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To assess healthy-related quality of life and psychosocial adjustment in children with newly diagnosed cancer and their parents immediately and 6 months after diagnosis and treatment of cancer.
A prospective, case control study was conducted on eighty-nine children with newly diagnosed cancer, aged between 6 months to 16.7 years (mean, 8.2 years), and ninety healthy children of matched age group and social background. The children were assessed with the Child Behavior Checklist (CBCL), and the Parenting Stress Index (PSI) and the SF-36 questionnaire were administered to their parents immediately after diagnosis of cancer, 3 months after chemotherapy, and 6 months after chemotherapy.
No matter at the period immediately after diagnosis of cancer, 3 months or 6 months after starting chemotherapy, the parents of children with cancer scored significantly worse on every domains of SF-36 except body pain and every subscales of PSI except distractibility/hyperactivity and attachment when compared with the control group. The cancer group scored consistently lower on all CBCL syndrome scales than the control group, with anxiety, depression and body pain being significantly different. After starting chemotherapy, the parents reported improved scores on quality of life and decreasing parenting stress in both parent and child domains since 3 months or 6 months after starting chemotherapy.
Considerable distress was experienced by both children with newly diagnosed cancer and their parents during the period immediately after diagnosis. However, parents can adjust gradually since 3 months after starting chemotherapy and experience improved quality of life.
Patients with chronic kidney disease (CKD) have more cognitive impairments. However, the etiologies are not fully clear. Plasma homocysteine levels and vascular burden rise in CKD; meanwhile, high homocysteine levels and vascular factors are known risk factors of dementia in non-CKD patients. Thus, we aimed to investigate the association between homocysteine, vascular burden and cognitive impairment in CKD and to see if the effect of elevated homocysteine on cognitive impairment mediated by vascular factor.
146 patients with CKD and 69 normal comparisons were recruited. Cognitive function was evaluated by comprehensive neuropsychological tests assessing processing speed, executive function, language, visuospatial function, memory, and attention domains. Vascular burden was assessed by Framinghan cardiovascular risk scale (FCRS) which indicates risk of atherosclerotic diseases including stroke.
In controlled analysis, patients with CKD had lower scores in all cognitive domains, and had higher homocysteine levels (18.5±6.4 vs. 9.8±2.9, p< 0.0001) and FCRS(17.0±4.7 vs. 14.0±4.7, p< 0.0001). Among patients with CKD, higher homocysteine levels (p=0.026) were associated with lower score on digit symbol task which is related to processing speed and executive function with controlling for age, sex, education and stage of CKD. The association persisted (p=0.047) after controlling for vascular risks.
Patients with CKD had extensive cognitive impairments. Elevated homocysteine levels may be an risk factor, which is independent of vascular burden, of cognitive impairment on processing speed and executive function. Further studies to investigate if normalization of homocysteine can improve cognitive function will be suggested.
Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings.
To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among a general Chinese patient population.
Self-report data were collected from 484 patients at five randomly selected hospitals.
The prevalence of hazardous alcohol-drinking problems was 19.2%. Logistic regression analysis revealed that risk factors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29.1% of participants were assessed for drinking problems in the past year. Only 38.7% of participants with drinking problems had received a drinking intervention in the past year.
Alcohol problems in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups and integrating psychiatric healthcare teams in general hospitals are important to prevent patients’ drinking problems.
This post-hoc analysis evaluated whether the efficacy of lurasidone in major depressive disorder (MDD) with mixed features is moderated by the number and characteristics of manic symptoms present at study baseline.
Patients meeting DSM-IV-TR criteria for MDD who presented with two or three manic symptoms (consistent with the DSM–5 mixed features specifier) were randomly assigned to 6 weeks of double-blind treatment with either lurasidone 20–60 mg/d (n = 109) or placebo (n = 100). Finite mixture models were applied to identify latent class patterns of the 10 baseline manic symptoms.
Three latent class profiles were identified: 105 (50.5%) patients had manic symptom profile 1 (MIX 1) with mean MADRS 33.0, mean YMRS 9.2, mean number of manic symptoms 3.8; 63 (30.3%) patients had manic symptom profile 2 (MIX 2) with similar baseline mean MADRS (32.4) and YMRS (9.3) and lower number of manic symptoms 3.5; 40 patients had manic symptom profile 3 (MIX 3) with significantly higher severity scores in MADRS (35) and YMRS (14.9) and mean number of manic symptoms 4.6. A significant moderating effect on change in YMRS score was observed for the “decreased need for sleep” symptom, with greater lurasidone effect size (vs. Placebo) found in patients without vs. With this symptom (P < 0.05).
In this post-hoc analysis of a placebo-controlled trial involving MDD patients with mixed features, absence of “decreased need for sleep” was found to be significantly associated with improvement in manic and depressive symptoms and to moderate the treatment effect on manic symptoms.
Disclosure of interest
I am full time employee of Sunovion pharmaceuticals Inc.
Electroconvulsive therapy (ECT) remains irreplaceable in the treatment of several psychiatric conditions. However, evidence derived using data from a national database to support its safety is limited. The aim of this study was to investigate in-hospital mortality among patients with psychiatric conditions treated with and without ECT.
Using data from the Taiwan National Health Insurance Research Database from 1997 to 2013, we identified 828,899 inpatients with psychiatric conditions, among whom 0.19% (n = 1571) were treated with ECT.
We found that ECT recipients were more frequently women, were younger and physically healthier, lived in more urbanized areas, were treated in medical centers, and had longer hospital stays. ECT recipients had lower odds of in-hospital mortality than did those who did not receive ECT. Moreover, no factor was identified as being able to predict mortality in patients who underwent ECT. Among all patients, ECT was not associated with in-hospital mortality after controlling for potential confounders.
ECT was indicated to be safe and did not increase the odds of in-hospital mortality. However, ECT appeared to be administered only on physically healthy but psychiatrically compromised patients, a pattern that is in opposition with the scientific evidence supporting its safety. Moreover, our data suggest that ECT is still used as a treatment of last resort in the era of modern psychiatry.
Alzheimer's disease and related dementias are associated with increasing health burden in low- and middle-income countries. Less well-recognized is the potential health burden experienced by other affected individuals, such as family caregivers. In this study, we sought to profile the burden of care and its association with symptoms of depression and anxiety among informal caregivers of people living with dementia in rural southwestern Uganda.
We conducted a cross-sectional study of 232 family caregivers of people with dementia. The key measured variables of interest were caregiving burden (Zarit Burden Index) and symptoms of depression and anxiety (Depression Anxiety Stress Scales). We fitted multivariable regression models specifying depression and anxiety symptoms as the primary outcomes of interest and caregiving burden as the primary explanatory variable of interest.
Family caregivers of people with dementia experience significant caregiving burden, with each item on the Zarit Burden Index endorsed by more than 70% of study participants. Nearly half [108 (47%)] of caregivers had Zarit Burden Interview scores >60, suggestive of severe caregiving burden. In multivariable regression models, we estimated a statistically significant positive association between caregiving burden and symptoms of both depression [b = 0.42; 95% confidence interval (CI) 0.34–0.49] and anxiety (b = 0.37; 95% CI 0.30–0.45).
Family caregivers of people with dementia in rural Uganda experience a high caregiving burden, which is associated with symptoms of depression and anxiety. Interventions aimed at reducing caregiving burden may have important collateral mental health benefits.
Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.
Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.
The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10–1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07–2.01) during the follow-up compared with the controls.
The unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
In the recent years, the development of wind turbines has been so hectic in Taiwan. The design of the turbine blades directly impacts power effectiveness. In this study, the effects of manufacturing parameters and environmental factors on the mechanical properties of carbon fiber/epoxy composites that are used in turbine blades are discussed. Parameters of the manufacturing process affect the mechanical properties. Carbon composites made by a different numbers of layers are tested on various aspects of performance such as mechanical strength and corrosion resistance.
We used all 167 typhoon warnings issued by the Taiwanese Central Weather Bureau from 1958–2006 to assess the long-term effect of cyclone disturbance on vascular epiphytes. Tracks and eyes of past typhoons were plotted as circles with radii of Beaufort scale 7 and 10, and the frequency of each cohort in 1-km2 grid cells was calculated. The presence of vascular epiphytes in the same grid cells was predicted using species distribution models (SDMs). First, we used herbarium specimens and other sources to compile a comprehensive georeferenced vascular epiphyte database that contained 39084 records in 331 species. Next, we assigned each epiphyte record to a cell in the same 1-km2 grid as above. Finally, we used SDMs (MaXent), based on 30 environmental variables except typhoon frequency, to predict the potential presence of each species in the grid cells. For our analysis we only considered cells east of the central mountain ridge where typhoons hit with full force. After elimination of rare species and species that could not be validated in the SDMs, we were left with 156 epiphyte species in 10725 1-km2 cells. The number of projected species in the cells was 36.5 on average, varying between two and 82 species. Correlation analyses showed that, over time, typhoons led to a decrease in epiphyte richness at Beaufort scale 7 and 10 (Pearson's r = −0.07 and −0.08 respectively). Ferns, orchids, hemiepiphytes and dicotyledons generally showed the same pattern, except hemiepiphytes that showed a positive correlation at B7 (Pearson's r = 0.15). A partial canonical correspondence ordination analysis showed that, independent of temperature- and rainfall-related variables, Beaufort scale 7 and 10 typhoons also had significant influence on the species composition of the vascular epiphyte communities in the landscape. We recommend in situ monitoring of epiphytes over a long period to corroborate the suggestion from this indirect study that typhoons have a long-term effect on the distribution of epiphytes in Taiwan.
Meltwater is important to understanding glacier health and dynamics. Since melt measurements are uncommon, ice ablation estimates are often based on models including the positive degree day (PDD) model. The PDD estimate is popular since it only requires air temperature as input, but suffers from the lack of physical motivation of an energy-balance model. We present a physics-based alternative to the PDD model that still only takes air/surface temperature as input. The model resembles the PDD model except accounting for time lags in ablation when cold ice needs to be warmed. The model is expressed as a differential equation with a single extra parameter related to the efficiency of heating a near-surface layer of ice. With zero thickness, the model reduces to the PDD model, providing a physical basis for the PDD model. Applying the model to data from Greenland, it improves modestly upon the PDD model, with the main improvement being better prediction of early season melting. This new model is a useful compromise, with some of the physics of more realistic models and the simplicity of a PDD model. The model should improve estimates of meltwater production and help constrain PDD parameters when empirical calibration is challenging.
Studies conducted in sub-Saharan Africa suggest a high prevalence of depression and suicidality among adolescents living with HIV (ALWH). This is an important public health issue because depression is known to compromise HIV treatment adherence. However, the drivers of depression and suicidality in this population are unclear. We conducted a cross-sectional study to estimate the associations between internalized stigma, bullying, major depressive disorder, and suicidality.
We conducted a cross-sectional survey between November 2016 and March 2017, enrolling a consecutive sample of 224 ALWH aged 13–17 years. We collected information on demographic characteristics, internalized HIV-related stigma (using the six-item Internalized AIDS-Related Stigma Scale), bullying victimization (using the nine-item Social and Health Assessment Peer Victimization Scale), major depressive disorder [using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)], and suicidality (also using the MINI-KID). We fitted multivariable logistic regression models to estimate the associations between stigma, bullying, major depressive disorder, and suicidality.
Thirty-seven participants (16%) had major depressive disorder, 30 (13%) had suicidality, and nine (4%) had high-risk suicidality. Ninety-one participants (41%) had high levels of internalized stigma, while 97 (43%) reported two or more bullying events in the past year. In multivariable logistic regression models, major depressive disorder had a statistically significant association with bullying (AOR = 1.09; 95% CI 1.00–1.20; p = 0.04); while suicidality (low, moderate, high risk) had statistically significant associations with both bullying (AOR = 1.09; 95% CI 1.01–1.17; p = 0.02) and stigma (AOR = 1.30; 95% CI 1.03–1.30; p = 0.02).
Among ALWH in rural Uganda, stigma and bullying are strongly associated with major depressive disorder and suicidality. There is a need to incorporate psychological interventions in the mainstream HIV care to address these challenges for optimal management of HIV among ALWH.
This study investigated the flow bifurcations of flows driven by a pressure gradient in a rectangular curved tube. When fluid flows within a curved tube, due to the centrifugal effect, secondary vortices can be induced in the cross section of the tube. The secondary flow states are dependent on the magnitude of the pressure gradient (q) and the aspect ratio (γ). In this study, the continuation method was applied to investigate the flow bifurcations in a curved tube with increasing pressure gradient (1 < q < 6000) and aspect ratio (0.9 < γ < 1.4).
The bifurcation diagrams are composed of solution branches, which are linked by limiting points or bifurcation points. The flow states in a solution branch belong to the same group. The ranges of the flow states and the relationship between the states can also be derived from the bifurcation diagrams. In this study, two types of bifurcation were found, one in the range of 0.9 < γ < 1.17, and another in the range of 1.18 < γ < 1.4. The ranges of stable flow solutions and the distributions of limit and bifurcation points in both pressure gradient and aspect ratio are derived in this study.
To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics.
A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators.
In-home survey interviews in south-western Uganda.
All adult residents across eight rural villages; 96 % response rate (n 1669).
Severe food insecurity was associated with greater depression symptom severity (b=0·4, 95 % CI 0·3, 0·5, P<0·001 for women; b=0·3, 95 % CI 0·2, 0·4, P<0·001 for men). There was no evidence of effect modification by social network factors for women. However, for men who are highly embedded within in their village social network, and (separately) for men who have few poor contacts in their personal network, the relationship between severe food insecurity and depression symptoms was stronger than for men on the periphery of their village social network, and for men with many poor personal network contacts, respectively.
In this population-based study from rural Uganda, food insecurity was associated with mental health for both men and women. Future research is needed on networks and food insecurity-related shame in relation to depression symptoms among food-insecure men.
Worldwide, tobacco smoke is still the leading cause of preventable morbidity and mortality. Many smokers develop chronic smoking-related conditions that require emergency department (ED) visits. However, best practices for ED smoking cessation counselling are still unclear.
A randomized controlled trial was conducted to determine whether an “ask, advise, and refer” approach increases 12-month, 30-day quit rates in the stable adult ED smoking population compared to usual care. Patients in the intervention group were referred to a community counselling service that offers a quitline, a text-based program, and a Web-based program. Longitudinal intention-to-treat analyses were performed.
From November 2011 to March 2013, 1,295 patients were enrolled from one academic tertiary care ED. Six hundred thirty-five were allocated to usual care, and 660 were allocated to intervention. Follow-up data were available for 70% of all patients at 12 months. There was no statistically significant difference in 12-month, 30-day quit rates between the two groups. However, there was a trend towards higher 7-day quit attempts, 7-day quit rates, and 30-day quit rates at 3, 6, and 12 months in the intervention group.
In this study, there was a trend towards increased smoking cessation following referral to a community counselling service. There was no statistically significant difference. However, if ED smoking cessation efforts were to provide even a small positive effect, such an intervention may have a significant public health impact given the extensive reach of emergency physicians.
Prior to integrated circuit (IC) packaging, die performance must be verified using probe cards to screen for defective products. With the decrease in IC line width, the dimensions of the pads used for performance verification and the spacing between adjacent pads have also decreased. However, when the pad pitch is reduced to less than 30 μm, commonly used probe cards will face manufacturing problems in miniaturization. To resolve probe card manufacturing problems caused by the miniaturization of IC components, the use of an anisotropic conductive film (ACF) in probe cards was proposed in this study. Theoretical calculations and experimental testing of this probe structure were conducted to demonstrate the feasibility of this concept.
In theoretical calculations, composite material and buckling theory were utilized to evaluate the buckling behavior of the ACF. In experimental testing, photolithography and electroplating techniques were used to control the line width and spacing intervals of the micron-scale metal wires in the ACF. After the ACF was fabricated, the mechanical properties of the ACF during wafer testing were assessed. Theoretical analyses and experimental testing verified that ACFs can potentially be applied to the performance verification of IC products. In the ACF structure, multiple probes came into contact with each pad. Therefore, ACFs can potentially be applied to the performance verification of IC components with pad diameters of less than 20 μm. The results of this study directly benefit the miniaturization of ICs.
Ocean tides influence the flow of marine-terminating glaciers. Observations indicate that the large fortnightly variations in ice flow at Rutford Ice Stream in West Antarctica originate in the floating ice shelf. We show that nonlinear variations in ice shelf buttressing driven by tides can produce such fortnightly variations in ice flow. These nonlinearities in the tidal modulation of buttressing stresses can be caused by asymmetries in the contact stress from migration of the grounding line and bathymetric pinning points beneath the ice shelf. Using a simple viscoelastic model, we demonstrate that a combination of buttressing and hydrostatic stress variations can explain a diverse range of tidal variations in ice shelf flow, including the period, phase and amplitude of flow variations observed at Rutford and Bindschadler Ice Streams.
The aim of this post-hoc analysis was to evaluate the efficacy of lurasidone in treating major depressive disorder (MDD) with mixed features including irritability.
The data in this analysis were derived from a study of patients meeting DSM–IV–TR criteria for unipolar MDD, with a Montgomery–Åsberg Depression Rating Scale (MADRS) total score ≥26, presenting with two or three protocol-defined manic symptoms, and who were randomized to 6 weeks of double-blind treatment with either lurasidone 20–60 mg/d (n=109) or placebo (n=100). We defined “irritability” as a score ≥2 on both the Young Mania Rating Scale (YMRS) irritability item (#5) and the disruptive-aggressive item (#9). Endpoint change in the MADRS and YMRS items 5 and 9 were analyzed using a mixed model for repeated measures for patients with and without irritability.
Some 20.7% of patients met the criteria for irritability. Treatment with lurasidone was associated with a significant week 6 change vs. placebo in MADRS score in both patients with (–22.6 vs. –9.5, p<0.0001, effect size [ES]=1.4) and without (–19.9 vs. –13.8, p<0.0001, ES=0.7) irritability. In patients with irritable features, treatment with lurasidone was associated with significant week 6 changes vs. placebo in both the YMRS irritability item (–1.4 vs. –0.3, p=0.0012, ES=1.0) and the YMRS disruptive-aggressive item (–1.0 vs. –0.3, p=0.0002, ES=1.2).
In our post-hoc analysis of a randomized, placebo-controlled, 6-week trial, treatment with lurasidone significantly improved depressive symptoms in MDD patients with mixed features including irritability. In addition, irritability symptoms significantly improved in patients treated with lurasidone.
In recent years, compact camera modules (CCMs) have been widely used in consumer electrical and electronic products. CCMs with low cost specially are necessary for portable devices. Therefore, the present group recently developed a miniaturized open-loop controlled camera module with low cost for cellphone applications, in which the Lorentz force is balanced by a magnetic restoring force. To enhance the performance of the camera module, this article reports a pattern structure to modify the linearity of the magnetic restoring force. We fabricated a CCM prototype with the dimensions of 8.5 mm × 8.5 mm × 5 mm and demonstrated the usefulness of the pattern structure with the CCM prototype. Its potential applications are foreseeable in portable devices, such as cellphones, web cameras, personal digital assistants and other commercial electronics.
School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children's water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.
We conducted a population-based, cross-sectional study of female household heads (N = 257) and their children ages 5–17 (N = 551) in the rural regions surrounding the town of Mbarara, in southwestern Uganda. We used multivariable linear regressions to estimate the association between water insecurity and missed schooling. We then assessed the extent to which the association was mediated by caregiver depression.
Among children, water insecurity had a statistically significant association with the number of missed school days (a standard deviation increase in water insecurity resulted in 0.30 more missed school days in the last week). The estimated association was partially mediated by caregiver depression. When stratified by sex, this mediating pathway remained significant for boys, but not among girls.
Water insecurity is a risk factor for missed schooling among children in rural Uganda. Caregiver depression partially mediated this relationship. Also addressing caregiver mental health in water insecure families may more fully address the needs of sub-Saharan African families and promote educational participation among youth.