMN (pDMN), aDMN-pDMN, DMN-parahippocampal gyrus (PHG), and DMN-temporal gyrus were compared between the two groups. The correlations between rumination, anxiety, and DMN coherence were examined in the MDD group., Results: (1) No difference was found in the delta, theta, alpha, and beta within the DMN brain regions between the two groups; the MDD group showed higher high beta coherence within DMN brain regions than the HC group. (2) Rumination was negatively correlated with theta coherence of aDMN, and positively correlated with beta coherence of aDMN and with alpha coherence of pDMN and DMN-PHG. (3) Anxiety was positively correlated with high beta coherence of aDMN, pDMN, and DMN-PHG., Conclusions: MDD patients with comorbid anxiety symptoms exhibited hypercoherence within the DMN brain regions. Hypercoherences were related to symptoms of rumination, and anxiety may be a biomarker for MDD patients with comorbid anxiety symptoms., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)