Psychometric properties of the brief self-report questionnaire for screening putative pre-psychotic states and validation of clinical utility in young adult.

INTRODUCTION: The Brief Self-Report Questionnaire for Screening Putative Pre-Psychotic States (BQSPS), a brief, self-reported screening tool for risk of psychosis, can detect auditory perceptual disturbances significantly associated with perceived need for psychological services among young adults. However, the relationship is largely explained by the existence of neurotic traits, anxiety and depression symptoms. OBJECTIVE: This study explores possible explanations of previous results from factor structures of the BQSPS and the clinical implications underlying each factor. METHODS: Construct validity, criterion-related validity, discriminant validity, internal consistency, and test-retest reliability of the BQSPS are determined among young adults (N = 289). RESULTS: We find that Social Anxiety, Positive Symptoms, and Negative Symptoms are three components in the BQSPS for young adults. Moreover, we find that each component of the BQSPS can be explained by related forms of psychopathology, self-esteem, or personality traits. Finally, the BQSPS can satisfactorily distinguish cases from non-cases using the Symptoms Check List-90-Revised. CONCLUSIONS: We clarify the clinical implications of each component of the BQSPS and thus expand its clinical utility. The BQSPS has good psychometric properties in young adults from an ethnically Chinese population. Limitations and directions for future research are also discussed.

Anticoagulation adherence and its associated factors in patients with atrial fibrillation: a cross-sectional study.

OBJECTIVE: To investigate anticoagulant adherence and its associated factors, including demographics, clinical variables, atrial fibrillation (AF) severity, knowledge, satisfaction with services, perceived barriers, perceived benefits, symptom severity and self-efficacy in patients with AF. DESIGN: This is a cross-sectional study. PARTICIPANTS AND SETTING: A convenient sample of patients with AF were recruited from cardiology clinics of two teaching hospitals in Taiwan. MEASURES: Data were collected using the study questionnaires, including the AF-related symptom subscale of the AF Severity Scale, the Knowledge of Warfarin Anticoagulation Treatment Scale, the Satisfaction Scale about Service and Warfarin Treatment, the perceived benefits subscale of the Beliefs about Anticoagulation Survey, the Concerns about Anticoagulation Therapy Scale, The Self-efficacy for Appropriate Medication Use Scale and the short-form Adherence to Refills and Medications Scale. RESULTS: A total of 151 patients with AF participated in the study; 53 treated with warfarin and 98 treated with novel oral anticoagulants (NOACs). The difference in adherence to warfarin (mean=8.6; SD=1.6) and NOACs (mean=8.9; SD=2.0) was statistically insignificant. Multiple linear regression analysis showed that perceived barriers (ß=0.18, p=0.017) and self-efficacy (ß=-0.48, p<0.001) were significant predictors of anticoagulation adherence. For every 1-unit increase in the perceived barriers, there will be a 0.18-unit increase in the adherence to anticoagulation therapy. For every 1-unit increase in the self-efficacy, there will be a 0.48-unit decrease in the adherence to anticoagulation therapy. Perceived barriers and self-efficacy collectively explained 34.0% of the variance in adherence to anticoagulation therapy (F(2,149)=38.11, p<0.001). CONCLUSION: We found no better adherence to NOACs compared with warfarin. Patients with greater self-efficacy and perceived fewer barriers showed better adherence to anticoagulation therapy.

Atypical posterior reversible encephalopathy syndrome in a noncompliant hemodialysis patient: Case report and literature review.

Posterior reversible encephalopathy syndrome (PRES) is a reversible vasogenic brain edema in patients who present with seizure, headache, visual disturbance, and altered mental status, and a characteristic neuroimaging profile. Although PRES predominantly affects the bilateral parieto-occipital areas, involvement of the frontal and temporal lobes, basal ganglia, brainstem, and cerebellum is not uncommon. Isolated involvement of the brainstem and cerebellum sparing the parieto-occipital lobe is rarely reported. Here, we describe a 47-year-old man with end-stage renal disease on chronic hemodialysis who presented with prominent hypertension and coma after missing three dialysis sessions. On examination, there was paucity of focal neurologic signs. Diagnosis of PRES was based on brain magnetic resonance imaging findings that were consistent with vasogenic edema of the pons and cerebellum without involvement of other areas. With antihypertensive therapy and intense ultrafiltration during hemodialysis, the patient's blood pressure and consciousness returned to normal, along with complete resolution of the abnormal imaging findings. This case stresses that noncompliance with dialysis should be considered a risk factor for PRES. This case is considered relative to the available literature on three patients with brainstem variant of PRES.

Long-term visibility trends in one highly urbanized, one highly industrialized, and two rural areas of Taiwan.

Visibility trends on the island of Taiwan were investigated employing visibility and meteorological (1961-2003), and air pollutant (1994-2003) data from one highly urbanized center (Taipei), one highly industrialized center (Kaohsiung), and two rural centers (Hualien and Taitung). Average annual visibility (1961-2003) was significantly higher at the rural centers. Unlike at the other centers, visibility in Taipei improved between 1992 (6.6 km) and 2003 (9.9 km), and this can be linked to the construction and expansion of a mass transit rail system in Taipei, the use of which has helped reduce emissions of traffic related air pollutants, particles, and NO2. This has left Kaohsiung with the lowest annual visibility since 1994, despite its 1961-2003 average being superior to that of Taipei. Precipitation lowers visibility, as demonstrated by the all-centers correlation coefficient for visibility and precipitation of -0.92. Hence, frequency of precipitation is one of the factors contributing to the average annual visibility number. The poorest air quality category ('episode'), most commonly experienced in Taipei and Kaohsiung, was characterized by relatively high concentrations of PM10 and NOx at those centers, with comparatively high atmospheric pressure and comparatively low visibility and wind speed. Excepting O3, pollutant concentrations were slightly higher during weekdays, although there was no consistent, significant difference in weekday-weekend visibility. Principal component analysis demonstrated that visibility was markedly reduced in Taipei, Kaohsiung, and Hualien by increased vehicular emissions, road traffic dust, and industrial activity, but not in Taitung, where visibility was as a result superior to that at the other centers and degradation in visibility was likely a response to long-range transport of pollutants rather than local sources. Optimal empirical regression models indicated a negative impact on visibility for each of PM10, SO2 and NO2, particularly so for PM10, and validity of these models for Taipei, Kaohsiung, and Hualien was confirmed by correlation coefficients of simulated and observed average visibility of 0.63-0.72 for daily visibility and 0.85-0.88 for monthly visibility. For Taitung these figures were only 0.46 and 0.50, respectively, indicating that simulations for Taitung should include long-range transport as a pollutant source.

The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension.

Regular aerobic exercise can reduce blood pressure and is recommended as part of the lifestyle modification to reduce high blood pressure and cardiovascular risk. Hypertension itself, or/and pharmacological treatment for hypertension is associated with adverse effects on some aspects of quality of life. This study was performed to evaluate the effects of regular endurance exercise training on quality of life and blood pressure. Patients with mild to moderate hypertension (systolic blood pressure 140-180 or diastolic blood pressure 90-110 mm Hg) were randomized to a moderate-intensity aerobic exercise group training for 3 sessions/week over 10 weeks or to a non-exercising control group. Health-related quality of life was assessed with the Short Form 36-item Health Survey (SF-36) at baseline and after 6 and 10 weeks. In the 102 subjects (47 male, mean age 47 years) who completed the study, reductions in blood pressure in the exercise group at 10 weeks (-13.1/-6.3 mm Hg) were significant (P < 0.001) compared to baseline and to the control group (-1.5/+6.0 mm Hg). Unlike the control group, the exercise group showed an increase in exercise capacity from 8.2 +/- 1.6 to 10.8 +/- 2.2 METS (P < 0.01) and showed higher scores on 7 out of 8 subscales (P < 0.05) of the SF-36. Improvement in bodily pain and general health sub-scores correlated with reduction in systolic blood pressure. Regular endurance training improves both blood pressure and quality of life in hypertensive patients and should be encouraged more widely.