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To examine the associations of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam, a country experiencing rapid economic growth.A cross-sectional study was conducted in a high school in northern Vietnam from July to September 2019. Symptoms of depression and anxiety were respectively assessed using the Center for Epidemiological Studies Depression Scale and the Vietnamese Anxiety Scale. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Internet use and demographic characteristics were obtained using structured questionnaires. A multiple logistic regression was performed.In total, 678 participants with an average age of 16.1 (standard deviation 0.9) years were included. Nearly one-third of the adolescents (30.7%) exhibited excessive internet use (4 h/day), 19.6% experienced depressive symptoms, 14.5% presented anxiety symptoms, and 58.8% reported poor sleep quality. Compared to non-excessive internet users, excessive internet users (4 h/day) experienced significantly higher levels of depressive symptoms (p = .001), anxiety (p = .008), and poorer sleep quality (p.001). Students who were female and with fair/poor self-rated health experienced higher depression, anxiety, and poor sleep quality (p.05). After adjusting for demographic and health-related factors, students with excessive internet use were 58% more likely to experience poor sleep quality (odds ratio, 1.58, 95% confidence interval [1.06, 2.35]).Excessive internet use in Vietnamese high school students was significantly associated with poor sleep quality, but not with depression or anxiety.

Background Suicide remains the second leading cause of death among youths. Family-related factors are considered important determinants of children's suicidal ideation, whereas their short-/long-term influence is seldom quantified. Aims We aim to confirm the simultaneous/lagged effects of family-related factors on the occurrence of recent suicidal ideation from childhood to young adulthood (aged from 10 to 22 years old). Method Data were derived from a longitudinal prospective cohort study. Participants included 2065 students who were followed up for 13 years. Generalized estimating equations were used to clarify the influential effects of family-related factors on suicidal ideation during the past month. Results The peak of the rate of recent suicidal ideation arrived during junior high school years. Family interaction, family support, family involvement, and parental punishment had simultaneous effects on recent suicidal ideation. Family involvement, parental conflict, and psychological control had lagged and lasting effects on suicidal ideation. Notably, the lasting protective effects of family involvement were more obvious than simultaneous effects. Conclusions Providing parents with sustained support and education to improve their "positive parenting literacy" can help with their children's mental health development. This is especially the case during COVID-19 quarantine periods when families spend the most time together at home.

Purpose The aim of the study was to examine if brisk walking is an effective physical activity for promoting adolescents' mental health. Design and methods This quasi-experimental study employs a one-group repeated-measure design. Sixty-four volunteer students in 10th to 12th grade were recruited from a high school in central Taiwan, and they participated in a brisk-walking program for 12 weeks. Psychological functioning was measured by self-concept, anxiety, and depression scores (Beck Youth Inventories-Second Edition; BYI-II). Measurements were conducted at baseline, and 4, 10 and 16 weeks after baseline. The effects of the program were analyzed using generalized estimating equations (GEE). Results Significant decreases were seen in anxiety and depression and an increase in positive self-concept. The effect of physical activity on anxiety was clear and could be observed after 6 weeks of the brisk-walking program. Brisk walking for 30-, 60-, and 90-min sessions was examined, with the 60-min session proving more effective than shorter or longer sessions. Conclusions The results suggest that a 12-week brisk-walking program may be effective both at decreasing depression and anxiety and at improving self-concept. The study also showed that anxiety could be considered a risk factor for depression. Further, self-concept was found to be a mediator acting on the psychosocial mechanism of physical activity promoting mental health in adolescents. Practice implications While most physical activity programs in past studies combined different activities, the present study demonstrated that brisk walking alone is a simple, effective exercise regime that promotes adolescents' mental health.

Background Hypertension increases the likelihood of cardiovascular diseases (CVDs). Cytochrome P450 1A2 (CYP1A2) single nucleotide polymorphism (SNP) is related to caffeine metabolism and the risk of CVD among coffee drinkers. CYP1A2 rs762551 influenced the risk of stroke among hypertensive patients. We examined the relationship between hypertension and coffee drinking based on CYP1A2 rs762551 SNP in Taiwanese adults. Methods We used data contained in the Taiwan Biobank database (2011–2018) and included 19,133 participants having complete information on hypertension, rs762551 polymorphism, coffee intake, etc. The risk of hypertension was determined using multiple logistic regression. Results Coffee intake was significantly associated with a lower risk of hypertension. The odds ratio (OR), 95% confidence interval (CI), and p-value were 0.877, 0.807–0.954, and 0.0032, respectively. CYP1A2 rs762551 was not significantly associated with the risk of hypertension, but it had a significant interactive association with coffee drinking (p value = 0.0303). After stratification by rs762551 genotypes, the inverse coffee drinking-hypertension association was retained, but significant results were observed only in those with the AC + CC genotype (OR 0.678, 95% CI 0.722–900, p value = 0.0001). According to the combination of coffee drinking and rs762551 genotypes (reference group: no coffee drinking and rs762551 AA), the coffee drinking-AC + CC group had a lower risk of hypertension (OR 0.888, 95% CI 0.789–0.999, p value = 0.0483). Conclusion Coffee drinking, particularly among individuals with the CYP1A2 rs762551 AC + CC genotype was associated with lower odds of hypertension.

Background Immigrant women in Taiwan experience a variety of acculturative and marital problems that result in a mental-health problems. We examined the mediational effect of marital adjustment on the relationship between acculturation and depressive symptoms in immigrant women in Taiwan. Methods All participants (N = 127) were interviewed to collect data regarding their basic sociodemographics, depressive symptoms, acculturation (using language proficiency and years in Taiwan as indicators), and marital adjustment. We used a Sobel test to examine how marital adjustment mediates the relationship between acculturation and depressive symptoms. Results Our results indicated that an increased length of residency exacerbated depressive symptoms (β = 0.62, p = 0.03) and that this relationship contributed, in part, to the mediational effect of marital adjustment. That is, marital adjustment deteriorated with the length of residency (β = − 0.26, p = 0.0013), resulting in the development of depressive symptoms (β = − 0.95, p = 0.0013). Conclusion Although the duration of residency may be useful as a proxy for acculturation in the assessment of some health outcomes, our findings imply that it is better to conceptualize it as a cumulative stress when considering the mental health of immigrant women. Marital maladjustment acts as a mediator in this relationship. As such, it is important to provide immigrant families with programs and resources to assist them in adapting to their marriages and to improve the mental health of immigrant women.

In recent years, children living in the downstream of the Choshui River in Taiwan have been exposed to violent dust episodes. For the sake of the health of these children, we aimed to investigate the effectiveness of protective equipment (sand-proof plastic cover and air purifier) installed outside/inside the classrooms on students’ pulmonary function and evaluate the health education program for preventing the adverse consequences of exposure to river-dust episodes. Public elementary school students in Yunlin County, which was severely affected by river-dust, were selected as the participants. Study 1 consisted of three-wave follow-up data (801 person-times) in high-/low-dust exposure regions to examine pulmonary function. Study 2 used 147 and 73 students in the high-/low-dust exposure regions, respectively, to establish our health education intervention. Paired t tests, repeated measures ANOVA, and generalized estimating equation were used to analyze the short- and long-term effects. The results showed that the students’ pulmonary function in schools that installed protective equipment was improved. The health education (such as the usage of correct masks and our designed PM2.5 full-cover sand-proof clothing) improved the students’ cognition and behaviors related to river-dust episodes and yielded both short- and long-term effects. Therefore, we suggest more schools with high-dust exposure to adopt protective equipment and health education program. Our designed PM2.5 full-cover sand-proof clothing can prevent from not only haze but also droplet transmission by infectious diseases such as COVID-19.

Background: Studies have confirmed that long-term use of ketamine can cause cystitis and cognitive deficits, but it remained unclear whether or not psychotic symptoms were induced as well. Therefor...

Few studies evaluating the relationship between depression and exercise consider peoples’ socio-demographic characteristics. This cross-sectional study investigated the interaction between exercise and marital status and depression in Taiwanese adults. Data from the 2-item Patient Health Questionnaire (PHQ-2) was recruited from the Taiwan Biobank. Participants indicated their exercise status, showing 5015 no-exercise cases and 3407 exercise cases. Marital status, including unmarried, divorced or separated, and widowed, were all significant, especially among the no-exercise group. The relationship between exercise/no exercise and marital status was examined; no exercise and unmarried, divorced or separated, and widowed, as well as exercise and married were significant to PHQ-2. Gender was significant in both the married and unmarried groups. The association between exercise, marital status, gender, and education on PHQ-2 score was also significant. Married people, especially men, had lower depression scores. Additionally, exercise had a protective effect against depression for unmarried people, especially women.

Background: Southeast Asian countries have long been considered epidemic areas for mosquito-borne diseases (MBDs), and most imported cases of infectious diseases in Taiwan are from these areas. Taiwanese migrant workers are mainly of Southeast Asian nationality, and of these, 22% are Filipino. Migrant workers’ knowledge of MBDs and self-protection behaviors are beneficial to disease prevention and treatment. This study aims to understand the effectiveness of a health education intervention (HEI) for Filipino migrant workers in Taiwan and explores the factors affecting preventive practices. Methods: The study was conducted between May to September 2018. Participants were recruited from two Catholic churches in Taichung City. A professional delivered a 30 min HEI in person, and a structured questionnaire was used to acquire and assess participants’ knowledge, health beliefs, and preventive behaviors for MBDs before and after the intervention. Results: A total of 291 participants were recruited. The intervention program showed a positive impact on the migrant worker’s knowledge and the perceived severity, perceived benefits, perceived barriers, and preventive practices. Knowledge, perceived severity, and perceived barriers were factors influencing preventive practices in Filipino migrant workers. Conclusions: The results of this study demonstrated that we can direct our efforts towards three areas: improving foreign migrant workers’ awareness of diseases, emphasizing the severity of the disease, and eliminating possible hindrances in the future. As one example, migrant workers could be proactively provided with routine medical examinations and multilingual health education lectures to improve knowledge and preventive practices to contain the spread MBDs.

Background The different profiles of e-cigarette users in different age groups have seldom been investigated, particularly in populations facing a high prevalence of cigarette smoking. This study aims to examine the prevalence and correlates of e-cigarette use separately for adolescents and adults in nationally representative samples in Taiwan. Methods Among 17,837 participants in the 2014 National Survey of Substance Use in Taiwan, 4445 were aged 12 to 17 years and 13,392 were aged 18 to 64 years. Individuals' lifetime tobacco use was divided into four groups: non-use, exclusive e-cigarette use, exclusive cigarette use, and dual use. Questions on sociodemographic features, use and problematic use of tobacco, alcohol, and other drugs, and psychosocial distress, among others, were administered using a computer-assisted self-interview on tablet computers. Results Among lifetime users of e-cigarette (2.2% for adults and 0.8% for adolescents), 4.5% for adults and 36.6% for adolescents were exclusive e-cigarette users. From use of exclusive e-cigarettes to use of exclusive cigarettes to dual use, those usage groups were related to an increasing trend of adjusted odds ratios for use of other psychoactive substances, particularly problematic use of alcohol or drugs, and with more depressive symptoms. Two correlates were specific to e-cigarette use: alcohol use had stronger relationships with e-cigarette use among adolescents, and younger adults (18-34) were more likely to try e-cigarettes compared to older adults. Conclusions These results provide essential information regarding e-cigarette use in the general population, and future prevention strategies should account for its specific correlates in young people.

Introduction: Directly Observed Treatment Short course (DOTS) is one of the most cost-effective approaches for TB treatment. However, TB incidence rates remain high in the mountain areas of Taiwan. A lay health advisor (LHA) strategy is integrated into DOTS as an Enhanced-DOTS (E-DOTS) to provide trustworthy, culturally-specific services in mountain areas that consider the characteristics of local ethnic groups. Methodology: We recruited two Taiwanese indigenes as LHAs (one for each county) to screen close contacts in five townships of Hualien and Nantou counties from January 1, 2011 to December 31, 2013. Incidence and active finding rates of TB during the E-DOTS periods (2011-2013 for Hualien and 2012-2013 for Nantou) were compared with data when traditional DOTS was implemented (2006-2010 for Hualien and 2006-2011 for Nantou) to evaluate the effectiveness of E-DOTS using the before-and-after study design. Results: Incidence rate in Hualien decreased from 393.3 in 2011 to 235.7 in 2013 per 100,000 population and from 338 in 2012 to 235.5 in 2013 in Nantou mountain area. Furthermore, the active case finding rate increased from 15.42% in 2012 to 27.38% in 2013 as compared to an average of 6.5% for CDC, Taiwan, for the specified years. TB treatment success rates were significantly improved from an average of less than 80% to an average of higher than 90% after E-DOTS was implemented. Conclusions: Our findings highlighted that the use of LHAs in E-DOTS is an effective and applicable strategy for controlling tuberculosis in the mountain areas of Taiwan.

Background: Immigrant women in Taiwan experience a variety of acculturative and marital problems that result in an inequity of mental health. This study examined the mediational role of marital adjustment on the relationship between the acculturation and depressive symptoms of immigrant women in Taiwan.Methods: All the participants (N = 127) were interviewed to collect data regarding their basic sociodemographics, depressive symptoms, acculturation (using language proficiency and years in Taiwan as indicators), and marital adjustment. The correlation between the various variables was calculated by Pearson correlation coefficients and a Sobel test was used to examine the mediational effect of marital adjustment between acculturation and depressive symptoms.Results: Results from the Sobel test indicated that the length of residency alleviated depressive symptoms (β = -0.62, p = 0.03) and marital adjustments have a mediational effect on the relationship between years in Taiwan and depressive symptoms.Conclusion: Marital adjustment deteriorates with the length of residency, thereby causing the occurrence of depressive symptoms. Findings suggest providing immigrant families with programs and resources to assist them in adapting to their marriages and enhance the mental health of immigrant women.

PM10 exposure has been found to have significant effects on a variety of physical conditions. However, whether it acts on psychopathology remains unclear. This study used 8-year data to examine the relationship between PM10 concentration and daily clinic visits of anxiety disorders. All residents of Yunlin County, Taiwan, which is a high river-dust exposure area, were selected as subjects. Data from the Taiwan National Health Insurance Research Database (NHIRD), 2002–2009, were analyzed. Individuals with any ICD code of 300.0 and 300.2 were categorized as with anxiety disorders. PM10 data were based on the Lunbei station (located at Yunlin County) of EPA, Taiwan. Time-series analysis showed that, during the observed 8 years, the number of daily clinic visits for anxiety disorders increased with PM10 levels, and the relationship remained significant after unemployment rate, and the Weighted Price Index of Taiwan Stock Exchange in the same period were controlled for. In particular, we found that there is a linear dose-response effect between daily clinic visits and PM10 levels when PM10 300 μg/m3. Findings from this study highlight that high level of PM10 exposure derived from severe weather or environment condition may affect the occurrence of anxiety disorders. In addition, there seems to have a threshold of PM10 in elevating the risk of anxiety disorders.

This meta-analysis was conducted to assess differences in a child's health-related quality of life (HRQOL) as reported by the child and their parents using the Pediatric Quality of Life InventoryEight studies encompassing 16 independent groups met the inclusion criteria and were combined and compared in this meta-analysis. Fixed effect analysis was applied in the subgroup analysis to compare differences between children with ADHD and those with typical development.Small to moderate magnitudes of parent-child discrepancies were found in the ratings of the children's HRQOL both in those with ADHD (g = -0.23 [-0.33, -0.13], p 0.001, physical HRQOL; g = -0.60 [-0.71, -0.48], p 0.001, psychosocial HRQOL) and in those with typical development (g = -0.27 [-0.31, -0.23], p 0.001, physical HRQOL; g = -0.29 [-0.33, -0.25], p 0.001, psychosocial HRQOL) except for emotional HRQOL in children with typical development (g = 0.003 [-0.04, 0.04], p = 0.90). The parent-child discrepancy in rating the child's psychosocial HRQOL was significantly larger in the children with ADHD than in those with typical development.This meta-analysis suggests that a child's HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports. Parent-child discrepancies, especially in psychosocial HRQOL, and sources of discrepancy need to be addressed when assessing the child's HRQOL and planning interventions in children with ADHD. Implications for Rehabilitation Parents reported a significantly worse health-related quality of life of their children than both the children with attention deficit hyperactivity disorder and those with typical development. A child's health-related quality of life needs to be assessed both by parent proxy and self-reports of the children. Children with attention deficit hyperactivity disorder and those with typical development differed significantly in parent-child discrepancy in child's psychosocial health-related quality of life, but not in physical health-related quality of life. Parent-child discrepancies, especially in psychosocial health-related quality of life, and sources of discrepancy (e.g., child, parent or family characteristics) need to be addressed when assessing the child's health-related quality of life and planning interventions in children with attention deficit hyperactivity disorder.

Background This study examined variation between users of ‘club' and ‘hard' drugs in Taiwan in terms of prevalence of use and demographics and psychosocial characteristics. Methods Data were derived from a survey of 17,837 Taiwanese civilians, aged 12–64 years, using stratified, multi-stage, random sampling. Participants completed a computer-assisted self-interview on tablet computers which covered use of legal substances, sedatives/hypnotics and prescription analgesics; use of illicit drugs/inhalants, risky sexual experiences; expectations of drugs; and psychological distress. Findings Approximately 1.29% of respondents reported ever using an illicit drug in their lifetime; prevalence estimates of club drugs (mainly ketamine, marijuana, and ecstasy) were slightly higher than hard drugs (mainly methamphetamine and heroin). Concurrent use of legal substances, particularly problematic use of alcohol and tobacco, as well as non-medical use of prescription drugs, were strong correlates of illicit drug use in general, with club drug use exhibiting an extremely strong association with alcohol use. Club drug users were demographically different from hard drug users, including in terms of their gender, age, and level of educational attainment. They were also more likely to be divorced or widowed, to report risky sexual partnerships and more depressive symptoms than hard drug users. Conclusions Our findings indicate drug type specific distinct psychosocial characteristics, which may warrant further attention in the design of treatment and intervention programs.

Morningness/eveningness (M/E) preference is an important circadian rhythm indicator with strong individual variation. M/E chronotype has been found to be correlated with depression in adults, yet the relationship is less clear in children and adolescents. Additionally, poor sleep quality is another commonly studied risk factor for depression. The aims of the present study are to investigate the independent effects of M/E chronotype on youth depression using both self-report and parental-report questionnaires. We also evaluated how poor sleep quality may affect the relationship through a mediating or moderating effect. In total, 2,139 students attending grades 1 to 7 participated in this study. They completed questionnaires regarding M/E chronotype, depression, and sleep quality. A total of 1,708 parents also participated and filled out parental-reports of emotional and behavioral problems of their children. The prevalence of self- and parental-report depression was 16.8% and 12.8% among young students, respectively. Overall, 15.4% of the students were the eveningness type. Being an eveningness type was independently associated with self-report depression after adjustment for poor sleep quality (OR = 1.86, 95% CI = 1.07-3.24). We also observed that poor sleep quality mediated the influence of M/E chronotype on self-report depression among students aged 7-13 years (p0.001). On the other hand, being an eveningness type was associated with a number of parental-report emotional and behavioral problems in the students, in addition to depression, although these associations become non-significant after adjusted for poor sleep quality. Our results demonstrate the importance of M/E chronotype on youth depression and poor sleep quality partly mediates this effect.

This study aims at determining the level of depression and suicidal status of adult HIV test-seekers. Of the total enrolled 850 males, almost 50% reported some risk behaviors, 38.9% experienced depression, and 7.2% had suicidal ideation. Subjects with risky sexual behaviors in terms of repeated HIV test, had a history of sexually transmitted disease, engaged in one-night stands, or did not use condoms all the time with causal sexual partners were more likely to have depression. Furthermore, subjects who were bisexual/homosexual, engaged in Internet sex, engaged in one-night stands, or used addictive drugs within the past 6 months were more likely to experience suicidal ideation. The HIV testers are at risk of experiencing depression and suicidal ideation; each is associated with different types of risky sexual behaviors. It is essential for the health authority to further provide mental health services for HIV testers and to draw up an effective strategy in reducing unprotected sexual behaviors.

Nonmedical prescription drug use (NMPDU) has become a major public health issue but little is known in Asian populations. This study aimed to investigate the prevalence and correlates of NMPDU in Taiwan. Participants from the 2014 national survey of 17,837 individuals, aged 12 to 64 year, completed anonymously a computer-assisted self-interview. Past-year prescription drug use was divided into medical use only (MUO) and nonmedical use (NMU), defined as using the drug without a prescription, or more frequently, or in larger doses than prescribed. Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT), problematic drug use using the 20-item Drug Abuse Screening Test (DAST), and depressive symptoms using the Center for Epidemiological Study-Depression (CES-D). The prevalence of past-year NMU was 3.02% for analgesics, 0.71% for sedatives/hypnotics, and 3.66% for either drug, with a very small overlap of NMU between analgesics and sedatives/hypnotics (0.07%). When individuals with NMU were compared to those without NMU (Non-NMU) and those with MUO, respectively, some correlates consistently identified, including young adulthood, tobacco smoking, alcohol drinking, and greater AUDIT's scores for analgesics, as well as hard drug use and greater DAST's scores for sedatives/hypnotics. NMU was associated with greater CES-D's scores for both analgesics and sedatives/hypnotics when compared to Non-NMU but not to MUO. Robust correlates of NMPDU could offer implications for development of prevention strategies of NMPDU. Keywords: Nonmedical use, Sedatives/hypnotics, Analgesics, Substance use, Illicit drug

Background Taiwan government has promoted the administration of a hepatitis A vaccine at public expense for high-risk groups as a preventive measure after the outbreak of hepatitis A virus (HAV) infections in 2015. The aim of this study was to evaluate the efficacy of such vaccination policy in patients with human immunodeficiency virus (HIV). Methods: From January 2016 to July 2017, we enrolled 658 HIV-positive male participants. Participants were stratified into anti-HAV-positive (n = 165) and anti-HAV-negative (n = 493) groups. A total of 364 anti-HAV-negative patients received vaccination against HAV and were followed up for 1.5 years. A Cox regression model was used to estimate the effects of factors predicting positive anti-HAV detection after vaccination. Results: Patients with HIV had an anti-HAV-positive prevalence of 25.1% before vaccination. Of the 364 patients inoculated with the first dose of vaccine, 58.0% received the second dose. Seroresponse rates were 50.0% and 80.6%, respectively. Antibody production was 30.0% lower in patients with a CD4 T-cell count

In this study we examine whether there is healthy immigrant effect among women immigrated to Taiwan through transnational marriage. A sample of immigrant women (N = 246) with original nativity of Southeast Asian countries and Taiwanese-born women sample (N = 201) was recruited from December 2008 to December 2009. Their depressive symptoms, acculturative stresses and family functioning were assessed by a series of questionnaires. Immigrant women had lower depressive scores than their native-born counterparts when other potential confounders were controlled for in the multiple regression model. Our findings suggest that the healthy immigrant effect exists among immigrant women in Taiwan. Although such effect may due to immigrant women is a highly selective population with hardy mental characteristics, it is crucial to improve immigrant women's mental health by helping them to enhance the ability of expressing emotions between family members as well as by mitigating socioeconomic inequality of cross-cultural immigrant families.

Three exposure groups (high exposure, low exposure, and control), using six elementary schools in Yulin County, were selected to study the impacts of aeolian river-dust on school children’s exposure to PM10 and associated metals. One classroom and about five school-aged children’s houses for each school were chosen to collect indoor PM10 during the river-dust episodes (RDEs) and non-river-dust episodes (NRDEs). The results indicated that the river-dust episodes had significant impacts on the school-aged children’s exposure to concentrations of PM10 and metals, especially in the high exposure group. For the Ni and Mn metals, the 8-h school exposure concentrations during RDEs were both higher than the standards suggested by the California Environmental Protection Agency. Three interventions for protecting school children from being affected by the river dust during RDEs are suggested in this study. Among the three interventions, children who have a day off of school during RDEs can result in the greatest decrease in the exposure levels of PM10 and associated metals.

This study aimed to explore the extent of association between the classes and patterns (single vs. multiple) of drug use and the psychiatric disorders among recently incarcerated male drug users to help formulate drug policies for correctional facilities and provide adequate treatment for incarcerated drug users. Data were recruited from 414 male first-time incarcerated illicit drug users in one detention center in Taiwan. Their lifetime historical profiles of illicit drug use were then assessed and their associations with current psychiatric disorders were compared with 257 community controls. Heroin and meth/amphetamine were the most commonly used drugs among single and combined users. Heroin users were more likely to exhibit major depression and social phobia; meth/amphetamine users showed more psychotic disorder and antisocial personality disorder than community controls. Multiple drug users were associated with two-thirds of the psychiatric disorders. This study suggests that heroin and meth/amphetamine users require specific treatments, which may effectively address associated psychopathologic conditions. Interventions for mental disorders for some detainees are also recommended.

Attention deficit hyperactivity disorder (ADHD) is a prevalent developmental disorder that seriously and negatively impacts a child's health-related quality of life (HRQOL). However, no meta-analysis has been conducted to examine the magnitude of impact, domains affected and factors moderating the impact. This review included nine studies that compared HRQOL of children or adolescents with ADHD with those with typical development using both child self-reports and parent proxy-reports. Seven among nine studies were meta-analytically synthesized to examine the degree of impact of ADHD on children and adolescents, parent-child discrepancy, and the moderators. The results indicate that ADHD impact a child's or adolescent's HRQOL negatively with a moderate effect in physical and a severe effect in psychosocial (i.e., emotional, social, and school) domains. Parental ratings of overall HRQOL in children or adolescents with ADHD were not significantly different from child's ratings when compared with typically developing children and adolescents. Age was negatively associated with all domains of HRQOL in children and adolescents with ADHD both by parent- and child-ratings, and the strongest effect was found in parental ratings of child's emotional HRQOL, with a moderate correlation. This meta-analysis suggests that HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports, and that interventions may be planned accordingly. Future meta-analysis may explore how measures of HRQOL and other factors including child, parental, familiar and school characteristics influence the impact of ADHD and the parent-child agreement in children and adolescents.

To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD). We conducted a matched case–control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD. 277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings. Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.

Background: Worldwide, smoking is a major public health problem, with exposure to environmental tobacco smoke (ETS) affecting both smokers, and passive smokers, including children. Despite ETS also describing secondhand, and thirdhand smoke (SHS, and THS respectively), the health effects of exposure to passive smoking via these sources are not fully understood, particularly in children. Although cotinine, the primary proximate metabolite of nicotine, has been widely used as a biomarker of ETS exposure, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), the metabolite of the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), provides a uniquely important contribution, both as a biomarker of exposure, and as a specific risk indicator for pulmonary carcinogenesis. Methods: We used LC-MS/MS to study NNK metabolites, cotinine, and 8-oxo-7,8-dihydro-2′-deoxyguanosine (a biomarker of oxidative stress), in the urine of 110 non-smoking adults (age range: 23–62) and 101 children (age range: 9–11), exposed to ETS. Results: In our study of passive smoking adults, and children exposed to ETS, we showed that although the children had a similar urinary level of cotinine compared to the adults, the children had approximately two times higher levels of urinary total NNAL (P = 0.002), and free NNAL (P = 0.01), than adults. The children also had three times lower ability to detoxify NNK than adults (P

Suicide is a major threat to adolescent health. Sleep problems increase the risk of adolescent suicidal behavior, but the role of sleep-disordered breathing (e.g., sleep apnea) is unclear. We investigated whether sleep apnea had an effect on suicidal ideation that was independent of depression and perceived stress. We examined a series of sleep variables with suicidal ideation in 746 fifth and seventh graders using self-reported questionnaires to assess time in bed, sleep quality, insomnia, and sleep apnea while controlling depression and perceived stress. Overall, 8.8% of students aged 10–14 years reported having recent suicidal ideation, and 33% or 3.8%, depending on the screening criteria, reported having suspected sleep apnea. The sleep variables were all associated with an increased risk of suicidal ideation, but the magnitude of effects was largely attenuated when depression and perceived stress were included in the models. Suspected sleep apnea using daytime sleepiness as a screening criterion was independently associated with suicidal ideation (odds ratio = 2.25, p

This study examines changes in and the relationship among religiosity, spiritual well-being, and depressive symptoms in primarily Buddhist or Daoist Taiwanese adolescents. A total of 2,239 16- to 18-year-old adolescents from 4 high schools were randomly selected and completed a questionnaire at baseline and at 6-month follow-up. Half of the Taiwanese adolescents reported being religious (50%), with Buddhism or Daoism predominating in terms of religious affiliation. Around 80% of adolescents believed in a God, but less than 40% believed that religion is important. Mixed models found no significant relationships between religiosity and spirituality or between religiosity and depressive symptoms. Self-efficacy and life scheme are valid domains for the spirituality construct, and a reciprocal relationship was found between spiritual well-being and depressive symptoms. This reciprocal relationship in adolescents is discussed in terms of a Buddhist or Daoist cultural context.

Aim: More and more studies are suggesting evidence for the comorbidity of cardiovascular disease and depressive disorders, yet the mechanism is obscure. Our study aimed to identify correlates common and unique to metabolic syndrome and depression, in order to clarify the relationship between the two diseases in terms of their taxonomy and potential overlapping mechanisms. Methods: Data from a large-scale community sample of 30-year-old or older residents of a Taiwanese city (N=11,258) were analyzed to compare sociodemographic and lifestyle factors between four groups: metabolic syndrome only, depression only, comorbid condition, and no disease. The metabolic syndrome was defined by using the standards published by National Health Promotion Administration and the depression was assessed by using the Mental Health Inventory-5. Results: Results showed that prevalence rates of metabolic syndrome and depression were 14% and 16.5%, respectively, whilst a low

Objective: To clarify the moderating and mediating effects of different types of life events on the relationships between personality traits and adolescent’s behavioral problems among 354 high school students in Taiwan. Methods: A school-based two-wave panel study was administered to 354 high school students. Sobel test was used to examine the complicated roles of life events in the relationships between personality and behavioral problems during adolescence. Results: The results showed that detrimental effects of high neuroticism traits on internalizing problems can be buffered by positive independent life events and moderated by positive dependent events. Additionally, behavioral problems occurred only through negative dependent life events generated by high levels of neuroticism among depressed adolescents. Conclusion: Adolescents with high neuroticism traits appear to be less able to conquer the stresses derived from the positive life events and therefore develop subsequent internalizing problems.

Aeolian river dust can seriously affect the air quality in central Taiwan. The main purpose of this study was to assess the concentration variations of PM10 and metals at different elementary schools during river dust episodes. River dust samples were taken from eight sites in the main bare soil areas of the Choshui River. PM10 aerosols from four elementary schools in Yulin County were collected by means of high-volume samplers. Fifteen elements (Fe, Al, Ca, Mg, Mn, Zn, Ti, Ni, V, Cr, As, Pb, Cu, Co, and Cd) in the river dust and PM10 were analyzed in this study. The coefficients of divergence (CDs) were obtained by comparing the metal compositions in PM10 aerosols at the four schools on the sampling days with the mean metal contents in the river soil samples as reference. The CD values showed that metal compositions in the aerosols at high-exposure sites during river dust episodes were similar to those compositions in the river dust. The concentrations of PM10 at the high-exposure schools during river dust episodes were much higher than those during non-river-dust episodes. This study also indicated that at the high-exposure sites, both the PM10 and metal concentrations were higher than at the low-exposure and control sites, not only during the river dust episodes, but also after the river dust episodes. The concentrations of toxic metals (Ni, Cr, As, and Cd) at the high-exposure sites were about 11.3 times higher during the river dust episodes (189 ng/m(3)) than during non-river-dust episodes (16.7 ng/m(3)) and about 8.9 times higher during the same periods at the control site (21.3 ng/m(3)).

Aim The present study investigated whether dual-task Timed Up & Go tests (TUG) could identify prefrail individuals more sensitively than the single-task TUG (TUGsingle) in community-dwelling middle-aged and older adults. Methods This cross-sectional study recruited adults aged 50 years and older who actively participated in local community programs. Time taken to complete single-task TUG and dual-task TUG, carrying a cup of water (TUGmanual) or carrying out serial-3 subtraction (TUGcognitive) while executing TUG, was measured. Prefrailty status was defined based on Fried's phenotypic definition. Results Of the 65 participants (mean age 71.5 ± 8.1 years), 33.3% of the 12 middle-aged (50–64 years) and 62.3% of the 53 older (≥65 years) adults were prefrail, mainly as a result of weak grip strength. The receiver operating characteristic curve analyses for differentiating prefrailty from non-frailty showed that the area under the curve (AUC) for TUGmanual (0.73, 95% CI 0.60–0.86) was better than that for TUGsingle (0.67, 95% CI 0.54–0.80), whereas the AUC value was not significant for TUGcognitive (0.60, 95% CI 0.46–0.74). The optimal cut-off points for detecting prefrailty using TUGsingle, TUGmanual and TUGcognitive were 7.7 s (sensitivity 68%), 8.2 s (sensitivity 83%), and 14.3 s (sensitivity 29%), respectively. After adjusting for age, logistic regression analyses showed that individuals with TUGmanual 8.2 s or slower were 7.2-fold more likely to have prefrailty than those with TUGmanual faster than 8.2 s. Conclusion TUGmanual is more valid and sensitive than TUGsingle in identifying prefrail individuals. The TUGmanual thus could serve as a screening tool for early detection of individuals with prefrailty in community-dwelling middle-aged and older adults. Geriatr Gerontol Int 2015; 15: 204–210.

This study examined the moderating effect of family functioning on the relationship between perceived discrimination and depressive symptoms in immigrant women. A total of 239 immigrant women were selected from four administrative regions in Central Taiwan. Questionnaires concerning perceived discrimination, family functioning (including family cohesion and family adaptability), depressive symptoms, and demographic characteristics were completed by either women themselves (N = 120) or their husbands (N = 119). The moderating effect of family functioning on the relationship between perceived discrimination and depression symptoms was analyzed using multiple regression analysis. Findings showed that a higher level of perceived discrimination among immigrant women is associated with more severe depressive symptoms. Family functioning serves as a moderator between the relationship of perceived discrimination and depressive symptoms, but the moderating effect of family adaptability was evident only in data reported by immigrant women. The results indicate that perceived discrimination has negative mental health implications, and also point to the importance of family functioning for depression. Findings suggest that providers should consider addressing immigrant women's mental health needs through declining their psychosocial distress at multiple ecological levels.

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder that may have a chronic and pervasive impact on the child's function and cause long-term stress to parents. A higher rate of depression is associated with mothers of children with ADHD. This observational study aimed to investigate the effect of maternal depression and the child's ADHD on the quality of the parent-child interaction in children with ADHD and their mothers with depression. The study participants comprised 39 mother-son dyads including children with ADHD and mothers with depression, children with ADHD and mothers without depression, and children without ADHD and mothers without depression. The Specific Affect Coding System, 20-code version was used to code interactional affect, including positive engagement, negative engagement, negative disengagement, and neural affect. There were no statistically significant group-by-context interaction effects or group effects on all affective variables between the group of children with ADHD and mothers without depression and the group of children without ADHD and mothers without depression. Stimulant medication may account for these nonsignificant findings. No significant difference of positive affect between neutral and conflict-solving contexts was observed in depressed mothers whose children were diagnosed as ADHD. Children with ADHD whose mothers were depressed were less positive in their parent-child interaction compared with children in the other groups. Maternal depression may play an important role in the affective presentation of dyads of children with ADHD and mothers with depression. Implications for clinical practice and future research are provided.

Two elementary schools (Shiuguang and Fongrong) from Yulin County in Taiwan, near a main area of potential exposure to Aeolian river-dust, were selected to collect outdoor and indoor PM10 aerosols and to measure five metals in PM10 (As, Ni, Cr, Cd, and Mn). Significant relationships (p

This meta-analysis examined the effect of behavioral parent training on child and parental outcomes for children with attention deficit hyperactivity disorder. Meta-analytic procedures were used to estimate the effect of behavioral parent training on children with attention deficit hyperactivity disorder. Variables moderating the intervention effect were examined. Forty studies were included and generated an overall moderate effect size at post-treatment and a small effect size at follow-up. The majority of outcome categories were associated with a moderate effect size at post-treatment that decreased to a small effect size at follow-up. Parenting competence was the only outcome that had a large effect, which decreased to moderate at follow-up. The strength of the effect differed between questionnaire and observation measures. Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder. Sustainability of the effects over time is a problem that awaits further scrutiny. Recommendations for further research and clinical practices are provided.

Human papillomavirus (HPV) infection is associated with cancer and can be prevented through vaccination. Few studies from Taiwan have reported on HPV infection among human immunodeficiency virus (HIV)-infected subjects. The aim of this study was to examine the prevalence of HPV infection among men who have sex with men (MSM) with and without HIV infection in Taiwan, and explore the behavioral risk factors thereof. We conducted a cross-sectional study in Taiwan during 2013 to 2016 to collect data on MSM aged 20 years or older. We used a questionnaire in a face-to-face interview, and subsequently collected oral, anal, and genital specimens from HIV-infected and HIV-uninfected subjects. Multivariate analysis was performed to predict factors associated with high-risk HPV (HR-HPV) positivity. Overall, 279 subjects, including 166 (59.5%) HIV-uninfected and 113 (40.5%) HIV-infected men were enrolled. Compared to HPV-negative subjects, HPV-positive subjects had significantly higher rates of receptive anal sex (91.3% vs 75.6%), substance use (22.6% vs 11%), history of sexually transmitted infections (75.7% vs 38.4%), anogenital or oral warts (39.1% vs 6.72%), syphilis (32.2% vs 11.6%), and HIV infection (69.6% vs 20.1%). We detected 489 HPV deoxyribonucleic acid (DNA) types (through 379 viable specimens), of which 43.6%, 5.7%, 56.4%, and 10.4% were HR-HPV type, HPV type 16, low-risk HPV types, and HPV type 6, respectively. In multivariate analysis, HIV-infected subjects had a significantly higher prevalence of HR-HPV infection (adjusted odds ratio, 5.80; 95% confidence interval, 2.57–13.11), compared to HIV-uninfected subjects. These results suggest that the prevalence of HPV infection was high among HIV-infected MSM. Additionally, anal HPV infection was observed to be common among both HIV-infected and HIV-uninfected MSM in Taiwan. The prevalence of oral and genital HPV infection, HR-HPV DNA types, and multiple HPV types was higher in HIV-infected subjects than in HIV-uninfected subjects. As only 35% of subjects practiced safe sex, we recommend routine HPV vaccination with 4-valent HPV or 9-valent HPV vaccines for both MSM, and HIV-infected subjects.