Shu Yu Lyu

The risk of temporomandibular disorder in patients with depression: a population-based cohort study

OBJECTIVES This study used a population-based retrospective cohort design to examine whether depression is a risk factor of temporomandibular disorder (TMD). METHODS From a universal insurance database, we identified 7587 patients who are newly diagnosed individuals with depression in 2000 and 2001. A total of 30,197 comparison subjects were randomly selected from a nondepression cohort. Both groups were followed until the end of 2008 to measure the incidence of TMD. RESULTS The incidence of TMD was 2.65 times higher in the depression cohort than in the nondepression cohort (6.16 versus 2.32 per 1000 person-years). The hazard ratio (HR) measured by multivariate Coxs proportional hazard regression analysis of TMD for the depression cohort was 2.21 (95% confidence interval (CI) 1.83-2.66), after controlling for socio-demographic factors and other psychiatric comorbidities. Women had higher risk to develop TMD than men (HR 1.61, 95% CI 1.36-1.92 for women without depression; HR 3.54, 95% CI 2.81-4.45 for women with depression). CONCLUSIONS This study demonstrates that patients with depression are at an elevated risk of developing TMD.

REDUCING SExUAL RISK AMoNG FILIPINA FEMALE BAR WoRKERS: EFFECTS oF A CBPR-DEVELoPED STRUCTURAL AND NETWoRK INTERVENTIoN

The effects of three interventions designed to reduce sexual risk among Filipina female bar workers (FBWs) were compared with each other and with usual care (nonintervention). The interventions were developed iteratively by a community-based participatory research (CBPR) partnership comprising lay community members, organizational representatives (including nongovernmental organizations), and academic researchers from the United States and the Philippines. Peer educators and bar managers from 110 different establishments in three southern regions were recruited and trained to increase knowledge of HIV and of condom use rules and regulations within establishments, as well as to change attitudes about risk reduction, provide HIV and sexually transmitted infection (STI) testing referrals, and build condom use skills among FBWs. Compared with the control community, all three interventions increased HIV and STI testing; however, only FBWs in the combination peer-educator and manager-training intervention significantly increased condom use from baseline to 2-year follow-up. Condom use was significantly associated with higher HIV knowledge, attendance of a prevention class, and being taught how to use condoms properly. Given these findings, research is warranted to further explore and understand various forms of commercial sex work and to test adapted peer-educator and manger-training interventions within HIV epicenters.

The role of non-formal education in combating the HIV epidemic in the Philippines and Taiwan

The Philippines is experiencing a low but slowly growing prevalence of HIV, with a UN estimate of 6,000–11,000 cases out of a population of 91 million, and a 150% increase in new cases in 2008 compared to previous years. Earlier education programmes employed non-formal educational training techniques in the southern Philippines to target high-risk groups such as female sex workers and their establishment managers; the effort was expanded to target males in the community. In comparison, as of 2009, Taiwan has an estimated 40,000 cases of HIV/AIDS in a population of 23 million. It experienced a major increase in HIV infection among injecting drug users, from 77 newly reported cases in 2003 to 2,381 such cases in 2007. This article compares and contrasts the response to the epidemic in each country, describing non-formal educational programmes targeted and tailored to specific high-risk populations.

Effects of education on harm-reduction programmes

e28 www.thelancet.com Vol 379 February 4, 2012 Harm-reduction programmes are remarkably successful in controlling HIV in injecting drug users worldwide, but more eff ort is needed to prevent even more HIV infections in this group. Recent reviews of the evidence on HIV in injecting drug users focused on risk environment, individual behavioural approaches, and medical treatment and care. Still, little is known about evidence-based educational intervention eff ects of harm-reduction programmes for injecting drug users. The HIV epidemic in injecting drug users in Asia began in the late 1980s. Aff ected countries included Thailand, India, Burma, China, Vietnam, Nepal, and Indonesia. From the early 2000s, HIV infection emerged in Taiwanese injecting drug users. The HIV seroincidence increased dramatically in the aftermath of the severe acute respiratory syndrome (SARS) pandemic in 2003, particularly in injecting drug users: new HIV cases peaked in 2005. As of April 30, 2011, a cumulative total of 20 638 Taiwanese have been infected with HIV since 1984 in a current population of 23 million. The major HIV risk factors for Taiwanese injecting drug users have been the reuse of drug paraphernalia and Eff ects of education on harm-reduction programmes publication, Judy Mikovitch, declared in a response to Science that “it is premature to retract our paper”. Hence, Science editor-in-chief Bruce Alberts has now published an Editorial Expression of Concern about the paper. In the past, several infectious agents have been associated with CFS but none of these could be confi rmed in subsequent studies, leaving the fi eld and patients in the same state of uncertainty as before. Sadly, we have to conclude that the world has witnessed another false claim that gave new hope to patients with CFS, who are desperately seeking a cause for their suff ering.

Diabetes mellitus and risk of subsequent depression: A longitudinal study

BACKGROUND Findings of previous studies on the association between diabetes and the risk of depression are contradictory. Furthermore, much less is known concerning the association among young adults. OBJECTIVE To investigate whether diabetes is associated with an increased risk of subsequent development of depression, with emphasis on age-specific variations. DESIGN A cohort study. SETTING Claims data of one million subjects randomly selected from 23 million people covered by the Taiwan National Health Insurance program. PARTICIPANTS From the claims data, we identified 14,048 patients aged ≥ 20 years with newly diagnosed diabetes in 2000-2002 and randomly selected 55,608 non-diabetic subjects for comparison, that were frequency-matched by calendar year, age, and gender. Incidence rates of depression to the end of 2007 were identified, and risks were compared between the two groups. RESULTS The incidence of depression was 1.80-times higher in the diabetic group than in nondiabetic subjects over a median follow-up of 6.5 years (adjusted hazard ratio [HR]=1.46, 95% confidence interval [CI]: 1.24-1.71). Age-specific HRs for incidence of depression in relation to diabetes were not statistically different between the patient subgroups aged 20-39, 40-49, 50-59, 60-69 and ≥ 70 years (p value for age-diabetes interaction=0.33). Stratified analyses showed that the association was much stronger for subjects without comorbid cardiovascular disease than for those with this comorbidity. Insulin treatment was associated with a 43% reduced risk of depression in diabetic patients. CONCLUSIONS In this population-based study, diabetic patients were at a higher risk for subsequent depression. Adequate treatment reduced the risk.

Psychiatric Morbidity in HIV-infected Male Prisoners

BACKGROUND/PURPOSE The seroincidence of human immunodeficiency virus (HIV) in Taiwan has drastically increased since 2004, particularly among injection drug users and prisoners. The major purpose of this study was to explore the prevalence and correlates of psychiatric morbidity among HIV-infected male prisoners. METHODS In 2006, data were collected from all of HIV-infected male prisoners (n = 535) in seven prisons in Taiwan. This collection was performed using a self-administered, anonymous questionnaire in group settings directed by our interviewers. Psychiatric morbidity was measured using the five-item Brief Symptom Rating Scale in 535 participants, which represented an 85% response rate. After excluding incomplete data, 479 participants were included in the analysis. RESULTS Psychiatric morbidity was present in 46% of participants. Multivariate logistic regression revealed that correlates of the five-item Brief Symptom Rating Scale defined cases included the following: being a recidivist, having poor self-rated health status, and having experienced psychiatric symptoms in ones lifetime (e.g. significant physical pain or discomfort, depression for 2 weeks or longer, serious anxiety or tension, trouble understanding, concentrating, or remembering, and serious thoughts of suicide), with a Nagelkerke R(2) equal to 0.365. CONCLUSION Psychiatric morbidity is prevalent among HIV-infected male prisoners. Tailored HIV/AIDS education related to mental health is therefore suggested for inclusion as part of a comprehensive HIV/AIDS training program among incarcerated populations.

Randomized trial of a secondhand smoke exposure reduction intervention among hospital-based pregnant women

OBJECTIVE This study sought to assess the effectiveness of a secondhand tobacco smoke (SHS) prevention program based on an expanded Health Belief Model (HBM) incorporating self-efficacy among pregnant women in a hospital setting in Taiwan. METHODOLOGY This study utilized a two-group longitudinal randomized controlled trial design. Participants in the intervention group (n=50) enrolled in a SHS prevention program based on the HBM, while participants in the comparison group (n=50) received standard government-mandated counseling care. Both groups were given questionnaires as a pre-test, two weeks into the intervention, and one month following the conclusion of the intervention. The questionnaire and intervention were developed based on the understanding gained through a series of in-depth interviews and a focus-group conducted among pregnant women. Exhaled carbon monoxide was also measured and used as a proxy for SHS exposure. RESULTS Intervention group scores were all significantly higher than comparison group scores (p<0.001), indicating a significant increase in knowledge, HBM scores, cues to action, self-efficacy, preventative behaviors, and a significant decrease in smoking exposure. These differences remained significant at the one-month follow-up assessment (p<0.001). CONCLUSIONS These results should encourage health professionals to educate pregnant women regarding the harms of SHS while both empowering and equipping them with the tools to confront their family members and effectively reduce their SHS exposure while promoting smoke-free social norms.

Incidence of pneumonia and risk factors among patients with head and neck cancer undergoing radiotherapy.

BackgroundThis study investigated the incidence and patient- and treatment-related risk factors related to pneumonia acquired during radiotherapy (PNRT) in head and neck cancer (HNC) patients.MethodsUsing the universal insurance claims data, 15,894 total HNC patients between 1998 and 2007 were included in this analysis. PNRT was defined as the occurrence of pneumonia within 90 days of the commencement of radiotherapy. Information also included some demographic characteristics, treatment-related factors, and comorbidities. Appropriate statistical tests were performed to assess the difference between patients with and those without PNRT. A logistic regression was used to estimate the odds ratio (OR) of PNRT among the variables examined.ResultsIn total, 772 patients (4.86%) were identified with PNRT as the case group, whereas 15,122 subjects of the same cancer without PNRT formed the control group. Of patients with PNRT, 632 (81.9%) were hospitalized with a mean length of stay of 25.9 days. Results from the multiple logistic regression showed that an older age and certain comorbidities were associated with an increased risk of PNRT. Patients with cancer of the tongue, buccal mucosa, oropharynx, and hypopharynx/larynx were at particularly higher risk (OR = 1.28, 1.28, 1.67, and 1.74, respectively). Compared to radiotherapy alone, concurrent chemoradiotherapy had no effect on the PNRT. Patients in the PNRT group had higher overall medical costs and length of stay.ConclusionThe incidence of PNRT in HNC patients receiving radiotherapy was approximately 5%. Notably, an older age, certain comorbidities, and certain specific tumor sites were associated with an increased risk.

Population-based Post-crisis Psychological Distress: An Example From the SARS Outbreak in Taiwan

Background/Purpose As a result of the severe acute respiratory syndrome (SARS) pandemic, the World Health Organization placed Taiwan on the travel alert list from May 21 to July 5, 2003. The aim of this study was to explore the post-crisis psychological distress among residents in Taiwan after the SARS epidemic. Methods The target population consisted of a nationwide representative sample of residents aged ≥ 18 years. Data were collected using computer assisted telephone interview systems by stratified random sampling according to geographic area. The survey (n = 1278) was conducted in November 2003, about 4 months after resolution of the SARS crisis in Taiwan. The maximum deviation of sampling error at the 95% confidence level was ± 2.74%. Psychological distress was measured by a question related to subjects changes in perception of life, plus the five-item Brief Symptom Rating Scale. Multivariate logistic regression was used to examine the correlation of psychological distress. Results About 9.2% of the participants reported that their perceptions of life became more pessimistic following the SARS crisis. The prevalence of psychiatric morbidity was 11.7%. Major predictors of higher levels of pessimism after the SARS epidemic included demographic factors, perception of SARS and preparedness, knowing people or having personal experiences of SARS-related discrimination, and individual worries and psychiatric morbidity. The correlates of symptomatic cases, as indicated by the five-item Brief Symptom Rating Scale, included age ≥ 50 years, senior high school graduate, and worries about recurrence of SARS. Conclusion Psychological distress was significantly correlated with demographic factors and perception regarding the SARS epidemic. It is suggested that marketing of mental health education should be segmented according to age and education level, which should enhance crisis communication for newly emerging infectious diseases among community populations.

A Case-control Study of HIV Infection Among Incarcerated Female Drug Users: Impact of Sharing Needles and Having Drug-using Sexual Partners

BACKGROUND/PURPOSE Taiwan experienced a rapid surge in human immunodeficiency virus (HIV) among injection drug users (IDUs) from 2003 to 2005. The male-to-female ratio of HIV cases decreased from 20:1 in 2003 to 6:1 in 2006. This change is primarily due to increasing numbers of female injection drug users in Taiwan. Our primary objective was to identify the risk factors associated with HIV infection among incarcerated female drug users. METHODS A case-control design involved recruitment of all eligible HIV-infected female inmates from all 24 prisons in Taiwan from November to December, 2007. Eligible HIV seronegative controls were chosen within the same prison and matched to the cases by age (within 3 years) and by history of illicit drug use. A subsample of these matches was randomly selected since there were many more eligible controls than HIV-infected cases. An anonymous self-administered questionnaire was completed with assistance from trained research assistants. RESULTS A total of 114 cases and 149 control participants were recruited, with a response rate of 82% and 54%. Injectable heroin use was significantly greater (p = 0.02) among HIV-infected cases (93.0%) than un-infected controls (84.6%). Compared to seronegative controls, HIV-infected cases were more likely to share drug paraphernalia and have drug-using sexual partners. Multiple logistic regression analysis revealed that the number of imprisonments (between 2-5 times; OR = 5.23), sharing mainly dilutes (OR= 63.47), and sharing dilutes concurrently with needles (OR= 127.33) significantly predicted HIV seroconversion, after controlling for age and years of education. CONCLUSION Sharing needles/dilutes and practicing unsafe intercourse with drug-using sexual partners places female drug users at considerable risk.