Impact of liminality and rituals on professional identity formation in physician training.

PURPOSE: The transition from medical student to practicing physician affects the complex processes of professional identity formation and professionalism, which have a lasting effect on the physician's career development. This study explored two different transitional processes of medical students in Taiwan, the associated rituals during this transitional period (the 'liminal phase') and their effect on the formation of professional identity. METHOD: Using snowball sampling, we recruited 13 medical students from two training systems: six from the traditional postgraduate year programme and seven from the accelerated postgraduate year (A-PGY) programme. Semi-structured interviews were thematically analysed to identify significant themes that encapsulated trainees' experiences. A consistent and mutually confirmed discussion ensured the identification of robust recurring themes. RESULTS: A comparative analysis of the two training modalities provided critical insights into the relative impact of the training dynamics. The A-PGY cohort, subjected to an altered 'incorporation' ritual, encountered an influx of unexpected symbolic social power, complicating their transformation within the liminal phase. Without a defined internship like in the PGY system, A-PGY trainees exhibited confusion and inconsistencies in professional identity formation marked by conflicting internal and external perceptions. This ambiguity affected their clinical training, social integration and overall development of professionalism. The absence of a structured, sequential liminal phase increased conflict and diminished motivation, culminating in an incomplete self-crafting journey for A-PGY trainees. CONCLUSIONS: This study highlights the impact of the well-sequenced implementation of rituals in liminality on professional identity formation. A good transition training programme for medical students should compass sequential rituals in the liminal phase, including clear starting and ending points, supervision by seniors, guided reflection and plenty of opportunities for observation and imitation in context. Optimal training and pivotal elements in a medical training system warrant delicate design and further research when developing and changing the structure of the training programme.

Next-generation sequencing and bioinformatics to identify genetic causes of malignant hyperthermia.

BACKGROUND/PURPOSE: Malignant hyperthermia (MH) is a life-threatening pharmacogenetic disease with only two known causative genes, RYR1 and CACNA1S. Both are huge genes containing numerous exons, and they reportedly only account for 50-70% of known MH patients. Next-generation sequencing (NGS) technology and bioinformatics could help delineate the genetic diagnosis of MH and several MH-like clinical presentations. METHODS: We established a capture-based targeted NGS sequencing framework to examine the whole genomic regions of RYR1, CACNA1S and the 16.6 Kb mitochondrial genome, as well as 12 other genes related to excitation-contraction coupling and/or skeletal muscle calcium homeostasis. We applied bioinformatics analyses to the variants identified in this study and also to the 48 documented RYR1 pathogenic variants. RESULTS: The causative variants were identified in seven of the eight (87.5%) MH families, but in none of the 10 individuals classified as either normal controls (N = 2) or patients displaying MH-like clinical features later found to be caused by other etiologies (N = 8). We showed that RYR1 c.1565A>G (p.Tyr522Cys)(rs118192162) could be a genetic hot spot in the Taiwanese population. Bioinformatics analyses demonstrated low population frequencies and predicted damaging effects from all known pathogenic RYR1 variants. We estimated that more than one in 1149 individuals worldwide carry MH pathogenic variants at RYR1. CONCLUSION: NGS and bioinformatics are sensitive and specific tools to examine RYR1 and CACNA1S for the genetic diagnosis of MH. Pathogenic variants in RYR1 can be found in the majority of MH patients in Taiwan.

Medical students' affective reactions to workplace experiences: qualitative investigation in a Chinese cultural context.

BACKGROUND: Compassion fatigue, unprofessional behavior, and burnout are prompting educators to examine medical students' affective reactions to workplace experiences. Attributes of both students and learning environments are influenced by their socio-cultural backgrounds. To prevent 'educational cultural hegemony', opinion leaders have advocated research in under-represented cultural contexts, of which Asia is a prime example. This study aimed to broaden the discourse of medical education by answering the question: how do students react affectively to workplace experiences in a Chinese cultural context? METHODS: In 2014, the authors recruited five female and seven male Taiwanese clerkship students to make 1-2 audio-diary recordings per week for 12 weeks describing affective experiences, to which they had consciously reacted. The authors analyzed transcripts of these recordings thematically in the original Mandarin and prepared a thick description of their findings, including illustrative extracts. An English-speaking education researcher helped them translate this into English, constantly comparing the interpretation with the original, untranslated data. RESULTS: (Mis) matches between their visions of future professional life and clerkship experiences influenced participants' affective reactions, thoughts, and behaviors. Participants managed these reactions by drawing on a range of personal and social resources, which influenced the valence, strength, and nature of their reactions. This complex set of interrelationships was influenced by culturally determined values and norms, of which this report provides a thick description. CONCLUSION: To avoid educational cultural hegemony, educators need to understand professional behavior in terms of complex interactions between culturally-specific attributes of individual students and learning environments. TRIAL REGISTRATION: The ethics committee of the National Taiwan University (NTU) Hospital gave research ethics approval ( 20130864RINB ).

Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data.

BACKGROUND: Elderly patients with aged physical status and increased underlying disease suffered from more postoperative complication and mortality. We design this retrospective cohort study to investigate the relationship between existing comorbidity of elder patients and 30 day post-anesthetic mortality by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) from Health Insurance Database. METHODS: Patients aged above 65 years old who received anesthesia between 2000 and 2010 were included from 1 million Longitudinal Health Insurance Database in (LHID) 2005 in Taiwan. We use age, sex, type of surgery to calculate propensity score and match death group and survival one with 1:4 ratio (death: survival = 1401: 5823). Multivariate logistic model with stepwise variable selection was employed to investigate the factors affecting death 30 days after anesthesia. RESULTS: Thirty seven comorbidities can independently predict the post-anesthetic mortality. In our study, the leading comorbidities predict post-anesthetic mortality is chronic renal disease (OR = 2.806), acute myocardial infarction (OR = 4.58), and intracranial hemorrhage (OR = 3.758). CONCLUSIONS: In this study, we present the leading comorbidity contributing to the postoperative mortality in elderly patients in Taiwan from National Health Insurance Database. Chronic renal failure is the leading contributing comorbidity of 30 days mortality after anesthesia in Taiwan which can be explained by the great number of hemodialysis and prolong life span under National Taiwan Health Insurance. Large scale database can offer enormous information which can help to improve quality of medical care.

A reliability generalization meta-analysis of coefficient alpha and test-retest coefficient for the aging males' symptoms (AMS) scale.

PURPOSE: The aging males' symptoms (AMS) scale is an instrument used to determine the health-related quality of life in adult and elderly men. The purpose of this study was to synthesize internal consistency (Cronbach's alpha) and test-retest reliability for the AMS scale and its three subscales. METHODS: Of the 123 studies reviewed, 12 provided alpha coefficients which were then used in the meta-analyses of internal consistency. Seven of the 12 included studies provided test-retest coefficients, and these were used in the meta-analyses of test-retest reliability. RESULTS: The AMS scale had excellent internal consistency [α = 0.89 (95% CI 0.88-0.90)]; the mean alpha estimates across the AMS subscales ranged from 0.79 to 0.82. The AMS scale also had good test-retest reliability [r = 0.85 (95% CI 0.82-0.88]; the test-retest reliability coefficients of the AMS subscales ranged from 0.76 to 0.83. There was significant heterogeneity among the included studies. CONCLUSIONS: The AMS scale and the three subscales had fairly good internal consistency and test-retest reliability. Future psychometric studies of the AMS scale should report important characteristics of the participants, details of item scores, and test-retest reliability.

Development of a short version of the Aging Males' Symptoms scale: Mokken scaling analysis and Rasch analysis.

The aim of this study was to develop a psychometrically sound short version of the 17-item Aging Males' Symptoms (AMS) scale using Mokken scale analysis (MSA) and Rasch analysis. We recruited a convenient sample of 1787 men (age: mean (SD) = 43.8 (11.5) years) who visited a men's health polyclinic in Taiwan and completed the AMS scale. The scale was first assessed using MSA. The remaining items were assessed using Rasch analysis. We used a stepwise approach to remove items with χ(2) item statistics and mean square values while monitoring unidimensionality. The item reduction process resulted in a 6-item version of the AMS scale (AMS-6). The AMS-6 scale included a 5-item psychosomatic subscale (original items 1, 4, 5, 8, and 9) and a 1-item sexual subscale (original item 16). Analyses confirmed that the 5-item psychosomatic subscale was a Rasch scale. The AMS-6 correlated well with the AMS scales: the 5-item psychosomatic subscale correlated with the AMS scale (r between 0.50 and 0.92); the 1-item sexual subscale correlated with the sexual subscale of the AMS scale (r = 0.81). A 6-item short form of the AMS scale had satisfactory measurement properties. This version may be useful for estimating psychosomatic and sexual symptoms as well as health-related quality of life with a minimal burden on respondents.

Metabolic syndrome among psychiatric outpatients with mood and anxiety disorders.

BACKGROUND: Few studies have simultaneously compared the impacts of pharmacotherapy and mental diagnoses on metabolic syndrome (MetS) among psychiatric outpatients with mood and anxiety disorders. This study aimed to investigate the impacts of pharmacotherapy and mental diagnoses on MetS and the prevalence of MetS among these patients. METHODS: Two-hundred and twenty-nine outpatients (men/women = 85/144) were enrolled from 1147 outpatients with mood and anxiety disorders by systematic sampling. Psychiatric disorders and MetS were diagnosed using the Structured Clinical Interview for DSM-IV-TR and the new International Diabetics Federation definition, respectively. The numbers of antipsychotics, mood stabilizers, and antidepressants being taken were recorded. Logistic regression was used to investigate the impacts of pharmacotherapy and psychiatric diagnoses on MetS. RESULTS: Among 229 subjects, 51 (22.3%) fulfilled the criteria for MetS. The prevalence of MetS was highest in the bipolar I disorder (46.7%) patients, followed by bipolar II disorder (25.0%), major depressive disorder (22.0%), anxiety-only disorders (16.7%), and no mood and/or anxiety disorders (14.3%). The percentages of MetS among the five categories were correlated with those of the patients being treated with antipsychotics and mood stabilizers. Use of antipsychotics and/or mood stabilizers independently predicted a higher risk of MetS after controlling for demographic variables and psychiatric diagnoses. When adding body mass index (BMI) as an independent variable in the regression model, BMI became the most significant factor to predict MetS. CONCLUSION: BMI was found to be an important factor related to MetS. Pharmacotherapy might be one of underlying causes of elevated BMI. The interactions among MetS, BMI, pharmacotherapy, and psychiatric diagnoses might need further research.

The "Aging Males' Symptoms" (AMS) Scale assesses depression and anxiety.

OBJECTIVE: Emotional distress may be associated with severe aging symptoms. This study aimed to investigate aging symptoms in male psychiatric outpatients and their relationship with anxiety and depression. METHOD: About 176 male psychiatric outpatients aged 40-80 years were enrolled into this single-center cross-sectional study, and completed self-reported questionnaires including "Aging Males' Symptoms" (AMS) scale and the Hospital Anxiety and Depression Scale (HADS). RESULT: Age was correlated with less anxiety (r = -0.23), less psychological (r = -0.16) and more sexual symptoms (r = 0.31). After controlling demographic variables, the partial correlation coefficients of HADS and AMS scores ranged from 0.30 to 0.73. Four groups were defined by HADS: control (C; n = 103), depression (D; n = 18), anxiety (A; n = 26) and mixed anxiety and depression (M; n = 29). The M group had the most severe aging symptoms, and the C group the least. The A group had more psychological and less sexual symptoms than the D group. "Impaired sexual potency" was the only aging symptom in males not significantly different among the four groups. CONCLUSIONS: Anxiety and depression was associated with more severe aging symptoms in male psychiatric outpatients. Sexual dysfunction could be regarded as the core manifestation to differentiate aging symptoms from syndromal emotional distress.

Neuropsychiatric complications in a patient with Marfan syndrome.

BACKGROUND: Marfan syndrome (MFS) is an autosomal dominant disorder of fibrillin-1 gene mutations, with the involvement of cardiovascular, skeletal, and ocular systems. In addition to physical abnormalities, MFS patients are also found to be susceptible to schizophrenia and other psychiatric conditions. OBJECTIVES: Awareness of the association between MFS and psychiatric conditions would improve the clinical management of MFS patients to reduce the risk or even to prevent the development of psychiatric complications in MFS patients. METHODS: Here, we describe a male MFS patient who manifested incoherent speech and impaired cognitive and social function at the age of 40 years. Results and conclusion His mental dysfunction could be attributed to his bilateral cerebral infarction, which is a neurovascular complication associated with MFS.

Stacked SiGe nanosheets p-FET for Sub-3 nm logic applications.

The fabrication of vertically stacked SiGe nanosheet (NS) field-effect transistors (FETs) was demonstrated in this study. The key process technologies involved in this device fabrication are low pressure chemical vapor deposition SiGe/Si multilayer epitaxy, selective etching of Si layers over SiGe layers using tetramethyl-ammonium-hydroxide wet solution, and atomic layer deposition of Y2O3 gate dielectric. For the fabricated stacked SiGe NS p-GAAFETs with a gate length of 90 nm, ION/IOFF ratio of around 5.0 × 105 and subthreshold swing of 75 mV/dec were confirmed via electrical measurements. Moreover, owing to its high quality of Y2O3 gate dielectric, the device showed a very small drain-induced barrier-lowering phenomenon. These designs can improve the gate controllability of channel and device characteristics.

Complaint of insomnia as a predictor of aging symptoms in males at a men's health clinic.

INTRODUCTION: Issues of men's health have been greatly researched by scholars in recent decades. At men's health clinics, many patients complain of both insomnia and aging males' symptoms (AMS). These symptoms might be influenced by biological, psychological or even social factors. The aim of this study was to investigate different aspects of the relationship between insomnia and aging symptoms. METHODS: This cross-sectional study included 231 males from a men's health clinic. Participants completed a set of general data and screening assessments, including the AMS rating scale, insomnia severity index (ISI), Beck depression inventory-II (BDI-II) and Beck anxiety inventory Chinese version (BAI), to investigate the severity of aging symptoms, insomnia, depression and anxiety. RESULTS: The ISI correlated significantly with the AMS scale, both with (partial correlation coefficient = 0.470) and without (r = 0.580) controlled variances of depression and anxiety. Using linear regression, aging symptoms were statistically predicted by the severity of the ISI, and a substantial proportion of the variance was explained (adjusted R(2) = 0.410). When all variables were included, this proportion rose to 55.3% (adjusted R(2) = 0.553). CONCLUSION: We suggest that insomnia is a good predictor of aging symptoms across all age groups of men.

Ge/Si multilayer epitaxy and removal of dislocations from Ge-nanosheet-channel MOSFETs.

Horizontally stacked pure-Ge-nanosheet gate-all-around field-effect transistors (GAA FETs) were developed in this study. Large lattice mismatch Ge/Si multilayers were intentionally grown as the starting material rather than Ge/GeSi multilayers to acquire the benefits of the considerable difference in material properties of Ge and Si for realising selective etching. Flat Ge/Si multilayers were grown at a low temperature to preclude island growth. The shape of Ge nanosheets was almost retained after etching owing to the excellent selectivity. Additionally, dislocations were observed in suspended Ge nanosheets because of the absence of a Ge/Si interface and the disappearance of the dislocation-line tension force owing to the elongation of misfit dislocation at the interface. Forming gas annealing of the suspended Ge nanosheets resulted in a significant increase in the glide force compared to the dislocation-line tension force; the dislocations were easily removed because of this condition and the small size of the nanosheets. Based on this structure, a new mechanism of dislocation removal from suspended Ge nanosheet structures by annealing was described, which resulted in the structures exhibiting excellent gate control and electrical properties.

Patients' experiences of long-acting injectable antipsychotics: a qualitative study.

BACKGROUND: In this study, we applied a qualitative approach to explore patients' subjective experiences of long-acting injectable antipsychotics (LAIs). METHODS: Patients undergoing psychiatric treatment from the chronic ward or outpatient department of a medical center in northern Taiwan who had experience with LAI treatment were enrolled. Information was obtained through semi-structured in-depth interviews. The interviews were audio-recorded and then translated verbatim, and the data were collected and analyzed concurrently to develop major themes and categories. RESULT: In total, 14 participants (8 female) were interviewed. In a bio-psycho-social model, the participants used LAIs as a method to become "normal," in order to achieve a balance between the "effects" and "side effects" that may influence their daily lives. Their past experiences constructed their concepts about and expectations regarding LAIs, and their relationships with their family members and co-workers also modeled their experiences. CONCLUSION: In our study, we sought to understand the experience of LAI in the daily life context of the patients. We attempted to use a bio-psycho-social model to evaluate the subjective experience of the patients; an improved understanding can help mental health specialists gain a closer insight into patient experience.

Effects of Etching Variations on Ge/Si Channel Formation and Device Performance.

During the formation of Ge fin structures on a silicon-on-insulator (SOI) substrate, we found that the dry etching process must be carefully controlled. Otherwise, it may lead to Ge over-etching or the formation of an undesirable Ge fin profile. If the etching process is not well controlled, the top Ge/SOI structure is etched away, and only the Si fin layer remains. In this case, the device exhibits abnormal characteristics. The etching process is emerging as a critical step in device scaling and packaging and affects attempts to increase the packing density and improve device performance. Therefore, it is suggested that optimization of operating the plasma reactor be performed through simulations, in order to not only adjust the process parameters used but also to modify the hardware employed. We are going to develop Ge junction-less devices by employing updated fabrication parameters. Besides, we want to eliminate misfit dislocations at the interface or to reduce threading dislocations by applying cyclic thermal annealing process to meet the goal of obtaining suspended structure of epitaxial Ge layers with high quality.

The association between exposure to second-hand smoke and major depressive disorder in perimenopausal women: results from apopulation-based study.

PURPOSE: The aim of this study was to test the hypothesis that exposure to second-hand smoke (SHS) would be positively associated with major depressive disorder (MDD) in perimenopausal women from a population-based perspective, after adjustment for all potential confounders. METHODS: This study used the National Health and Nutrition Examination Survey (NHANES) database, 2005-2012, to report on MDD in perimenopausal women. RESULTS: The odds ratio (OR) for MDD increased when there was a smoker was in the home, as compared to not having a smoker in the home (aOR = 2.97, 95% confidence interval [CI] = 1.15-7.67); however, in the non-poor group, the OR for MDD showed no difference between those who had or did not have a smoker in their home. For participants who self-rated their health condition as excellent, very good or good, the OR for MDD increased; it also increased if there were smokers in the home, as compared to those without smokers in the home (aOR = 2.58, 95% CI = 1.08-6.14). CONCLUSIONS: The present study results augment our understanding of the clinical and public health significance of SHS, as well as the role of various socioeconomic and self-rated health conditions, in perimenopausal women. Key messages An increasing OR for MDD was demonstrated with regard to health status such as CVD, chronic respiratory tract disease, arthritis, thyroid problems, lower eGFR, fair or poor self-rated health condition, and elevated CRP level. Participants who self-rated their health condition as excellent, very good or good had an increased OR for MDD. The OR also increased if the women had smokers in their home versus women who did not have smokers in the home.

An observational study: The utility of perfusion index as a discharge criterion for pain assessment in the postanesthesia care unit.

Acute post-operative pain can remain untreated if patients cannot express themselves. The perfusion index (PI) may decrease when pain activates sympathetic tone and may increase after analgesics are administered. We evaluated if the perfusion index is a feasible indicator for objectively assessing pain relief in the postanesthesia care unit (PACU) and calculated the changes in PI measurements at the time of discharge from the PACU relative to baseline PI measurements to examine if the PI is a useful criterion for discharging patients from the postanesthesia care unit. This retrospective observational study enrolled female patients who were admitted for gynecological or general surgery. The patients received general anesthesia and were admitted to the postanesthesia care unit. The PI, visual analogue scale (VAS) score, heart rate, and blood pressure were recorded before and after administration of intravenous morphine. Changes in these parameters before and after analgesics were administered and the difference of these parameters between age and BMI subgroups were compared. The correlation between the PI and VAS score, ΔPI and ΔVAS, and %ΔPI and %ΔVAS were also evaluated. The percentage change in ΔPI (P9-T0/T0) of the patients at the time of discharge from the postanesthesia care unit relative to baseline PI measurements was calculated. Eighty patients were enrolled, and there were 123 instances during which analgesia was required. Heart rate, PI, and VAS score were significantly different before and after analgesics were administered (p < 0.0001). The difference of parameters between age and BMI subgroups were not significant. The correlation between the PI and VAS score, ΔPI and ΔVAS, and the percentage change in ΔPI and ΔVAS showed weak correlations in age, BMI subgroups, and all measurements. The baseline PI and the PI when arriving at and when being discharged from the postanesthesia care unit were significantly different (p < 0.01). The mean percentage change in Δ PI at the time of discharge from the PACU was 66.2%, and the 99% confidence interval was 12.2%~120.3%. The perfusion index was increased, and the VAS score was decreased significantly after analgesics were administered, but the correlation was weak in each subgroup. The VAS score is a subjective and psychometric parameter. The PI increased when partial pain relief was achieved after morphine was administered but did not reflect pain intensity or changes in the VAS score regardless of age or BMI. A percentage change in ΔPI at the time of discharge from the PACU relative to baseline PI measurements of greater than 12% can be used as a supplemental objective discharge criterion for pain assessment in the postanesthesia care unit.

Biomarkers and echocardiography for evaluating the improvement of the ventricular diastolic function after surgical relief of hydronephrosis.

The pathophysiology of cardio-renal syndrome (CRS) is complex. Hydronephrosis caused by urolithiasis may cause cytokine release and lead to cardiac dysfunction. The aim of this study was to evaluate cardiac function changes observed in patients who received double J placement using feasible biomarkers and echocardiography. This was a prospective, single-center study. Eighty-seven patients who presented with acute unilateral hydronephrosis and received ureteroscope stone manipulation were enrolled. Echocardiography and cytokines were measured on the day of the operation and 24 hours after the procedure. Changes before and after surgery were assessed by the paired t-test and Wilcoxon test. Correlation analyses between echocardiographic diastolic indices and cytokine levels were performed using Pearson's correlation coefficients. Patients with hydronephrosis showed a higher left atrium volume index (LAVI), decreased E', and increased E/ E' ratio, which indicated diastolic dysfunction. Patients with hydronephrosis also exhibited decreased global strain rates during isovolumetric relaxation (SRIVR) and E/ SRIVR, which confirmed the diastolic dysfunction. Significant reductions in LAVI, increases in SRIVR and decreases in E/ SRIVR were observed after the operation. Biomarkers, such as TGF-ß and serum NT-proBNP, were significantly decreased after surgery. In addition, a significant correlation was observed between the post-surgical decrease in TGF-ß1 and increase in SRIVR. Unilateral hydronephrosis causes cardiac diastolic dysfunction, and relieving hydronephrosis could improve diastolic function. Improvements in cardiac dysfunction can be evaluated by echocardiography and measuring cytokine levels. The results of this study will inform efforts to improve the early diagnosis of CRS and prevent further deterioration of cardiac function when treating patients with hydronephrosis.

Ultra-large suspended graphene as a highly elastic membrane for capacitive pressure sensors.

In this work, we fabricate ultra-large suspended graphene membranes, where stacks of a few layers of graphene could be suspended over a circular hole with a diameter of up to 1.5 mm, with a diameter to thickness aspect ratio of 3 × 10(5), which is the record for free-standing graphene membranes. The process is based on large crystalline graphene (∼55 µm) obtained using a chemical vapor deposition (CVD) method, followed by a gradual solvent replacement technique. Combining a hydrogen bubbling transfer approach with thermal annealing to reduce polymer residue results in an extremely clean surface, where the ultra-large suspended graphene retains the intrinsic features of graphene, including phonon response and an enhanced carrier mobility (200% higher than that of graphene on a substrate). The highly elastic mechanical properties of the graphene membrane are demonstrated, and the Q-factor under 2 MHz stimulation is measured to be 200-300. A graphene-based capacitive pressure sensor is fabricated, where it shows a linear response and a high sensitivity of 15.15 aF Pa(-1), which is 770% higher than that of frequently used silicon-based membranes. The reported approach is universal, which could be employed to fabricate other suspended 2D materials with macro-scale sizes on versatile support substrates, such as arrays of Si nano-pillars and deep trenches.

The prevalence and correlates of the positive Androgen Deficiency in the Aging Male (ADAM) questionnaire among psychiatric outpatients: a cross-sectional survey of 176 men in a general hospital in Taiwan.

INTRODUCTION: The Androgen Deficiency in the Aging Male (ADAM) questionnaire is widely used to screen for late-onset hypogonadism. The positive response to the ADAM questionnaire (positive ADAM) has been associated with depression and poorer quality of life in a number of studies. It is unclear whether there is any value of the ADAM questionnaire in psychiatric populations. In this study, we aimed to determine the utility of the ADAM questionnaire in a convenient sample of male psychiatric outpatients. METHODS: One hundred and seventy-six men (mean age: 54.3 years; standard deviation: 10.7 years; range: 40-80 years) completed the ADAM questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Aging Males' Symptoms (AMS) scale. Anxiety was defined as a HADS anxiety subscore ≥8; depression as a HADS depression subscore ≥8; and moderate/severe impairment of health-related quality of life (HQoL) as AMS ≥37. ADAM, anxiety, and depression was used to model the moderate/severe impairment of HQoL. RESULTS: One hundred and sixty-four (93%) men had positive ADAM. Positive ADAM was associated with a lower body mass index (P<0.05) and moderate/severe impairment of HQoL (P<0.001), but was not associated with anxiety or depression (P>0.05). Positive ADAM was associated with five symptoms of the AMS scale: "decline of one's feeling of general well-being", "depressive mood", and three sexual symptoms. In regression analysis, positive ADAM was associated with increased risk of moderate/severe impairment of HQoL (unadjusted odds ratio 20.1, 95% confidence interval 3.77-372, P<0.01), which remained significant with covariates of anxiety and depression (adjusted odds ratio 15.6, 95% confidence interval 2.52-309, P<0.05). CONCLUSION: The ADAM questionnaire can be used to screen the sexual symptoms but not depression/anxiety in male psychiatric outpatients. Positive ADAM may indicate moderate/severe impairment of HQoL.