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Background: Alzheimer's disease (AD) is associated with impairment of large-scale brain networks, disruption in structural connections, and functional disconnection between distant brain regions. A...

Objective: The cesarean section rate in Taiwan is 32%–34%, exceeding the rate that the World Health Organization considers reasonable. A doula is a trained woman who provides physical, emotional, and informational support to pregnant women before, during, and after delivery. This study investigated the effectiveness of a new doula program in Northern Taiwan. Materials and Methods: A quasi-experimental research design was employed. Two hundred and twenty women, divided into an experimental group with doula services and a no-doula control group receiving routine hospital care, participated in the present study. Participants' basic information was collected; the study tools were the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, labor pain visual analog scale, a labor timetable, and Mother's Level of Childbirth Satisfaction Rating Scale, which were distributed to participants during the postpartum hospitalization period. Results: The highest level of satisfaction was with the spouse in the control group and the doula in the experimental group. The results indicated that the childbirth process involved considerable anxiety in both groups. After delivery, the doula group exhibited a greater reduction in anxiety than the control group, but the reduction was not significant; however, a statistically significant difference was identified in the cesarean section (C/S) rate (13.0% vs. 43.2%) and normal spontaneous delivery (NSD) rate (87.0% vs. 56.8%) between the doula and control groups after controlling for the factor of primara. Conclusion: Providing continuous doula program to pregnant women requiring labor support may reduce the C/S rate and increase the NSD rate. The regression model showed that the factors including high prenatal anxiety, total time needed for doula accompaniment, and epidural and analgesics use were associated with labor women receiving C/S. The factors of continuous doula support and oxytocin use were associated with receiving NSD.

This study aimed to investigate the risk of dementia among subgroups of patients receiving concurrent antidepressant and hypnotic treatment, antidepressants alone, and hypnotics alone.Multivariate Cox proportional hazards regression models were used to determine the effects of antidepressants and hypnotics on dementia risk after adjusting for potential confounders.Compared with the reference group, patients receiving concurrent antidepressant and hypnotic treatment had the highest adjusted hazard ratio (aHR: 2.390, 95% CI: 2.224-2.536; P0.001) for all-cause dementia, followed by those receiving antidepressants alone (aHR: 1.919, 95% CI: 1.811-2.012; P0.001) and hypnotics alone (aHR: 1.458, 95% CI: 1.397-1.527; P0.001). With regard to dementia subtypes, trends similar to those for all-cause dementia were observed for Alzheimer's dementia, vascular dementia and other types of dementia. The sensitivity analysis conducted also found the robustness of findings. Notably, inconsistent findings were observed in subgroup with depression, revealing a null association between concurrent antidepressant and hypnotic treatment (aHR: 0.496; 95% CI: 0.183-1.343; P = 0.175) or hypnotics alone (aHR: 2.750; 95% CI: 0.797-9.482; P = 0.102) and the risk of dementia, and a negative association between antidepressants alone (aHR: 0.351; 95% CI: 0.130-0.942; P = 0.032) and the risk of dementia.A null or negative association was observed between concurrent antidepressant and hypnotic treatment, antidepressants alone, hypnotics alone, and the dementia risk in the subgroup of patients with depression, suggesting the absence of an association between dementia risk and antidepressants alone or hypnotics alone.

Transnational marriage-based immigrant women in Taiwan have moved to a country where alcohol use is prevalent and they face the challenge of adaptation into a new society, which could influence their drinking behavior.To describe the prevalence of alcohol drinking and examine factors associated with drinking patterns among immigrant women in Taiwan.This study was a cross-sectional questionnaire survey and data were collected from June through November in 2013. Convenience samples of 757 immigrant women were recruited across Taiwan. Alcohol use patterns during the past year were divided into abstinent, low-risk drinking, and hazardous drinking based on the Alcohol Use Disorder Identification Test. Measures included subject characteristics, exposure to cigarettes and alcohol, acculturation level, and perceived stress.The prevalence of drinking during the past year among immigrant women was 29.9% (low-risk drinking 27.6% and hazardous drinking: 2.3%). Multinomial logistic regression showed that women who were employed, who smoked, whose husbands drank, and who interacted with Taiwanese friends frequently were significantly more likely to be in the low-risk drinking group compared with the abstinent group. Women who were divorced/widowed, who had low education levels, who smoked, and whose husbands drank were significantly more likely to be in the hazardous drinking group compared with the abstinent group.More acculturation in immigrant women as indicated by working and frequently interacting with friends in mainstream society was related to low-risk drinking behavior; adversities as indicated by loss of marriage and low education level were related to hazardous drinking behavior.

Background: The aim of this study was to examine the relationship between low-income and schizophrenia among the Taiwanese population. Methods and Findings: We recruited 1,773,693 participants (15,098 low-income and 1,758,595 non-low-income individuals) from the National Health Insurance Research Database (NHIRD). Low-income individuals were identified in 2001–2003 and followed up from 2004 to 2010 to ascertain a positive diagnosis of Schizophrenia. Cox proportional hazard regression analysis was used to determine the hazard ratios (HRs) with their 95% confidence interval (CI). The attributable risk percent (AR%) was also determined. The prevalence of schizophrenia was 0.26% in non-low-income and 1.23% in low-income individuals. In the low-income group, the incidence rates were 0.71 (0.45-1.11), 3.46 (2.61-4.57), 3.22 (2.22-4.66), and 1.67 (0.97-2.87) per 10,000 person-months in men, and 0.31 (0.16-0.59), 1.85 (1.40-2.46), 1.48 (0.80-2.75), and 1.86 (0.97-3.57) per 10,000 person-months in women aged 0-17, 18-44, 45-64 and ≥65 years, respectively. Higher incidence rates were evident in the 18-64 age category of low-income individuals. The adjusted HRs were 4.06 (2.52-6.53), 6.42 (4.82-8.58), 13.03 (8.80-19.30), and 7.48 (4.22-13.28) in low-income men, and 1.87 (0.96-3.66), 4.66 (3.48-6.23), 4.02 (2.15-7.53), and 5.47 (2.79-10.72) in low-income women aged 0-17, 18-44, 45-64, and ≥65 years, respectively. The adjusted AR% of schizophrenia were 75.4%, 84.4%, 92.3%, and 86.6% in low-income males, and 46.6%, 78.5%, 75.1%, and 81.7% in low-income females of above age categories. Conclusions: Schizophrenia was more common in low-income individuals compared to their non-low-income counterparts. In the low income group, schizophrenia was more common in men than in women under 65.

The longer patients remain in a methadone treatment program, the longer they stay away from drug abuse, and the more counseling and support services they are given, which means that the treatment is more likely to be effective. We analyzed the factors associated with retention in a methadone maintenance treatment in order to predict and improve the retention rate and compliance in heroin-dependent patients. We recruited 356 patients in a methadone maintenance program at a psychiatric hospital in northern Taiwan l. Most participants were male (n=295, 82.86%), had a troubled marriage (n=287, 80.62%), had attended only elementary or junior high school (n=225, 63.20%), and had to pay their own expenses (n=255, 71.62%). Cox’s proportional hazards model was used to evaluate the association of retention rates (up to 700 days) and to analyze the potential risk factors of gender, marital status, education level, payment method, and age.

Objectives: Evidence suggests that depression is associated with a decreased trend of heart rate variability (HRV), which has been considered to be associated with unfavorable physical outcomes, and not resolved using various antidepressant medication treatments despite resolution of depression symptoms. In the present study, we intended to evaluate the effectiveness of HRV in respiratory sinus arrhythmia-biofeedback therapy (RSA-BT) on depression and HRV. Methods: We recruited 67 depressed male patients who received antidepressant or benzodiazepine treatments, received a psychological assessment, and were followed with a 3-week, 6-session RSA-BT. Results: After RSA-BT, HRV reactivity showed a significant mean decrease of 6.06 in low-frequency normal unit (p = 0.001) and 0.24 in the low-frequency/high-frequency (LF/HF) ratio (p < 0.05) and borderline but nonsignificant increase of 2.63 in HF normal unit (HFnu) during the stress task compared with those data at baseline (rest), indicating parasympathetic dominance during mental stress. At resting, post-RSA-BT showed a significant increase in LF, total power, variation (VAR), LFnu, and LF/HF (p = 0.001) and a significant decrease in HFnu (p = 0.001), indicating HRV activity increase and a shift autonomic nervous balance to sympathetic side compared to pre-RSA-BT data. Those patients also showed significant reductions in depression severity post-RSA-BT (p < 0.001) after controlling medication effect. Conclusion: The study results highlight the potential rôle of RSA-BT on the increased HRV activity with a shift sympathetic predominance at rest and decreased HRV reactivity toward parasympathetic dominance during mental stress in patients with depression, which is not related to the effects of antidepressant or benzodiazepine medication.

Major depressive disorder (MDD), the most prevalent mental disorder is a global public health issue. The aim of this study was to assess the association between low income and major depressive disorder (MDD) by age and sex. The National Health Insurance Research Database (NHIRD) of Taiwan was used to retrieve data. A total of 1,743,948 participants were eligible for the study. Low-income individuals were identified from 2001 and 2003 (specifically, Group Insurance Applicants, ie, category"51" or "52") and followed from 2004 to 2010. MDD was identified using the ICD-9-CM 296.2 and 296.3 codes. Among non-low-income individuals, the MDD incidence rates increased with age in both males and females, that is, 0.35, 0.93, 0.97, 1.40 per 10,000 person-months for males and 0.41, 1.60, 1.89, 1.95 per 10,000 person-months for females aged 0 to 17, 18 to 44, 45 to 64, and ≥65 years, respectively. Low-income females (18-44 years) and males (45-64 years) had the highest incidence of MDD, which was 3.90 and 3.04, respectively, per 10,000 person-months. Among low and non-low-income individuals, the MDD incidence rates were higher in the females than males in all age groups. Males aged 45 to 64 and 0 to 17 years had highest hazard ratios (HR) of 2.789 (95% confidence interval [CI], 1.937-4.014) and 2.446 (95% CI, 1.603-3.732), respectively. The highest HRs for females were 2.663 (95% CI, 1.878-3.775) and 2.219 (CI, 1.821-2.705) in the 0 to 17 and 18- to 44-year age groups. Low income was not found to serve as a risk factor for the development of MDD in males and females aged ≥65 years. Among the non-low-income males and females, the incidence rates of MDD were found to increase with age. Low income was found to serve as a significant risk factor for MDD only in individuals under age 65.

Aphonia induced by conversion disorder during surgery is a rare event. We report a woman 28 years of age who was undergoing a Cesarean section under epidural anesthesia. The patient sustained aphonia without detected neurologic deficits. Emergency consultations of a psychiatrist and neurologist were carried out in the operating room postoperatively. After a thorough medical and neurologic work-up, the consultative psychiatrist and the neurologist unanimously made the diagnosis of conversion disorder. Thirty-six hours after the operation, the patient's voice started to return. We venture on sharing the findings of this case with our fellow anesthesiologists in order to highlight discussion and illuminate the differential diagnosis. We have reviewed the literature and excluded an organic lesion as the culprit of the event.

The purpose of this interpretive phenomenological study is to describe the commonality of the lived experience of suicide survivors and how it influences their family relationships in Taiwan from a sociocultural perspective. Thirteen suicide survivors have participated in this study. Study results reveal that some survivors blame themselves, some blame others, and some are blamed by their family as part of their need to find a reason for the death. Consequently, family members ignore each other and treat each other as if they are invisible. These Chinese suicide survivors, unlike Western survivors, maintain their strained family connections because of strong cultural influences. Therefore, health professionals should acknowledge the experiences of living with an invisible family when supporting Chinese suicide survivors.

The purpose of this study was to determine the effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. This was a longitudinal study and sixty-eight schizophrenic patients were assigned to 8 weeks of a nicotine-patch therapy program or a control group. The generalized estimating equation analysis revealed that there were significant reductions in the subjects' nicotine dependence (Fagerstrom Tolerance Questionnaire), the number of cigarettes per day, and CO levels over an 8-week period of nicotine-patch therapy and 3-month follow-up. The point-prevalence rates of abstinence from smoking were an abstinence of 26.9% at 8 weeks and 26.9% at a 3-month follow-up. At the 3-month follow-up, the rate of continuous smoking abstinence in the nicotine-patch group was 23.1%.

Prenatal cigarette smoking exposure is not an uncommon phenomenon despite adverse publicity emphasizing its dangers. As nicotine stimulates nicotinic acetylcholine receptors, it is believed that this may disrupt the maturation of the developing brain. Several lines of evidence have accumulated to indicate that tobacco-related neurobehavioral impacts are by no means negligible. From human studies, various neuropsychiatric domains, including infant temperament, attention, externalizing behaviors, and higher cortical functions, have been examined. Although most studies have come out against smoking during pregnancy, a few studies have pointed to the fact that the epiphenomenon of smoking, rather than nicotine itself, is actually responsible for the neurobehavioral deficits or problems. Different genotypes among various candidate genes, including DAT1, DRD4, MAOA, COMT and GSTM-1, have been reported to interact with smoking to cause an adverse behavioral profile. Epigenetic approaches have also been initiated that carry us beyond the realm of genotype associations. Finally, animal studies have identified various direct neuroteratogenic effects in different regions of the developing animal brain, including neuron loss, acetylcholine receptor upregulation, diminished acetylcholinergic tone, dysregulated catecholaminergic tone, and altered intracellular signaling pathways. Notwithstanding the fact that the toxic effect that prenatal cigarette smoking exposure appears to have on neurodevelopment, there remains much to learn. Further and improved studies across all fields are encouraged in order to form a complete picture of nicotine as a teratogen, and it is hoped that this will emerge in the near future.