Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study.

BACKGROUND: Both sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls. METHODS: A comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison. RESULTS: The mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls. CONCLUSIONS: Early detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.

Impact of COVID-19-Induced Academic Stress on Insomnia and Suicidal Ideation among Taiwanese Health Trainees and Junior Doctors.

BACKGROUND Clinical training for allied health trainees (AHTs) and postgraduate-year (PGY) doctors needed to go online during the outbreak of coronavirus disease 2019 (COVID-19), which may have caused academic stress and consequent outcomes among this cohort. MATERIAL AND METHODS To evaluate academic-related stress, clinical confidence, psychological distress, and insomnia, an online survey-based study was conducted among Taiwanese AHTs and PGY doctors between July and December, 2022, during the COVID-19 pandemic. The survey included the 21-item Depression, Anxiety, and Stress Scale (DASS-21), the Insomnia Severity Index (ISI), and self-designed questions. It was distributed using convenience sampling and snowball sampling and was completed by 522 participants. RESULTS Structural equational modelling showed that academic stress was negatively associated with clinical confidence (standardized coefficient [ß]=-0.382, p<0.001). Clinical confidence was negatively associated with psychological distress (ß=-0.397, p<0.001), which was associated with insomnia (ß=0.648, p<0.001). Additionally, clinical confidence and psychological distress were the significant mediators. Results indicated that higher academic stress was associated with higher level of insomnia via the mediation of clinical confidence and psychological distress. CONCLUSIONS Academic stress related to changes in clinical training may have led to insomnia among AHTs and PGY doctors during the pandemic. Factors to reduce academic stress should be investigated to promote good mental health while providing sufficient clinical training, especially during events that can cause increased stress (eg, epidemics, pandemics).

Socioeconomic Disparity in the Effect of SARS-CoV-2 on Outpatient Visits among People with Type 2 Diabetes in Taiwan.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak posed impact on healthcare. This study evaluated the effect of SARS-CoV-2 outbreak on the outpatient visits of patients with type 2 diabetes and determined the most affected groups. We analyzed Taiwan's National Health Insurance data, including 1,922,702 patients diagnosed with type 2 diabetes from 2018 to 2021. Group-based trajectory modelling identified four distinct outpatient visit patterns, namely, consistently high (Group 1, 74.2%), low-to-high (Group 2, 8.1%), high-to-low (Group 3, 6.0%) and consistently low (Group 4, 11.7%) utilization. Logistic regression was used to analyze correlations between trajectory types and patients' demographics and health statuses. Group 3 members had higher odds of being male [adjusted odds ratio (aOR) = 1.04, 95% confidence interval (CI) 1.03-1.05] and earning below 20,000 New Taiwan Dollar monthly (aOR = 1.29, 95% CI 1.26-1.31) than those in Group 1. However, they were less likely to be under 80 years old (aOR = 0.70-0.97), from lower median family income regions (aOR = 0.81-0.89) or possess a Charlson Comorbidity Index score > 2 (aOR = 0.67, 95% CI 0.66-0.68). Patients with lower income in affluent areas displayed the highest likelihood of falling into Group 3. Patients with type 2 diabetes and low income from wealthy areas were vulnerable during the pandemic. This result emphasizes the need to target resources and support for this subgroup during such crises.

Herpes zoster associated with stroke incidence in people living with human immunodeficiency virus: a nested case-control study.

BACKGROUND: The incidence of stroke is increasing among younger people with human immunodeficiency virus (HIV). The burden of stroke has shifted toward the young people living with HIV, particularly in low- and middle-income countries. People infected with herpes zoster (HZ) were more likely to suffer stroke than the general population. However, the association of HZ infection with the incidence of stroke among patients with HIV remains unclear. METHODS: A nested case-control study was conducted with patients with HIV registered in the Taiwan National Health Insurance Research Database in 2000-2017. A total of 509 stroke cases were 1:10 matched to 5090 non-stroke controls on age, sex, and date of first stroke diagnosis. Logistic regression models were used to estimate the odds ratio and 95% confidence intervals (CI) of stroke incidence. RESULTS: The odds ratio of stroke was significantly higher in the HIV-infected population with HZ (adjusted odds ratio [AOR]: 1.85, 95% CI: 1.42-2.41). A significantly increased AOR of stroke was associated with hypertension (AOR: 3.53, 95% CI: 2.86-4.34), heart disease (AOR: 2.32, 95% CI: 1.54-3.48), chronic kidney disease (AOR: 1.82, 95% CI: 1.16-2.85), hepatitis C virus infection (AOR: 1.49, 95% CI: 1.22-1.83), hyperlipidemia (OR: 1.41, 95% CI: 1.12-1.78), and treatment with protease inhibitors (AOR: 1.33, 95% CI: 1.05-1.69). CONCLUSIONS: Our findings suggest that HZ concurrent with HIV may increase the risk of stroke. The incidence rates of stroke were independent of common risk factors, suggesting strategies for early prevention of HZ infection among people living with HIV.

Associations of parental mental disorders and age with childhood mental disorders: a population-based cohort study with four million offspring.

This Taiwan study examined the associations of parental age and mental disorders with the offspring risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), major depressive disorder (MDD), and bipolar disorder (BD). Children born between January 1991 and December 2004 in Taiwan were enrolled as the birth cohort (n = 4,138,151) and followed up until December 2011. A logistic regression analysis was performed to identify the odds ratio (OR). The advanced age effects were significant in ADHD (range of OR: 1.04 to 1.49) and ASD (range of OR: 1.35 to 2.27). Teenage mothers, teenage fathers, and fathers ≥ 50 years had higher offspring risks of MDD (range of OR: 1.24 to 1.46); and teenage mothers and fathers ≥ 50 years had increased offspring risks of BD (range of OR: 1.23 to 1.87). Both paternal and maternal mental disorders were associated with higher risks of within-disorder transmission for ADHD, ASD, MDD, and BD (range of OR: 2.64 to 30.41). Besides, parents with one of these four mental disorders (ADHD, ASD, MDD, and BD) might have higher risk of cross-disorder transmission to at least one of the other three mental disorders in the offspring (range of OR: 1.35 to 7.15). Parental age and mental disorders had complex and nuanced patterns in association with offspring mental disorders.

Utilization of mental health services in relation to the intention to reduce chemsex behavior among clients from an integrated sexual health services center in Taiwan.

INTRODUCTION: The intention of chemsex-practicing gay and bisexual men and other men who have sex with men (GBMSM) to reduce their drug use is an important factor for the utilization of harm reduction services. This study aimed to examine data from an integrated sexual health services center to understand the relationship between the intention to reduce chemsex behavior and chemsex-related utilization of mental health services among GBMSM who engage in chemsex. METHOD: We used data collected from Healing, Empowerment, Recovery of Chemsex (HERO), an integrated health center in Taiwan, between November 2017 and December 2021. As the baseline, clients were asked to rate the current and ideal proportions of their sexual activities that involved the use of MDMA, ketamine, methamphetamine, GHB/GBL, or mephedrone. Having the intention to reduce chemsex was defined as having a lower proportion of ideal engagement compared to actual engagement. The data on the use of the services provided at HERO were linked to the survey responses and compared to information gathered during regular follow-up visits. Univariable and multivariable logistic regression analyses and a Poisson regression analysis were performed on the data. RESULTS: A total of 152 GBMSM reported engaging in chemsex, of whom 105 (69.1%) expressed the intention to reduce their chemsex behavior. Service utilization ranged from 23.0% for participating in meetings of a chemsex recovery group, 17.1% for visiting a mental health clinic, and 10.5% for using both of these services. The intention to reduce chemsex behavior significantly associated with visiting a mental health clinic (aOR = 4.68, p < 0.05), but its association with attending meetings of a chemsex recovery group was only marginally significant (aOR = 2.96, p < 0.1). Other factors that remained significantly associated with service use were a high frequency of substance use and living with HIV. CONCLUSION: Comprehensive harm reduction strategies, which touch on mental health, drug use management and recovery, are needed for those who want to reduce their chemsex behavior. Public health practitioners should endeavor to raise awareness of resources that are available for people who engage in chemsex and to minimize the barriers blocking their access to the appropriate services.

[Reflections on the Design of English-Medium Instruction Courses in Nursing].

In line with the Taiwan government's 2030 bilingual national policy, nursing education must emphasize the importance of enhancing English proficiency, developing international competitiveness, and fostering global literacy. English is used as the medium of instruction (EMI) in nursing education with the main goal of conveying professional knowledge and skills through effective communication and linguistic awareness. The achievement of this goal may be enhanced by the use of artificial intelligence (AI) technology and software to assist teachers and students improve their linguistic awareness. EMI curricula provide to students of different nationalities opportunities to learn and appreciate multicultural perspectives, allowing them to practice respect for different cultural perspectives, cooperate in international learning environments, and build global competence.

[Detection of Fever Using Continuous Skin Temperature Monitoring in Hospitalized Older Adults].

BACKGROUND: The continuous monitoring of body surface temperature has been proven to help detect potential fever events in hospitalized patients. However, the efficacy of using body surface temperature to detect fever in older adults remains unclear due to the relatively low and slower-to-change body surface temperature in this population. PURPOSE: This study was designed to investigate 1) the relationship between changes in body surface and routine tympanic temperatures, 2) the correlation between body surface temperature measurement frequency and detection of fever, and 3) the factors related to the incidence of fever in hospitalized older adults. METHODS: A prospective study was conducted on 33 hospitalized older adults aged 65 years or older who were suspected to have or diagnosed with an infection in an infectious disease and medical ward at a medical center in southern Taiwan from March to November 2020. Demographic, routine tympanic temperature, and heart rate data were collected by reviewing the participants' medical records. Body surface temperatures were monitored continuously using HEARThermo every 10 seconds until one of the following conditions were met: hospital discharge, no fever for three continuous days, and HEARThermo was removed. Descriptive analysis was used to compare the variations in body surface temperature and routine tympanic temperature measurements. Pearson correlation was used to analyze the correlation between different measurement frequencies and fever events. Finally, mixed effects logistic regression was used to analyze the factors significantly related to fever events. RESULTS: Seven hundred and twenty routine body temperature measurements were taken, with 209 (29.0%) fever events detected in 23 (69.7%) of the participants. The body surface temperatures were more closely correlated with tympanic temperatures during fever events than non-fever events (r = .260, p < .001). More fever events were detected using body surface temperature monitoring frequencies of every 10 seconds and every 1 minute. After controlling for demographic factors, the results of the mixed effect model indicate that body surface temperature and heart rate are significant factors related to fever events in hospitalized older adults (odds ratio, OR: 1.74, p < .001; OR: 1.11, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The continuous monitoring of body surface temperature may improve the detection of fever events in hospitalized older adults. The application of wearable devices and cloud platforms may further facilitate the real-time assessment and care capabilities of nurses, thus reducing their workload and improving care quality.

Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression.

OBJECTIVE: The association between human immunodeficiency virus (HIV)/AIDS and suicidality is not well understood, partly because of variability in results. This meta-analysis aimed to investigate the predictive value of HIV/acquired immune deficiency syndrome for incident suicidality. METHODS: A literature review was conducted of articles published between January 1, 2010, and October 31, 2021. The following databases were searched: Embase, MEDLINE, CINAHL, Web of Science, and Scopus. The search terms included human immunodeficiency virus (HIV), suicidal behavior, auto mutilation, and self-injurious behavior. Observational studies were screened following a registered protocol, and eligible ones were meta-analyzed and followed by meta-regression. RESULTS: A total of 43 studies were included in this systematic review, and a meta-regression included 170,234 participants. The pooled prevalence estimates of suicidal ideation, attempted suicide, and deaths by suicide were 22.3%, 9.6%, and 1.7%, respectively. The following significant risk factors for suicide ideation were found: substance use, depression, low quality of life, low social support, without HIV status disclosure, living alone, low level of memory problems, family history of suicide, and stage III of HIV. Risk factors for suicide attempts were depression and family history of suicide. An elevated risk for suicide-related death was found for people living with HIV (PLHIV) who had a psychiatric disorder and in studies conducted in hospital-based settings (versus national database studies or HIV clinic settings). CONCLUSIONS: The risk of suicidality is high among PLHIV within all six World Health Organization regions during the modern antiretroviral therapy era. Assessment of socioeconomic and psychological factors is recommended for further management to prevent suicide among PLHIV. The present findings are useful for design of intervention protocols and development of clinical practice guidelines intended to manage the well-being of PLHIV worldwide.

Predicting human papillomavirus vaccine uptake in men who have sex with men the influence of vaccine price and receiving an HPV diagnosis.

BACKGROUND: To understand how human papillomavirus (HPV) screening results, HPV-related knowledge and attitudes are related to vaccination intention in three cost ranges and the actual vaccination behavior in a community sample of men who have sex with men (MSM). METHODS: MSM aged 20 years of age or older were recruited between October 2015 and May 2016 from community health centers that provide HIV testing and consultation services in Southern Taiwan and on social media. MSM were seen at baseline and again at 6 months after baseline in a cohort study. The baseline study included 253 individuals; 182 of them returned for the 6th-month follow-up. At each visit, MSM were asked to receive HPV screening and filled out a questionnaire. Structural equation modeling was used to test whether attitudinal factors and HPV screening results from the baseline affect their self-reported actual vaccine uptake at the in 6th-month follow-up. RESULTS: Our research included 171 participants from the cohort because they had full information of the study variables (mean ± SD age = 29.21 ± 6.18). Our model showed good model fit using indices such as the comparative fit index (value = 0.998) and root mean square error of approximation (value = 0.013). HPV knowledge can predict those who have intention to take up HPV vaccine no matter what the price (p = .02), and then predict vaccine uptake at the follow-up (p < .001). A positive HPV screening result can predict vaccine uptake at the follow-up (p = .004). CONCLUSION: Our findings highlight the impact of vaccine price and HPV screening results on the intention and uptake of HPV vaccine. It is important to raise awareness of HPV in male populations. Clinicians and health educators should establish a safe and private environment for male patients for inquiring about HPV vaccine and HPV-related cancers.

HIV-related knowledge, information, and their contribution to stigmatization attitudes among females aged 15-24 years: regional disparities in Indonesia.

BACKGROUND: Stigmatization attitudes among youths toward people living with HIV (PLWH) is still an issue and concern in Indonesia. The purpose of this study was to determine the regional disparities, levels of HIV-related knowledge, information, and contributions related to stigmatization attitudes among females aged 15-24 years in Indonesia. METHODS: A cross-sectional study with The 2017 Indonesian Demographic Health Survey (IDHS) was used. A total of 12,691individual records of females aged 15-24 years were recruited through two-stage stratified cluster sampling. The endpoint was stigmatization attitude. Then, bivariate and multivariate binary logistics were performed. RESULTS: The findings showed that female youths who have no HIV-related knowledge (62.15%) and some source of information (52.39%). The highest prevalence of stigmatizing attitude was 59.82%, on Java Island. Multivariate analysis showed that females living in Sulawesi and Kalimantan; those living in a rural area; and those with more HIV-related knowledge were less likely to have a stigmatizing attitude. Conversely, females with the middle- to richest-wealth index and had some HIV-related information were more likely to have a stigmatizing attitude. CONCLUSION: An understanding of stigmatizing attitudes should be considered through demographic factors, knowledge, and source of HIV-related information. The Indonesian government should pay more attention to indicators of HIV-related knowledge and information. Moreover, we suggest that the government collaborates with youths to disseminate information and restructure and reanalyze policies about HIV.

Factors associated with insomnia and suicidal thoughts among outpatients, healthcare workers, and the general population in Taiwan during COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Insomnia and suicidal thoughts are two of the negative impacts that have been caused by the COVID-19 pandemic. Identifying the factors that contribute to these psychological problems may help develop strategies to sustain the mental health of the public. The present study examined the psychosocial impacts caused by the COVID-19 pandemic among different populations in Taiwan, and investigated the relationships between these psychosocial variables, insomnia, and suicidal thoughts. METHODS: Between September 2020 and May 2021, online questionnaires including psychometrically validated scales were distributed to a convenience sample of outpatients (n = 205), healthcare workers (HCWs) (n = 500), and individuals in the general population (n = 1200) in Taiwan to collect data regarding their insomnia severity, suicidal thoughts, fear of COVID-19, trust of information, and resilience. Multivariate logistic regression methods were used to identify variables associated with suicidal thoughts and insomnia. RESULTS: Greater fear of COVID-19 was significantly associated with suicidal thoughts: odds ratios (ORs) with 95% confidence interval (CI) = 1.155 (1.002-1.330) for outpatients; 1.127 (1.035-1.228) for HCWs; and 1.100 (1.130-1.222) for those in the general population. Higher resilience was significantly associated with lower insomnia: OR (95% CI) = 0.819 (0.725-0.926) for outpatients; 0.803 (0.728-0.887), for HCWs; 0.829 (0.785-0.875), and for those in the general population. In addition, there was a statistically significant association between insomnia diagnosis and greater fear of COVID-19 among HCWs (OR [95% CI] = 1.102 [1.062-1.144]) and those in the general population (OR [95% CI] = 1.079 [1.053-1.106]). Among outpatients, there was a statistically significant association between suicidal thoughts and lower trust of information (OR [95% CI] = 0.794 [0.646-0.976]), while among those in the general population there was a statistically significant association between suicidal thoughts and higher insomnia severity (OR [95% CI] = 1.175 [1.13-1.222]). A statistically significant association was also found between insomnia diagnosis and higher suicidal thoughts among those in the general population (OR [95% CI] = 3.455 [2.338-5.106]). CONCLUSIONS: Trust of information, fear, and resilience were important factors for suppressing suicidal thoughts and insomnia among the three study populations. Health policies that monitor psychological status and build resiliency of the public are recommended to help develop tailored strategies for different populations affected by the COVID-19 pandemic.

[Effectiveness of Nursing Leadership Training Programs: Mixed-Methods Research].

BACKGROUND: Taiwan Nurses Association (TWNA) has recommended nursing leader applicants to the International Council of Nurses (ICN) Global Nursing Leadership Institute since 2009, held the Nightingale Nursing Leadership Institute Training Program since 2011, and co-hosted the ICN Leadership for Change Program with ICN since 2015. The TWNA actively cultivates nursing leaders with vision and an international perspective. PURPOSE: To investigate the professional efficacy of nursing leaders who had attended these leadership training programs. METHODS: A mixed-methods research design was adopted. One hundred and sixty-seven nursing leaders who had attended at least one of the three leadership training programs were enrolled as participants. Data collected from online surveys were used in the quantitative analysis. Data collected from the content analysis of achievement reports and focus groups were used in the qualitative analysis. RESULTS: Diligence in work and listening were the highest-scoring items in the leadership and communication skills categories for the three leadership training programs. The results of the content analysis found that the achievement reports of the Nightingale Nursing Leadership Institute and Leadership for Change programs were mostly concerned with the professional issues in organizations. The impact of leadership training and suggestions for future program planning were discussed in the focus groups. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support that these training programs have been successful in promoting a commitment to organizational improvement among program participants and have increased the professional impact of nursing on society.

Factors Associated with Preferred Pre-Exposure Prophylaxis Dosing Regimen Among Men Who Have Sex with Men in Real-World Settings: A Mixed-Effect Model Analysis.

When provided with both choices of pre-exposure prophylaxis (PrEP) in MSM, men may choose to use either method based on their sexual practice. The study objective was to describe the switches between dosing regimens and identify factors that predict choice of a dosing regimen among MSM. We performed a multi-center, observational, prospective PrEP cohort study conducted at three study sites in Taiwan between January 2018 and March 2019. A total of 215 participants made 469 visits. In half of the visits (49.7%), participants reported using on-demand PrEP. There were 36 regimen switches: 20 from daily to on-demand and 16 from on-demand to daily. Among 28 participants who switched regimens, 22 switched regimens once and 6 switched more than once. The frequency of condomless anal sex and a history of post-exposure prophylaxis use were associated with taking PrEP on-demand (p < 0.05). PrEP adherence intervention should be tailored specifically to sexual behavior to increase adherence to PrEP.

RESUMEN: Cuando se les proporcionan ambas opciones de la profilaxis pre-exposición (PrEP) en HSH, los hombres pueden elegir usar cualquiera de los métodos según su práctica sexual. El objetivo del estudio fue describir los cambios entre los regímenes de dosificación e identificar los factores que predicen la elección del régimen de dosificación entre los HSH. Realizamos un estudio de cohorte prospectivo, observacional y multicéntrico de la PrEP realizado en tres sitios de estudio en Taiwán entre enero de 2018 y marzo de 2019. Un total de 215 participantes contribuyeron con 469 visitas. En la mitad de las visitas (49.7%), los participantes informaron haber usado PrEP a pedido. Hubo 36 cambios de régimen: 20 de diario a pedido y 16 de pedido a diario. Entre los 28 participantes que cambiaron de régimen, 22 cambiaron de régimen una vez y 6 cambiaron más de una vez. La frecuencia del sexo anal sin condón y cualquier uso previo de la PEP fueron asociados con la toma de la PrEP a pedido (p < .05). La intervención de adherencia a la PrEP debe adaptarse específicamente al comportamiento sexual para aumentar la adherencia a la PrEP.

Mobile HIV Testing Through Social Networking Platforms: Comparative Study.

BACKGROUND: Improving HIV screening in key populations is a crucial strategy to achieve the goal of eliminating AIDS in 2030. Social networking platforms can be used to recruit high risk-taking men who have sex with men (MSM) to promote the delivery of voluntary counseling and testing (VCT) as mobile HIV testing. Therefore, client recruitment and availability of mobile HIV testing through social networking platforms requires further evaluation. OBJECTIVE: The aim of this study is to compare the effects of targeting high risk-taking MSM and HIV case finding between two mobile HIV testing recruitment approaches: through the traditional website-based approach and through social networking platforms. METHODS: A comparative study design and propensity score matching was applied. The traditional VCT model, that is, the control group, recruited MSM through a website, and a trained research assistant visited the walk-in testing station at a gay village on Friday and Saturday nights. The social networking VCT model, the experimental group, recruited MSM from social networking platforms by periodically reloading into and conducting web-based discussions on dating apps and Facebook. The participants then referred to others in their social networks via a popular messenger app in Taiwan. The test was conducted at a designated time and place during weekdays by a trained research assistant. Across both modes of contact, before the mobile HIV testing, participants needed to provide demographic characteristics and respond to a questionnaire about HIV risk-taking behaviors. RESULTS: We recruited 831 MSM over 6 months, with a completion rate of 8.56% (616/7200) in the traditional VCT model and 20.71% (215/1038) in the social networking VCT model. After propensity score matching, there were 215 MSM in each group (mean age 29.97, SD 7.61 years). The social networking model was more likely to reach MSM with HIV risk-taking behaviors, that is, those seeking sexual activity through social media, having multiple sexual partners and unprotected anal intercourse, having experience of recreational drug use, and never having or not regularly having an HIV test, compared with the traditional model. HIV positive rates (incidence rate ratio 3.40, 95% CI 1.089-10.584; P=.03) and clinic referral rates (incidence rate ratio 0.03, 95% CI 0.001-0.585; P=.006) were significantly higher among those in the social networking VCT model than in the traditional VCT model. CONCLUSIONS: Through effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted, as compared with the traditional VCT model, to target high risk-taking MSM and increase testing outcomes.

Is nurse-led case management effective in improving treatment outcomes for cancer patients? A systematic review and meta-analysis.

AIMS: To identify and synthesize the outcomes of nurse-led case management interventions for improving cancer treatment. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, MEDLINE, CINAHL, EMBASE, Cochrane Library and CEPS were searched for articles published from inception till June 2019, and search was finalized in January 2020. REVIEW METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The quality of evidence was assessed using Joanna Briggs Institute Critical Appraisal Tools. Outcomes were analysed by using a pool of data of 95% confidence intervals (CIs), p value and fitting model based on heterogeneity of test results. RESULTS: Eleven articles were included in the meta-analysis. When compared with the regular care group, the nurse-led case management group had: 1) shorter time from diagnosis to treatment by 9.07 days, 2) an improved treatment completion rates (OR = 2.45) and 3) more number of patients received hormone therapy. CONCLUSION: The synthesized results presented that nurse-led case management is more effective than regular care in improving treatment timeliness, treatment completion rates and hormone therapy rates.

The impact of physician subspeciality on the quality of diabetes care for people living with HIV.

BACKGROUND: Management of comorbidities of people living with HIV (PLHIV) involves different care models, including providing diabetes care and HIV care by the same infectious diseases physician (IDP) ("consolidated care") or providing diabetes care by the physicians other than IDP ("shared care"). The impact of diabetes care model on PLHIV with diabetes mellitus (DM) has not been well-evaluated. METHODS: A nationwide cross-sectional sample in the Taiwan National Health Insurance Research Database was used to compare the performance rates of seven guideline-recommended tests provided by the different subspecialists. RESULTS: Of 523 PLHIV with DM, there were 54.88% (n = 287) in the consolidated care group and 45.12% (n = 236) in the shared care group. More patients in the consolidated care group received the tests of lipid profile (92.33% vs. 79.24%), creatinine (Cr) (93.73% vs. 78.39%), and alanine transaminase (ALT) (91.99% vs. 75.42%), but fewer received urine protein test (35.54% vs. 51.69%) and fundoscopic examination (8.01% vs. 33.90%). The two groups did not differ in the performance rates of serum fasting glucose and HbA1c. After controlling for demographic factors and diabetic severity, the consolidated group was less likely to miss the serum tests of lipid profile (odds ratio [OR]: 0.30), Cr (OR: 0.19), and ALT (OR: 0.23), but more often missed urine protein test (OR: 1.56) and fundoscopic examination (OR: 4.97). CONCLUSION: These findings suggest the need to focus on different process indicators of diabetes cares in different care models to enhance the diabetes care for PLHIV.

Poor mental health among Taiwanese people experiencing the public debates on and referendums for same-sex marriage: A Facebook online survey.

BACKGROUND/PURPOSE: Public debates on legalization of same-sex marriage occurred in Taiwan since the latter half of 2016. Taiwanese people voted on same-sex marriage referendums on November 24, 2018. The aim of this Facebook online study was to examine the changes in rates of poor mental health status among Taiwanese people during the 23-month period of public debates on and referendums for legalizing same-sex marriage. METHODS: A two-wave internet survey was conducted using Facebook to gather information regarding mental health and attitudes toward same-sex marriage among 3286 participants (1456 heterosexual and 1830 nonheterosexul) in Wave 1 (one week after the first reading of the Marriage Equality Bill) and 1370 participants (540 heterosexual and 830 nonheterosexul) in Wave 2 survey (one week after the referendum of same-sex marriage). The five-item Brief Symptom Rating Scale was used for assessing mental health status. RESULTS: The rate of poor mental health status significantly increased from the Wave 1 to Wave 2 surveys in heterosexual, lesbian, gay and bisexual (LGB) participants. In nonherterosexual groups, the rates of poor mental health status increased in LGB and female and male nonheterosexual participants of all age. The rates of poor mental health status also increased in heterosexual participants who were female, were young, and supported same-sex marriage. CONCLUSION: The rates of poor mental health status increased in both heterosexual and nonheterosexual people during the period of public debates on and the referendums for same-sex marriage. Heterosexual people who were female, were young, and supported same-sex marriage had also increased rates of poor mental health state during the same period.

Prevalence and risk factors of anogenital human papillomavirus infection in a community sample of men who have sex with men in Taiwan: baseline findings from a cohort study.

OBJECTIVES: Men who have sex with men (MSM) are a highly neglected population in the current recommendation of girls-only human papillomavirus (HPV) vaccination programmes in many countries. To better assess the cost effectiveness of HPV vaccination among men requires data on the prevalence of HPV infection in MSM using a community sample, which is still sparse in several regions. We examined the prevalence of and factors associated with anogenital HPV infection among MSM in Taiwan. METHODS: MSM 20 years of age and older were recruited from the community and social media in Taiwan in 2015-2016 and screened for HPV infection to detect 37 genotypes. MSM were seen at baseline and were/will be seen at 6, 12, 24 and 36 months. Men completed a questionnaire regarding their sexual experiences. Multivariable regression analyses were conducted to identify associated behavioural risk factors using the baseline data. RESULTS: A total of 253 MSM were recruited; 87 % were below 35 years of age. Diagnosis of HIV was reported in 4% of men; just over 20% had three or more anal sex partners in the past year. The prevalence of any tested HPV type was 29.4% at the anal site and 11% at the penile site. One quarter of MSM were infected with any of the 9-valent vaccine HPV types. Anal HPV detection was associated with having three or more receptive anal sex partners in the past year (adjusted odds ratio (aOR)=2.92, 95% CI 1.29 to 6.61) and having older sex partners (aOR=2.51, 95% CI 1.07 to 5.90). CONCLUSIONS: Our data provide the base to calculate the reproductive rate for HPV transmission in a low-risk community sample and cost-effectiveness to include men in HPV vaccination policies. Adding evidence from a community sample adds comprehensiveness for future estimates of disease transmission and vaccine effectiveness.

The moderator effect of retention in care on late presentation in HIV-infected patients.

The moderator effect of retention in care on late presenters in HIV patients has not been well evaluated. A nationwide cohort study focusing on HIV-infected patients with new engagement in care was conducted by using the Taiwan National Health Insurance Research Database. Retention in care was defined based on the healthcare utilization in the first year after engaging in HIV care. Then, the impact of late presentation, retention in care, and their interaction on the risk of subsequent hospitalizations due to opportunistic infections (OIs-hospitalizations) in the second year were examined. More than half (59.38%) of the total patients (n = 9112) were retained in care in the first year, 8.63% were late presenters, and 110 (1.21%) patients had subsequent hospitalization in the second year. Late presentation and non-retention were independent predictors of OIs-hospitalizations in the second year (OR: 2.58 and OR: 3.27, respectively) and the interaction between them was statistically significant (non-retention in care × late presentation, OR: 3.82). This study showed that retention in care in the first year is a moderator providing a stronger protective effect for late presenters than early presenters. Our findings call for policymakers to develop different strategies for early or late presenters.