Meng Che Tsai

Factors associated with adolescents’ perspectives on health needs and preference for health information sources in Taiwan

Objective To identify health needs, preferred sources of health information and associated factors in Taiwanese adolescents. Design Cross-sectional questionnaire-based survey conducted in Taiwanese adolescents aged 12–18 years in 2010. Outcome measures Adolescents were queried about their health needs, healthcare service utilisation and preferred sources of health information. We compared differences in reported health needs and available sources among gender groups and grade levels. Demographic correlates of adolescent health needs were further examined using multiple ordinal logistic regression analysis. Results Participants (n=5018) needed weight and height information most, followed by dietary health advice. Academic stress was emphasised more than behavioural issues. Perceived needs for health information varied by age and gender. General high school programme, suburban location and chronic illness were associated with higher need. Only a small proportion (4.3%) of adolescents used healthcare services for mental and emotional concerns. Parents were the primary sources of health information, although students also turned to teachers, particularly for sensitive issues. Moreover, the mass media and internet were increasingly popular sources of information. Conclusions To achieve continuous care from childhood through adolescence to adulthood, paediatricians should understand adolescents’ diverse views of health needs and preferred sources of health information. Several demographic variables were shown to influence their health needs, reflecting the East Asian cultural context. Anticipatory guidance on body image, dietary health and academic stress should be emphasised while caring for these adolescents. We therefore advocate the development and effective delivery of culturally relevant adolescent-friendly health services.

Mood disorders after traumatic brain injury in adolescents and young adults: a nationwide population-based cohort study.

OBJECTIVE To delineate the relationship between traumatic brain injury (TBI) and mood disorders from population-based data in Taiwan. STUDY DESIGN This prospectively followed cohort study involved a subset of the National Health Insurance Research Database containing complete inpatient and outpatient data of 1 million randomly drawn beneficiaries. We included 10- to 24-year-old patients (n = 15,203) receiving the diagnosis of TBI in ambulatory visits or hospitalization from 2000-2004 and their age- and sex-matched comparison insureds using health service in the same year (n = 76,015). Diagnosis of mood disorders was recorded within 5 years after the traumatic event or index use of health service. Baseline demographics, clinical characteristics, and premorbid psychiatric conditions were compared using χ(2) analysis. Increased risk during the 5-year follow-up period was represented by crude and adjusted hazard ratios with 95% CI using a Cox proportional hazard regression. RESULTS A total of 451/15,203 patients with TBI (2.97%) received a diagnosis of mood disorders in the 5-year follow-up period compared with 1153/97,445 individuals (1.52%) without antecedent TBI. After adjusting for select premorbid comorbidities, TBI remained a significant predisposing factor with a 1.96-fold (95% CI 1.74-2.22) increase in risk of mood disorders. CONCLUSIONS Our findings show a higher likelihood of manifesting mood disorders in adolescents and young adults who sustained a prior TBI. Health professionals should carefully monitor both the physical and psychological impacts of head trauma.

Longitudinal Effects of Self-Report Pubertal Timing and Menarcheal Age on Adolescent Psychological and Behavioral Outcomes in Female Youths from Northern Taiwan

BACKGROUND Early puberty is linked to adverse developmental outcomes in adolescents in Western societies. However, little is known about this relationship in an East Asian context. In addition, whether the impact of subjective pubertal timing (PT) and menarcheal age (MA) on adolescent psychosocial development persists into early adulthood remains unclear and is worthy of investigation. METHODS A subset of data was retrieved from the Taiwan Youth Project, which recruited and followed a longitudinal cohort of 7th- and 9th-grade female Taiwanese students from 2000 to 2007. Subjective PT was defined using the Pubertal Developmental Scale (PDS), which mainly measures pubertal changes. MA was recalled by participants themselves. Various psychological and behavioral factors were recorded and measured until the age of 20, including the use of alcohol and cigarettes, psychological well-being, sexual activity, and socially problematic behaviors. A χ2 test for linear-by-linear association and one-way analysis of variance followed by multivariate regression models were used to dissect the differential effects of PT and MA in the association with the outcome variables. RESULTS In total, 1545 female participants with an average age of 14.5 (±1.1) years were deemed valid for analysis. Among them, 257 (16.6%) participants perceived themselves as having early PT, defined as more than 1 standard deviation above the mean PDS score, and 82 (5.3%) had early MA (occurring before the 4th grade). In univariate analysis, participants with early PT had higher rates of smoking and sexual activity, and MA was not related to their psychobehavioral outcomes. After multivariate adjustment, only late PT was significantly correlated with lower amounts of cigarette smoking and sexual activity before the age of 20. CONCLUSION Conceptual and actual pubertal developments may be differentially associated with psychobehavioral outcomes among young Taiwanese girls. Clinical attention should be given to adolescent self-perception of sexual maturation and developmental guidance provided accordingly.

Psychometric evaluation and wording effects on the Chinese version of the parent-proxy Kid-KINDL

BackgroundThe pediatric quality of life (QoL) questionnaire, the child-rated Kid-KINDL, has wording effects. However, no studies have examined for its parallel questionnaire, the parent-proxy Kid-KINDL. This study aimed to examine the psychometric properties and wording effects of the parent-proxy Kid-KINDL.MethodsParents with 8- to 12-year-old children (n = 247) completed the parent-proxy Kid-KINDL, 83 of them completed it again 7–14 days later, and 241 of their children completed the child-rated Kid-KINDL. Internal consistency was examined using Cronbach’s α; test-retest reliability and concurrent validity, using Pearson correlation coefficients (r); construct validity and wording effects, using confirmatory factor analyses (CFAs).ResultsThe internal consistency of the parent-proxy Kid-KINDL total score was acceptable (α = .86). Test-retest reliability (r = .33–.60) and concurrent validity (r = .27–.42) were acceptable or nearly acceptable for all subscales and the total score. The CFA models simultaneously accounting for QoL traits and wording effects had satisfactory fit indices, and outperformed the model accounting only for QoL traits. However, four subscales had unsatisfactory internal consistency, which might be attributable to wording effects.ConclusionWhen children are unable to complete a QoL questionnaire, the parent-proxy Kid-KINDL can substitute with all due cautions to wording effects and inconsistent reliability among different raters.

Raters Interpret Positively and Negatively Worded Items Similarly in a Quality of Life Instrument for Children: Kid-KINDL

Measurement invariance is an important assumption to meaningfully compare children’s quality of life (QoL) between different raters (eg, children and parents) and across genders. Moreover, QoL instruments may combine using negatively and positively worded items—a common method to reduce response bias. However, the wording effects may have different levels of impact on different raters and genders. Our aim was to investigate the measurement invariance of Kid-KINDL, a commonly used QoL instrument, across genders and raters and to consider the wording effects simultaneously. Third to sixth graders (208 boys and 235 girls) completed the self-rated Kid-KINDL, and 1 parent each of 241 children completed the parent-rated Kid-KINDL. The wording effects were accounted for by correlated traits-uncorrelated methods model. The measurement invariance was examined using multigroup confirmatory factor analysis. Item loadings and item intercepts were invariant across gender and rater when we simultaneously accounted for the wording effects of Kid-KINDL. Our results suggest that Kid-KINDL could be used to compare QoL across gender and that parent-rated Kid-KINDL could be used to measure children’s QoL. Specifically, the invariant factor loadings across child-rated and parent-rated Kid-KINDL suggest that the score weights in each item were the same for both children and parents (ie, the important items identified by the children are the same items identified by the parents). The invariant item intercepts suggest that both children and parents share the same threshold for each item. Based on the results, we tentatively recommend that each score of a parent-rated Kid-KINDL can stand for each child’s QoL.