A P-type pentatricopeptide repeat protein ZmRF5 promotes 5' region partial cleavages of atp6c transcripts to restore the fertility of CMS-C maize by recruiting a splicing factor.

A fast evolution within mitochondria genome(s) often generates discords between nuclear and mitochondria, which is manifested as cytoplasmic male sterility (CMS) and fertility restoration (Rf) system. The maize CMS-C trait is regulated by the chimeric mitochondrial gene, atp6c, and can be recovered by the restorer gene ZmRf5. Through positional cloning in this study, we identified the nuclear restorer gene, ZmRf5, which encodes a P-type pentatricopeptide repeat (PPR) family protein. The over-expression of ZmRf5 brought back the fertility to CMS-C plants, whereas its genomic editing by CRISPR/Cas9 induced abortive pollens in the restorer line. ZmRF5 is sorted to mitochondria, and recruited RS31A, a splicing factor, through MORF8 to form a cleaving/restoring complex, which promoted the cleaving of the CMS-associated transcripts atp6c by shifting the major cleavage site from 480th nt to 344 th nt for fast degradation, and preserved just right amount of atp6c RNA for protein translation, providing adequate ATP6C to assembly complex V, thus restoring male fertility. Interestingly, ATP6C in the sterile line CMo17A, with similar cytology and physiology changes to YU87-1A, was accumulated much less than it in NMo17B, exhibiting a contrary trend in the YU87-1 nuclear genome previously reported, and was restored to normal level in the presence of ZmRF5. Collectively these findings unveil a new molecular mechanism underlying fertility restoration by which ZmRF5 cooperates with MORF8 and RS31A to restore CMS-C fertility in maize, complemented and perfected the sterility mechanism, and enrich the perspectives on communications between nucleus and mitochondria.

Mapping the gene of a maize leaf senescence mutant and understanding the senescence pathways by expression analysis.

KEY MESSAGES: Narrowing down to a single putative target gene behind a leaf senescence mutant and constructing the regulation network by proteomic method. Leaf senescence mutant is an important resource for exploring molecular mechanism of aging. To dig for potential modulation networks during maize leaf aging process, we delimited the gene responsible for a premature leaf senescence mutant els5 to a 1.1 Mb interval in the B73 reference genome using a BC1F1 population with 40,000 plants, and analyzed the leaf proteomics of the mutant and its near-isogenic wild type line. A total of 1355 differentially accumulated proteins (DAP) were mainly enriched in regulation pathways such as "photosynthesis", "ribosome", and "porphyrin and chlorophyll metabolism" by the KEGG pathway analysis. The interaction networks constructed by incorporation of transcriptome data showed that ZmELS5 likely repaired several key factors in the photosynthesis system. The putative candidate proteins for els5 were proposed based on DAPs in the fined QTL mapping interval. These results provide fundamental basis for cloning and functional research of the els5 gene, and new insights into the molecular mechanism of leaf senescence in maize.

Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: a qualitative study.

Although recent medical studies have found a significant correlation between betel quid chewing and oral cancer, some Taiwanese aboriginal people continue the traditional betel quid culture. Using the transtheoretical model framework, we conducted a qualitative study to examine the stages of behavioral change in betel quid chewing in the Paiwan sociocultural context. We conducted in-depth interviews with 20 aboriginal chewers of betel quid. Results of a content analysis showed significant patterns in the precontemplation, contemplation, action, and maintenance stages, but none in the preparation stage. Relapse was most likely to occur between the contemplation and action stages. In the precontemplation stage, interviewees showed no motivation to change their chewing behavior due to shared positive attitudes of psychosocial benefits and cultural identity. In the contemplation stage, dependent-type chewers were aware of oral damage and pain caused by chewing betel quid but could not resist their cravings; social-type chewers showed approach-avoidance conflicts between social needs and cessation. Chewers entered the action stage once they decided to quit; "to stop immediately" or "reduce quantity" were the most frequent strategies reported. In this stage, chewers endured withdrawal symptoms and refused betel quid from others but tended to relapse easily. Participants entering the maintenance stage were not affected by withdrawal symptoms and did not have ulcers or pain. Future research should identify ways to preserve traditional aboriginal culture while encouraging aboriginal people to quit betel quid chewing to promote the prevention and treatment of oral cancer.

Mediating effects of fatigue on the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis.

The aim of this study was to explore how hemodialysis patients' quality of life is related to sociodemographic data and depression as predicting variables, and how it is affected by fatigue as a mediating variable. Participants were 405 patients who has been receiving hemodialysis treatment regularly. SPSS Amos path analysis was used to explore the causal relationship and the mediating effect of fatigue among the variables of sociodemographic characteristics, depression, and quality of life. Unstandardized estimates determined that while sociodemographic characteristics were a significant predictor of fatigue, they were not directly related to quality of life. The results showed that depression and fatigue in patients receiving hemodialysis are important factors that affect patients' quality of life to a greater (fatigue) or lesser (depression) extent. Depression can affect patients' quality of life either directly or indirectly via fatigue. In this study, we demonstrated that fatigue plays an important role in the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis. The results of the study further suggest that comprehensive management programs should be applied with patients to reduce their fatigue, and ultimately to improve their quality of life.

Patterns of Betel Quid, Cigarette, and Alcohol Use, and Their Correlates With Betel Quid Cessation in a Male Inmate Population.

BACKGROUND: There are few published studies addressing multiple substance uses and their effects on subsequent cessation of betel quid (BQ) chewing in the Asia Pacific region. OBJECTIVES: This study aims to investigate the usage patterns of BQ chewing, cigarette smoking, and alcohol drinking, and their correlates with subsequent BQ cessation among a male inmate population. METHODS: Data from 473 male inmates with a history of BQ use who were incarcerated in Taiwan Kaohsiung Prison was used for this analysis. Participants were asked to report their lifetime usage patterns of cigarette, alcohol, and BQ, and their cessation status of each substance. A stepwise logistic regression analysis was performed to identify predictors of voluntary BQ cessation. RESULTS: Seventy-five percent of all participants reported habitual use of all three substances. A total of 185 (39%) participants reported voluntary cessation of BQ prior to incarceration, and 288 (61%) reported cessation because of incarceration. Inmates who quit smoking before incarceration were more likely to voluntarily quit BQ. Inmates who had drinking habits were less likely to quit BQ, but those who quit drinking before incarceration were more likely to quit BQ. Inmates who preferred the type of BQ known as lao-hwa quid were more likely to quit BQ, and a longer chewing history correlated with a lower likelihood of quitting BQ. CONCLUSIONS IMPORTANCE: Our data suggest that coexisting habitual use of cigarette, alcohol, and BQ is very common in this inmate population. BQ cessation is significantly associated with not only inmates' usage patterns of cigarette and alcohol, but also their cessation status of these substances.

The impact of depression on fatigue in patients with haemodialysis: a correlational study.

AIMS AND OBJECTIVES: To investigate the fatigue levels and important fatigue predictors for patients undergoing haemodialysis. BACKGROUND: Fatigue is a common symptom for haemodialysis patients. With its debilitating and distressing effects, it impacts patients in terms of their quality of life while also increasing their mortality rate. DESIGN: A descriptive correlational study. METHODS: Convenience sampling was conducted at six chosen haemodialysis centres in Southern Taiwan. Data were collected via a structured questionnaire from 193 haemodialysis patients. The scales involved in this study were socio-demographic details, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Scale for haemodialysis patients. Data analysis included percentages, means, standard deviations and hierarchical multiple regression analysis. RESULTS: The fatigue level for haemodialysis patients was in the moderate range. Results from the hierarchical multiple regression analysis indicated that age, employment status, types of medications, physical activity and depression were significant. Of those variables, depression had the greatest impact on the patients' fatigue level, accounting for up to 30·6% of the explanatory power. The total explanatory power of the regression model was 64·2%. CONCLUSION: This study determined that for haemodialysis patients, unemployment, increased age, taking more medications or lower exercise frequencies resulted in more severe depression, which translated in turn to higher levels of fatigue. Among all these factors, depression had the greatest impact on the patients' fatigue levels. RELEVANCE TO CLINICAL PRACTICE: Not only is this finding beneficial to future studies on fatigue as a source of reference, it is also helpful in our understanding of important predictors relating to fatigue in the everyday lives of haemodialysis patients. It is recommended that when caring for fatigued patients, more care should be dedicated to their psychological states, and assistance should be provided in a timely way so as to reduce the amount of fatigue suffered.

The relationships among work stress, resourcefulness, and depression level in psychiatric nurses.

Psychiatric nurses are exposed to highly stressful work environments that can lead to depression over time. This study aimed to explore the relationships among work stress, resourcefulness, and depression levels of psychiatric nurses. A cross-sectional design with randomized sampling was used; 154 psychiatric nurses were recruited from six medical centers in Taiwan. Psychiatric nurses' work stress was found positively correlated with their depression level, and negatively related to resourcefulness. Work stress significantly predicted depression level. These results suggest that the hospital administrative units may develop training courses about resourcefulness skills to reduce psychiatric nurses' work stress, and improve their mental health.

The association of peritoneal dialysis and hemodialysis on mitral and aortic valve calcification associated mortality: a meta-analysis.

Cardiac valve calcification (CVC), characterized by the accumulation of calcium in the heart valves, is highly prevalent among patients undergoing dialysis. This meta-analysis aimed to provide an updated summary of recent studies on the prognostic value of CVC in patients undergoing dialysis. We conducted a search of PubMed, Embase, and Web of Science to identify observational studies investigating cardiovascular or all-cause mortality associated with CVC in dialysis patients until March 2023. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated for the meta-analysis, and the strength and significance of the associations between CVC and mortality outcomes in dialysis patients were assessed. From 6218 initially identified studies, we included 10 critical studies with a total of 3376 dialysis patients in a further meta-analysis. Pooled analyses demonstrated a significant association between CVC and an elevated risk of all-cause and cardiovascular mortality in dialysis patients. In our study, we discovered HRs of 1.592 (95% CI 1.410-1.797) for all-cause mortality and 2.444 (95% CI 1.632-3.659) for cardiovascular mortality. Furthermore, subgroup analysis revealed elevated all-cause mortality among patients with mitral valve calcification (HR 1.572; 95% CI 1.200-2.060) compared to those with aortic valve calcification (HR 1.456; 95% CI 1.105-1.917). Similarly, patients undergoing peritoneal dialysis faced a greater risk for all-cause mortality (HR 2.094; 95% CI 1.374-3.191) than those on hemodialysis (HR 1.553; 95% CI 1.369-1.763). This highlights the possibility of CVC being an independent risk factor for dialysis patients, particularly in relation to mitral valve calcification or peritoneal dialysis.

Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs.

AIM: Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre-end-stage renal disease (ESRD) care. METHODS: One hundred and forty incident haemodialysis patients were classified into the CKD Care Group (n = 71) and the Nephrologist Care Group (n = 69) according to participation in the CKD care program before dialysis initiation. The 'total observation period' was divided into '6 months before dialysis' and 'at dialysis initiation'. Quality of pre-ESRD care, service utilization and medical costs were evaluated and compared between groups. RESULTS: The mean estimated glomerular filtration rates at dialysis initiation were low in both groups; but the levels of haematocrit and serum albumin of the CKD Care Group were significantly higher. The percentages of patients initiating dialysis with created vascular access, without insertion of double-lumen catheter and without hospitalization were 57.7%, 50.7% and 40.8%, respectively, in the CKD Care Group, and 37.7%, 29.0% and 18.8% in the Nephrologist Care Group (P < 0.001). Participation in the CKD care program, though with higher costs during the 6 months before dialysis ($US1428 +/- 2049 vs US$675 +/- 962/patient, P < 0.001), was significantly associated with lower medical costs at dialysis initiation ($US942 +/- 1941 vs $US2410 +/- 2481/patient, P < 0.001) and for the total period of observation ($US2674 +/- 2780 vs $US3872 +/- 3270/patient, P = 0.009). The cost-saving effect came through the early preparation of vascular access and the lack of hospitalization at dialysis initiation. CONCLUSION: CKD care programs significantly improve quality of pre-ESRD care, decrease service utilization and save medical costs.

Systematic review and meta-analysis of Chinese herbal medicine as adjuvant treatment in advanced non-small cell lung cancer patients.

INTRODUCTION: Whether combining Chinese herbal medicines (CHMs) and chemotherapy to treat patients with advanced non-small-cell lung cancer (NSCLC) has clinical benefits has yet to be confirmed. A meta-analysis was performed to address the efficacy of CHM in patients with advanced NSCLC. METHODS: Seven databases, including PubMed, MEDLINE, Cochrane Library, Embase, CINAHL Plus with Full Text (EBSCO), WANFANG DATA and the Chinese National Knowledge Infrastructure (CNKI), were systematically searched for available literature through March10, 2020. A meta-analysis was conducted to generate combined risk ratios(RRs) with 95 % confidence intervals (CIs) for objective response rates (ORRs), disease control rates (DCRs), and 1-year overall survival (OS) rates, and a random-effects model was used to estimate the standardized mean differences (SMDs) with 95 % CI for quality or life (QOL), median survival time (mST) and progression-free survival (PFS). RESULTS: Reports of 14 randomized controlled trials involving 1451 patients were included in the analysis. Among them, 739 patients received CHMs, and 712 patients received chemotherapy alone. The ORR (RR = 1.37, 95 % CI [1.20-1.58], p = .000), DCR (RR = 1.13, 95 % CI [1.07-1.21], p = 0.000), QOL (SMD = 1.47; 95 % CI [0.30-2.64]; p = 0.014), mST (SMD = 1.62; 95 % CI [1.15-2.08];p = .000), and 1-year OS rate (RR = 1.24, 95 % CI [1.05-1.47], p = 0.01) were higher in patients with NSCLC who received CHMs than in those who received only chemotherapy. However, the CHM group was not found to have a higher median PFS (SMD = 1.27, 95 % CI [-0.22-2.78], p = .095) than the chemotherapy group. Publication bias for ORR and DCR was indicated by funnel plot. For the efficacy endpoint, no evidence of a lack of robustness was found, according to the sensitivity analysis. These results must be interpreted with caution due to differences in the designs of the trials and patients' characteristics, and also due to the presence of missing data. CONCLUSIONS: Our study found that higher ORR, DCR, QOL, mST and 1-year OS rate were associated with CHM use as an adjuvant to chemotherapy. Although these results require further confirmation, CHMs apparently have potential therapeutic value for patients with advanced NSCLC.

Higher-order exploratory factor analysis of the Dental Subscale of Children's Fear Survey Schedule in a Taiwanese population.

OBJECTIVES: The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is extensively used to assess the level of child dental anxiety. The present study aimed to explore the higher-order factor structure of the parental Chinese version of the CFSS-DS with a large sample of young children in Taiwan. DESIGN: The parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5 to 8- year-old children at kindergartens and elementary schools in Kaohsiung city, Taiwan. Subjects were selected by stratified random sampling. The stratification was done by geographic district, age group, and gender. PARTICIPANTS: The sample was 1,819 children aged 5 to 8 years old. MAIN OUTCOME MEASURES: A first-order factor analysis was performed using the principal components method with promax rotation, and a second-order factor was obtained by applying the Schmid-Leiman solution (SLS). RESULTS: The present study found three first-order factors, defined as: (1) fear of dental aspects, (2) fear of medical aspects, and (3) fear of potential victimization. The second-order factor defined as "dental fear" accounted for most of the variance in the second-order factor structure. The results of higher-order factor analysis according to different gender or age levels were identical. CONCLUSIONS: A higher-order factor structure consisting of a single second-order factor and three first-order factors was extracted, giving a fuller understanding of the CFSS-DS. The second-order factor structure of Chinese version CFSS-DS was stable and reliable.

Self-care behaviour and related factors in older people with Type 2 diabetes.

AIM: The present study examined the factors related to self-care behaviour in type 2 diabetic patients aged > or =65 years. In addition, this study tested the effect of the important explanatory factors on self-care behaviour. BACKGROUND: Along with the development of an ageing society, diabetes occurs frequently among older people. Diabetes requires continual medical treatment, with patients responsible for self-care. Although the relationships among social support, depression and self-care have been widely studied, little is know about older diabetic patients, especially in Taiwan. DESIGN: A correlational design was adopted. In total, 165 patients recruited using convenience sampling were diabetic outpatients at three hospitals in southern Taiwan from January-March 2005. METHODS: The participants were interviewed using the Personal Resource Questionnaire 2000 (PRQ 2000), Diabetes Self-Care Scale and Taiwan Geriatric Depression Scale (TGDS). Data were analysed using descriptive statistics and multiple regression analysis. RESULT: Self-care behaviour scores were significantly influenced by different gender, education level, economic status and religious beliefs of older diabetic patients. Depression and self-care behaviour were negatively correlated. Social support, education and duration of diabetes significantly affected self-care behaviour, accounting for 35.6% of total variance. CONCLUSIONS. Social support plays a vital factor in contributing to the facilitation of self-care behaviour. These analytical findings demonstrate the importance of social support, education and duration of diabetes in determining self-care behaviour for diabetic older diabetic patients and serve as references for future studies of self-care behaviour in type 2 older diabetic patients. RELEVANCE TO CLINICAL PRACTICE: Implication for nurses highlights the significance of providing patients with social support that will enable them to have good support systems during their disease treatment to enhance self-care abilities and improve quality of life.

Mental Symptoms in Different Health Professionals During the SARS Attack: A Follow-up Study.

AIM: The aims of the study were to assess the psychological impact of SARS bio-disaster on healthcare workers. METHODS: The participants were 127 healthcare workers who had taken care of suspected SARS patients. All participants completed the Chinese Health Questionnaire (CHQ), Eysenck Personality Questionnaire, and Parental Bonding Instrument at the first stage and the CHQ again a year later. RESULTS: Healthcare workers that had mental symptoms at follow-up reported the symptoms were associated with daily-life stress and not the SARS crisis. The physicians had more somatic symptoms than nurses, suggesting different professions have different impact on mental health. Additionally, individual's early maternal attachment and neuroticism were found to have greater effect on mental health of life-threatening stress. CONCLUSIONS: Life-threatening and daily-life stress show two different patterns of influence on mental health. These results provided a preclinical model for understanding, and preventing, human stress-related psychiatric disorders in the future.

The clinically related predictors of dental fear in Taiwanese children.

BACKGROUND: Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. OBJECTIVE: This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. DESIGN: The dental history of 247 children (2-10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviour of children, respectively. RESULTS: We found that the CFSS-DS score and clinical anxiety have different predictors, but age < or = 3.99 years old and cooperativeness in the first dental visit were important predictors for both the CFSS-DS score and the clinical anxiety. Furthermore, the other predictors of the CFSS-DS score were maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic; the other predictors of clinical anxiety were first-born, regular dentist, and CFSS-DS score. Finally, the only significant predictor for uncooperative behaviour was clinical anxiety. CONCLUSION: Children's dental fear and their anxious response during dental treatment were dynamic processes that consisted of many different factors. The direct conditioning of subjective experience of pain was more important than the objective pathway of child dental fear, and the indirect conditioning does not seem influential in this study sample.

Correlates of depression in type 2 diabetic elderly patients: a correlational study.

OBJECTIVES: This aim of this study was to investigate depression and related factors in elderly patients (65 years) with type 2 diabetics. METHODS: The study utilized a descriptive-correlational design. Convenience sampling was applied to enroll 156 subjects, aged >or= 65 years from diabetic outpatient clinics at three hospitals in Kaohsiung. This study applied the Personal Resource Questionnaire 2000 (PRQ 2000), Taiwan Geriatric Depression Scale (TGDS), and a form for demographic data. RESULTS: (1) The mean index score for depression level was 26, indicating that study subjects had a low level of depression. The social support index score was 76. (2) Significant differences in TGDS scores existed for diabetes duration, diabetes complications, and treatment type. (3) Social support and regular exercise were significantly and negatively correlated with depression. (4) Social support and diabetes complications were significant correlates of depression and accounted for 25.9% of variance in depression. CONCLUSION: Analytical results may assist nurses in understanding depression and related factors for diabetic patients aged >or= 65. Therefore, this study could form a basis for caring older people with diabetes, and provide a reference for further research.

Qualitative study for betel quid cessation among oral cancer patients.

The psychoactive effects of using areca nut and its potential for dependence have been observed. However, the factors that create barriers to or promote chewing cessation are not well understood. This study aims to explore the behavioral changes of betel quid chewers who have been diagnosed with oral cancer within a transtheoretical model framework. Thirty oral cancer patients with betel quid chewing history were chosen for in-depth interviews. Qualitative content analysis was used to analyze the data and identify themes that described the behavioral changes of betel quid cessation. Our research showed that betel quid chewers with oral cancer typically experience four significant stages of behavior: pre-contemplation, contemplation, action, and maintenance. Each stage change was marked by specific characteristics. At first, chewers showed positive attitudes toward the psychoactive or social effects of betel quid. They then realized the negative effects of betel quid, such as dental or other physical problems. Some also realized that they were addicted to betel quid. When they decided to quit, most chewers reported going "cold turkey." Some chewers successfully quit betel quid and attributed it to willpower. Those quitting because of the loss of oral functions were unable to chew anymore, though some chewers had experienced a relapse. In the maintenance stage, ex-chewers reported overcoming their addiction; however, relapse was possible. In this study, those who quit betel quid because of oral cancer usually quit tobacco and alcohol as well, with a lesser chance of recurrence. As the maintenance of chewing betel quid is multifactorial, this study provides information for betel quid cessation and oral cancer prevention.

Mediators of the Effects of Gender on Uric Acid Nephrolithiasis: A Novel Application of Structural Equation Modeling.

Numerous epidemiological studies have shown that male patients with uric acid nephrolithiasis outnumber female patients. To our knowledge, no research exists evaluating the reasons gender affects the development of uric acid nephrolithiasis. We hereby used a novel application of structural equation modeling to analyze the mediators of the effects of gender on uric acid nephrolithiasis. In 1,098 patients with nephrolithiasis between 2012 and 2016, male gender was found to have a statistically significant positive indirect effect on the development of uric acid nephrolithiasis, which was mediated by lower urine pH (estimate: 0.010, standard error: 0.005, critical ratio: 2.135, 95% confidence interval: 0.002-0.023, P = 0.017), lower estimated glomerular filtration rate (estimate: 0.014, standard error: 0.005, critical ratio: 2.993, 95% confidence interval: 0.006-0.025, P < 0.001), and higher incidence rate of gout (estimate: 0.009, standard error: 0.005, critical ratio: 2.028, 95% confidence interval: 0.002-0.021, P = 0.009). We conclude that low urine pH, impaired renal function, and gout are the mediators of the effect of male gender on the development of uric acid nephrolithiasis. The survey, treatment, and follow-up of kidney diseases, acidic urine, and uric acid metabolism disorders should be considered in men with uric acid nephrolithiasis.

Parental attachment, premorbid personality, and mental health in young males with hyperventilation syndrome.

The aim of the study was to examine the predisposing and precipitating factors in the development of hyperventilation syndrome in males during military training in Taiwan. The participants included 110 young males who visited the emergency room of a teaching hospital in southern Taiwan because of an episode of acute hyperventilation during military training. Another 53 males, who had the same military training, and who did not experience hyperventilation or any psychiatric symptoms, were recruited as the control group. The risk of hyperventilation syndrome was increased by the following factors: greater neuroticism, less extraversion, parental overprotection, and less parental caring. A final parsimonious structural equation model showed a cause-effect relationship between the direct effects of maternal overprotection and introversion and the individual's neurotic characteristics, which contributed to the individual's current mental health status and the development of hyperventilation syndrome. Military training could be a precipitating factor in the development of hyperventilation syndrome in young males. The elucidation of these factors may contribute to the understanding and treatment of hyperventilation syndrome. The determination of competing risk factors and mediating effects in males with hyperventilation syndrome should be considered in future studies.

Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children.

OBJECTIVES: Many people experience discomfort to a greater or lesser degree about the prospect of dental treatment. Dental treatment can be a terrible experience, especially for children with dental anxiety. This study estimated the prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City, Taiwan. METHODS: The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was translated into Chinese, and a receiver operating characteristic (ROC) curve was made based on criteria determined from pretest clinical observations of a sample population to set a cutoff score. Then, the parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5- to 8-year-old children at kindergartens and elementary schools in Kaohsiung City, Taiwan. Participants were selected by stratified random sampling. The stratification was done by geographic district, age group, and sex. A total of 3,597 valid questionnaires were collected. RESULTS: The Chinese version of the CFSS-DS had an optimal cutoff score of 38/39 (sensitivity was 0.857, specificity was 0.882) with an area under the ROC curve of 0.912. The estimated prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City was 20.6 percent. The dental anxiety score was found to decrease as age increased; primary school boys had significantly lower scores. CONCLUSIONS: The prevalence of dental anxiety was found to be high for 5- to 8-year-old Taiwanese children. The study's findings point to the urgent need for preventive health education and intervention programs in Taiwan to promote children's oral health and reduce dental anxiety.

Impact of pay-for-performance on mortality in diabetes patients in Taiwan: A population-based study.

BACKGROUND: The impact of pay-for-performance (P4P) programs on long-term mortality for chronic illnesses, especially diabetes mellitus, has been rarely reported. Several studies described the favorable impact of P4P for diabetes mellitus on medical utilizations or intermediate outcomes. Therefore, this study aimed to investigate the impact of a P4P program on mortality in patients with type 2 diabetes. METHODS: The P4P group in this population-based cohort study was 2090 individuals with a primary diagnosis of type 2 diabetes who had been newly enrolled in the P4P program of Taiwan between January 1, 2004 and December 31, 2004. Matched by 1:1 ratio, patients in the non-P4P group were selected by propensity score matching (PSM) for sex, age, the first year of diagnosis as diabetes, and 32 other potential confounding factors. Mean (SD) age was 60.91 (12.04) years when diabetes was first diagnosed and mean (SD) duration of diabetes was 4.3 (1.9) years at baseline. The time-dependent Cox regression model was used to explore the impact of P4P on all-cause mortality. RESULTS: During a mean of 5.13 years (SD = 1.07 years) of follow-up, 206 and 263 subjects died in the P4P group and the non-P4P group, respectively. After adjusting for the potential confounding factors at baseline, survival was significantly longer in the P4P group than in the non-P4P group (hazard ratio, 0.76 [95% confidence interval, 0.64-0.92], P = 0.004, by log-rank test). This decrease in mortality is equivalent to one less death for every 37 patients who were treated in the P4P program for 5.13 years. In this study, the P4P program significantly increased the medical utilization of physician visits and diabetes-related examinations, improved the adherence of oral hypoglycemic drugs during the first 3 years and that of insulin during the second 3 years, and was negatively associated with risk of cancer and chronic kidney disease. In annual health expense, there was no significant difference between P4P and non-P4P groups, P = 0.430. CONCLUSIONS: As compared with control, pay-for-performance program significantly improved survival in patients with diabetes without increasing the medical cost. The P4P group had significantly lower risk of cancer and chronic kidney disease.