Early predictors for maltreatment-related injuries in infancy and long-term mortality: a population-based study.

INTRODUCTION: Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood. METHODS: We conducted a retrospective cohort study comprising 2.2 million infants born in 2004-2014 in Taiwan. Incident cases of child maltreatment were defined by hospitalization or emergency department visits for three heterogeneous diagnostic groups of maltreatment-related injuries (i.e., maltreatment syndrome, assaults, and undetermined causes) within 12 months after birth. The generalized linear model and landmark survival analyses were used to evaluate risk factors. RESULTS: An estimated 2.9‰ of infants experienced at least one maltreatment-related injury, with a three-year mortality rate of 1.3%. Low birthweight was associated with increased risk of receiving the diagnosis of three maltreatment injuries, particularly maltreatment syndrome (adjusted Incidence Rate Ratio [aIRR] = 4.08, 95% confidence interval [CI]: 2.93-5.68). Socially advantaged family condition was inversely linked with receiving the diagnosis of maltreatment syndrome and assaults (e.g., high income: aIRR = 0.55 and 0.47), yet positively linked with undetermined cause (aIRR = 2.05, 95% CI: 1.89-2.23). For infants exposed to maltreatment, low birth weight and non-attendance of postnatal care were highly predictive of fatality; low birthweight served as a vital predictor for premature death during toddlerhood (aIRR = 6.17, 95% CI: 2.36-15.4). CONCLUSIONS: Raising awareness of maltreatment-related injuries in infancy and predictors should be a priority for appropriate follow-up assessment and timely intervention.

Diffusion heterogeneity and vascular perfusion in tumor and peritumoral areas for prediction of overall survival in patients with high-grade glioma.

OBJECTIVE: To evaluation of diffusion heterogeneity and vascular perfusion in tumor and peritumoral areas for prognostic prediction in high-grade glioma (HGG, WHO III/IV grade). METHODS: Forty patients with HGG underwent diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), and arterial spin labeling (ASL) MRI before operation. After normalization, the parameters were divided into diffusion heterogeneity parameters (rD, rMD, rMK, rKr, rKa) and vascular perfusion parameters (rD*, rF, rCBF). Univariate and multivariate Cox regression analyses were used to evaluate associations between overall survival (OS) and the above parameters, clinical factors, and IDH1 status. The Mann-Whitney test was used to evaluate differences in the parameters between different IDH1 states. RESULTS: In the univariate Cox regression analysis, OS was significantly associated with tumor resection range, IDH1 status, tumor heterogeneity parameters (rD, rMD, rMK, rKr, rKa), and rCBF in tumor area(all p < 0.05). In addition, rD and rCBF measured in the peritumoral region were also predictors of poor OS (both p < 0.01). Multivariate Cox regression analysis indicated that rMK in the tumor area and rCBF in the peritumoral area (hazard ratio = 7.900 and 5.466, respectively, for each 0.1 increase in the normalized value) were independent predictors of OS. CONCLUSION: The rMK of tumor area and rCBF of peritumoral area had independent predictive value for OS in patients with HGG. ADVANCES IN KNOWLEDGE: This study explored useful imaging biomarkers from the diffusion heterogeneity and vascular perfusion of tumor and peritumoral areas in HGG, which is useful to help clinician to make precise therapeutic plans, and predict the prognostic for glioma patients.

The use of premixed drugs in commodity packets in the population: prevalence and correlates revealed by the 2018 National Survey of Substance Use in Taiwan.

BACKGROUND: Administering premixed drugs in commodity packets was first reported in Asia in 2015, but there continues to be a dearth of related population-based data. This study aimed at examining (1) the prevalence of drug packet use in the population and (2) the sociodemographic profiles, particularly gender distribution, of drug packet users. METHODS: Data were derived from a survey of 18,626 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling in 2018. Participants anonymously completed a computer-assisted self-interview on tablet computers which covered the use and problematic use of illicit drugs/inhalants, prescription drugs and other psychoactive substances, among others. RESULTS: Approximately 1.46% of respondents had a lifetime use of illicit drugs, with drugs in commodity packets (0.18%) being ranked the fifth-most commonly used illicit drugs, higher than nitrous oxide (0.14%) and heroin (0.09%). Ten formats of drug packets were endorsed by users. Approximately 81.6% of persons with drug packet use had a lifetime use of other illicit drugs. The correlates of the use of drugs in commodity packets were similar to those of the exclusive use of other drugs except that there was a lack of gender differences in the use of drugs in commodity packets but not in the exclusive use of other drugs. CONCLUSION: Drugs in commodity packets have become a common way of administering illicit drugs in the population in Taiwan, and there were no gender differences among users. Our findings have implications for more efficient drug testing and culturally appropriate intervention for drug packet use.

Using quantitative MRI to study the association of isocitrate dehydrogenase (IDH) status with oxygen metabolism and cellular structure changes in glioma.

OBJECTIVE: To investigate the characteristics of oxygen metabolism and the cellular structure of glioma using quantitative MRI to predict the isocitrate dehydrogenase 1 (IDH1) status and to further understand the biological characteristics of gliomas. METHODS: In this retrospective study, 94 patients with gliomas eventually received quantitative MRI measures to study oxygen metabolism. The oxygen metabolism biomarker maps (oxygen extraction fraction [OEF] and cerebral metabolic rate of oxygen [CMRO2]) and the tissue-cellular-specific (R2t*) MRI relaxation parameter were evaluated in different regions of glioma. RESULTS: MRI results showed differences in oxygen metabolism measures in all patients with gliomas of different IDH1 statuses. Compared to patients with IDH1 mutant gliomas, patients with IDH1 wild type gliomas showed increased (P < 0.01) CMRO2, OEF, cerebral blood volume [CBF], and R2t* measures in tumor regions, while only OEF, CBF and R2t* were found to be increased (P < 0.05) in the peritumoral area. OEF achieved the best performance for distinguishing IDH1 wild type and mutant gliomas in the tumor area (AUC = 0.732, P < 0.001). R2t* values correlated with Ki-67(R = 0.35, P < 0.001) in the tumor area, while no significant correlations between Ki-67 and R2t* were found in the peritumoral area (R = 0.19, P = 0.072). CONCLUSION: Quantitative MRI has potential applications in studying the tumor and peritumoral areas of glioma, and it has the ability to predict and reveal the characteristics of oxygen metabolism and cellular structure in different regions of gliomas.

Association between Outpatient Visits and Initiating Medication among Elderly Patients after an Osteoporotic Vertebral Fracture.

PURPOSE: A treatment gap exists in vertebral fracture (VF) patients. An outpatient visit is a necessary step to initiate treatment. The study aimed to evaluate factors associated with an outpatient visit following a VF diagnosis, and the association between the interval of an outpatient visit after VF diagnosis and its impact on prescribing of anti-osteoporosis medications (AOMs). METHODS: Subjects 65 years and older from Tianliao Township in Taiwan with newly diagnosed VF between 2009 and 2010 were included. Information about outpatient visits and AOMs prescriptions were derived from the National Health Insurance Research database and followed up for 2 years. Factors associated with outpatient visits and the initiation of AOMs were assessed using the multivariable Cox proportional regression model analysis. The receiver operating characteristic curve (ROC curve) was analyzed to determine the predictive effects of the interval between an outpatient visit following the diagnosis of a new VF on initiating AOMs and the potential optimal cutoff point. RESULTS: Of 393 participants, 42.2% had outpatient visits within 2 years after a new VF diagnosis, for which the mean interval was 4.8 ± 4.8 months. Patients who were female and reported a current use of supplements were positively associated with visits after a new VF diagnosis, but the bone mineral density (BMD) T-score was negatively associated with visits. Furthermore, 140 (35.6%) patients had initiated AOMs within 2 years after the diagnosis of a new VF. It was found that a higher BMD T-score and a longer interval between an outpatient visit following diagnosis was negatively associated with initiation of AOMs. The ROC curve analysis showed outpatient visits within 3 months after a VF diagnosis had the highest Youden index and maximum area under the curve. CONCLUSIONS: Patients who were female, were currently taking supplements, and those who had a lower BMD T-score were more likely to visit doctors after being diagnosed with a new VF. Furthermore, a lower BMD T-score and a shorter interval, within 3 months and not more than 8 months, between an outpatient visit following the diagnosis of VF increased the likelihood of being prescribed AOMs.

Influence of Care Delivery Models on Quality of Diabetes Care Among Individuals With Schizophrenia.

Objective: Managing chronic conditions in individuals with severe mental illnesses is critical for amending health disparities in this vulnerable group. The study aimed to compare the management and outcomes of diabetes care under different care models in individuals with schizophrenia in Taiwan.Methods: A population-based retrospective cohort comprising incident cases of diabetes in individuals (N = 9,109) with schizophrenia (ICD-9-CM code 295) in Taiwan between 2008 and 2015 was selected using the National Health Insurance Research Database. Generalized estimating equation (GEE) modeling was used to compare 3 care models: the sole-physician model, the colocation model, and the different-facilities model. Each individual was followed up for 3 years. Propensity score matching was used to address potential selection bias.Results: Patients in the sole-physician model had the highest number of recommended routine examinations (incident rate ratio [IRR] = 1.2; 95% CI, 1.1-1.2) and the highest likelihood of having regular diabetes-related visits as recommended (odds ratio [OR] = 2.6; 95% CI, 2.1-3.2), followed by those in the colocation model (number of recommended routine examinations: IRR = 1.1; 95% CI, 1.1-1.2; likelihood of regular visits: OR = 1.6; 95% CI, 1.3-1.9) and those in the different-facilities model. However, the sole-physician group had a significantly higher likelihood of admission for diabetes-related ambulatory care sensitive conditions within 1 year (OR = 1.9; 95% CI, 1.3-2.8) and 3 years (OR = 1.6; 95% CI, 1.2-2.1) than its counterparts. Within the sole-physician group, patients of psychiatrists had more favorable disease outcomes than those of non-psychiatrists.Conclusions: The sole-physician and colocation models may significantly improve the process quality of diabetes care; however, such models alone are not sufficient to improve diabetes outcomes.

Body-Weight Gain in Women During Smoking Cessation Is a Sex-Specific Predictor of 6-Month Abstinence: A Retrospective Cohort Study.

Background: Smoking behavior differs between the sexes. Weight control is one of the main reasons leading to tobacco abuse in women but not in men. Studies on the predictive factors of cessation failure between sexes are scarce. This study is aim to investigate whether there are sex differences in the effect of weight gain on smoking cessation rate. Methods: Participants in the smoking-cessation program at a Medical Center in Taiwan between 2018 and 2019 were included. Details of age, sex, comorbidities, depression screening, nicotine dependence, body weight, and cessation medications of the participants were collected. The participants were classified based on their sex, and multivariable logistic regression analyses were conducted. Multivariable logistic regression analyses were performed for sensitivity analysis after stratifying the participants according to their weight loss (weight loss ≥ 1.5 kg and weight loss ≥ 3.0 kg). Results: A total of 1,475 participants were included. The body-weight gain in women was associated with failed abstinence (adjusted odds ratio (OR): 3.10, 95% CI: 1.10-9.04). In contrast, body-weight gain in men was associated with successful 6-month prolonged abstinence (adjusted OR: 0.77, 95% CI: 0.61-0.98). The adjusted ORs for any body-weight loss, body-weight loss ≥1.5 kg, and body-weight loss ≥3.0 kg were 0.28 (95% CI: 0.09-0.88), 0.14 (95% CI: 0.03-0.55), and 0.03 (95% CI: 0.01-0.42), respectively. Conclusion: Body-weight gain in women during a hospital-based smoking-cessation program is associated with abstinence failure. Further multicenter studies, including participants of different races and cultural backgrounds, are warranted.

Multiple in-hospital counseling increases six-month smoking abstinence among individuals participating in a hospital-initiated smoking cessation program.

BACKGROUND: A cessation program for hospitalized smokers is an effective strategy to achieve smoking abstinence. The effects of multiple in-hospital counseling sessions on 6-month smoking abstinence require further investigation. METHODS: We retrospectively analyzed the data of smokers who participated in hospital-initiated cessation programs at a medical center between 2017 and 2019. Data on age, sex, comorbidities, daily number of cigarettes, cessation motivation, nicotine dependence, cessation medications, discharge diagnosis, length of hospitalization, and intensive care unit admission were collected. We conducted multiple logistic regression analysis to investigate the effect of multiple in-hospital counseling sessions on 6-month sustained smoking abstinence. Sensitivity analyses were carried out excluding participants who underwent post-discharge cessation programs and assuming that the loss to follow-up participants had failure in 6-month smoking abstinence. RESULTS: A total of 1943 participants aged ≥ 20 years were analyzed. Compared with single in-hospital counseling session, the adjusted odds ratios (ORs) for 2 and ≥ 3 counseling sessions were 1.44 (95% confidence interval [CI] 1.05 to 1.98) and 2.02 (95% CI 1.27 to 3.22), respectively, with a significant trend for increasing the number of counseling sessions (P < 0.001). The results remained significant after excluding participants who underwent a post-discharge cessation program or when assuming that lost to follow-up participants had failure in smoking abstinence. CONCLUSION: Multiple in-hospital counseling sessions were associated with a higher 6-month sustained smoking abstinence rate. This strategy could be used to reduce the prevalence of smoking.

Urban-Rural Differences in Depression Literacy Among High School Teachers in the Kingdom of Eswatini.

BACKGROUND: Concerns have been raised over teachers' mental health literacy in low-income countries and lower- and middle-income countries wherein pediatric mental health resources are limited. This study aims to investigate adolescent depression literacy among teachers in Eswatini and to explore the role of urbanicity. METHODS: We conducted a cross-sectional survey in 59 public high schools in Eswatini in 2019-2020. Data were collected by a paper-and-pencil questionnaire; depression literacy was assessed by the 17-item Adolescent Depression Knowledge Questionnaire. RESULTS: Teachers' adolescent depression literacy item-level correct rates fell between 27 and 80%. Although the multivariate response models indicated that teaching in urban areas was slightly associated with having higher depression literacy in general (adjusted odds ratio [aOR] = 1.46; 95% confidence interval = 1.00-2.12), such urban-rural differences did not manifest homogeneously across all items: urban teaching was significantly linked with reduced correct responses toward certain items concerning depression etiology and treatment, including "depression runs in some families," "major stress as a necessary cause," and "a curable illness" (aOR = 0.57 ∼ 0.68). CONCLUSION: Urban-rural differences in teachers' depression literacy were manifested at both scale- and item-levels. A critical need exists for urban/rural areas-tailored intervention on teachers' literacy toward mental disorders in the resource-limited regions to better improve health and developmental outcomes of students.

Men's decrease and women's increase in harmful alcohol use from the 2014 to 2018 national surveys in Taiwan: A harbinger for an emerging national trend in East Asia?

BACKGROUND: Gender differences in alcohol use have narrowed in Western societies, but that in Asia has been less investigated. By comparing the 2014 and 2018 waves of the national survey in Taiwan, we aimed to examine the gender differences in population trends in past-month alcohol use, binge drinking, and harmful alcohol use. METHODS: The national survey enrolled 17,837 participants in 2014 and 18,626 participants in 2018. Binge drinking was defined as having ≥5 drinks on one occasion in the past month, and harmful alcohol use as having an Alcohol Use Disorders Identification Test score of ≥8. RESULTS: There were significant decreases from 2014 to 2018 in the population's prevalence of past-month alcohol use, binge drinking, and harmful alcohol use. However, males and females had different trends: males showed significant reductions in all three alcohol use behaviours (a decrease of 3.79%, 1.59%, and 2.60%, respectively), while females exhibited a significant rise in harmful alcohol use (from 1.32% to 1.72%), particularly among those aged 18-29 years. CONCLUSION: There was gender convergence in alcohol use in Taiwan, mainly due to men's decrease and women's increase in harmful alcohol use. Our findings have important implications for the intervention and prevention of the problematic use of alcohol in East Asia.

Diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging for distinguishing pseudoprogression from glioma recurrence: a meta-analysis.

BACKGROUND: It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies. This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a tool for distinguishing glioma recurrence and pseudoprogression. METHODS: According to particular criteria of inclusion and exclusion, related studies up to May 1, 2019, were thoroughly searched from several databases including PubMed, Embase, Cochrane Library, and Chinese biomedical databases. The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies. By using the "mada" package in R, the heterogeneity, overall sensitivity, specificity, and diagnostic odds ratio were calculated. Moreover, funnel plots were used to visualize and estimate the publication bias in this study. The area under the summary receiver operating characteristic (SROC) curve was computed to display the diagnostic efficiency of DCE-MRI. RESULTS: In the present meta-analysis, a total of 11 studies covering 616 patients were included. The results showed that the pooled sensitivity, specificity, and diagnostic odds ratio were 0.792 (95% confidence interval [CI] 0.707-0.857), 0.779 (95% CI 0.715-0.832), and 16.219 (97.5% CI 9.123-28.833), respectively. The value of the area under the SROC curve was 0.846. In addition, the SROC curve showed high sensitivities (>0.6) and low false positive rates (<0.5) from most of the included studies, which suggest that the results of our study were reliable. Furthermore, the funnel plot suggested the existence of publication bias. CONCLUSIONS: While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression, it was capable of improving diagnostic accuracy. Hence, further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.

Gender differences in the risk of depressive disorders following the loss of a young child: a nationwide population-based longitudinal study.

BACKGROUND: Losing a child to death is one of the most stressful life events experienced in adulthood. The aim of the current study is to investigate parental risk of seeking treatment for major depression disorders (MDD) after a child's death and to explore whether such connection may operate differentially by parents' prior medical condition. METHODS: We studied a retrospective cohort of 7245 parents (2987 mothers and 4258 fathers) identified in the National Health Insurance Research Database of Taiwan (NHIRD) who had lost a child with age between 1 and 12 years. For comparison, the parents of 1:4 birth year- and gender-matched non-deceased children were retrieved (16,512 mothers and 17,753 fathers). Gender-specific Cox regression analyses were performed to estimate risk. RESULTS: Nearly 5.0% and 2.4% of bereaved mothers and fathers sought treatment for MDD within three years after a child's death, significantly higher than 0.8% and 0.5% in the non-bereaved parents. With covariate adjustment, the hazard ratio (HR) for maternal and paternal seeking treatment for MDD was estimated 4.71 (95% confidence interval [CI]: 3.35-6.64) and 1.93 (95% CI: 1.27-2.95), respectively. The increased risk of MDD varied by prior disease history; specifically, the increased risk of seeking treatment for MDD was especially prominent for those without chronic physical condition (CPC) (e.g., mothers with CPC: aHR = 2.38, 95% CI: 1.56-3.65 vs. no CPC: aHR = 9.55, 95% CI: 6.17-14.79). CONCLUSIONS: After the death of a child, parental elevated risk of MDD was especially prominent for the women and those without prior medical condition. Effective strategies addressing bereavement may require family-based, integrated physical and mental healthcare and even extended counseling service.

Association between childhood negative life events with alcohol expectancies in early adolescence: Cumulative risk and latent class approaches.

BACKGROUND: The present study aims to investigate the effects of childhood negative life events (NLEs) on alcohol expectancies (AEs) in early adolescence through cumulative risk and latent class approaches. METHODS: Data were obtained from a prospective cohort of 945 sixth graders (age 11-12) ascertained from 17 elementary schools in northern Taiwan (response rate = 61.0 %wt); subsequent assessments were conducted during eighth grade (n = 775, follow-up rate [FR] = 82.6 %wt). Information concerning socio-demographics, 14 NLEs, alcohol-related experience, and four-domain AEs was collected by self-administered questionnaires at childhood and follow-up. Latent class and multivariate analyses were used to evaluate the association estimates. RESULTS: Nearly one half of children had experienced at least one NLE in sixth grade, with one-tenth experiencing four or more NLEs. Three latent classes of NLEs were identified: "lesser experience (68.1 %wt)," "stressed relationship (27.6 %wt)," and "family instability (4.3 %wt)." The observed NLE-associated increase in AEs was relatively stronger in the cumulative approach: children experiencing four or more NLEs (ßwt = 1.27, 95 % CI = 0.27-2.27) and in the "stressed relationship" NLE class appeared to develop greater AEs (ßwt = 0.86, 95 % CI = 0.30-1.42). Moreover, such NLE-associated increase was especially salient in the AE domains regarding "global positive transformation" and "promoting relaxation or tension reduction". CONCLUSIONS: Our results provide insight into which experiences of multiple and "stressed relationship" negative life events arising from the family context in childhood may shape endorsed alcohol expectancies in adolescence, and implied that such effects may not uniformly operate across AE domain.

Subsequent Primary Cancers of the Digestive System Among Childhood and Adolescent Cancer Survivors From 1975 to 2015 in the United States.

INTRODUCTION: Among survivors from first primary cancers that occurred during childhood and adolescence, their risks of developing subsequent primary digestive system cancers are not well understood. Therefore, we conducted the largest and most comprehensive analysis examining risks for diverse types of digestive system cancers after survival from a wide variety of first primary childhood and adolescent cancers. METHODS: We identified 41,249 patients diagnosed with first primary cancer from 1975 to 2015 before 20 years of age from 9 Surveillance, Epidemiology and End Results Program registries. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) for digestive system cancers were calculated controlling for age, sex, race, and calendar year. RESULTS: Among 41,249 cancer survivors, 133 developed subsequent primary digestive system cancer, with a median digestive system cancer diagnosis age of 37 years. The SIR and AER for any digestive system cancer were highest among survivors of bone cancer, lymphoma, and neuroblastoma. Among survivors from any first primary cancer, the SIR was significantly elevated for cancer of the esophagus, stomach, small intestine, large intestine, liver, and pancreas, whereas the AER was highest for large intestine cancer. DISCUSSION: Childhood and adolescent cancer survivors diagnosed from 1975 to 2015 have significantly elevated risks of digestive system cancers compared with the US general population. Our detailed findings may contribute to surveillance recommendations of childhood and adolescent cancer survivors and promote future studies to further understand mechanisms by which having various first primary cancers lead to subsequent primary digestive system cancers.

Differential Nonenrollment of Taiwanese Children in School-Based Substance Use Prevention Studies: A Multilevel Analysis.

OBJECTIVE: The present study investigated the extent to which individual and school characteristics may differentially affect parental consent and child assent in the enrollment of a school-based substance use prevention study in Taiwan. METHOD: This study linked field notes on response and consent status during enrollment of the school-based prevention study with administrative survey data reported by the targeted students when they were in fourth grade (age 10-11) (N = 2,560; 53% male, 97.8% matched). The outcome variables, defined by the combined status of parental consent/child assent, were nonresponse and negative, discordant, and positive consent. Individual characteristics included family (parental education, employment) and child (psychological/behavioral, substance use) factors. Aggregate school-level substance use and percentage of aboriginal students and nonnative parents served as school-level factors. Multilevel multinomial regression analyses were performed. RESULTS: Successful consent was obtained from only 820 students (32%). Male gender and feeling neglected by families were associated with failing to respond (adjusted odds ratio = 1.78 and 1.71, respectively). Higher parental educational attainment reduced the odds of negative consent by 30%, whereas having unemployed parents increased the odds of discordant consent by 326%. Children attending schools with a higher percentage of indigenous students were two times more likely to have nonresponse, negative consent, and discordant consent. CONCLUSIONS: Nonresponse to the consent request or negative consent appeared to be associated with disadvantaged background and unfavorable parent-child interaction. This suggests complex pathways underlying ascertainment and a need to modify the consent practices in school-based prevention studies involving minors, especially in schools with higher ethnic minority composition.

Adverse effects on birth weight of parental illegal drug use during pregnancy and within two years before pregnancy.

This study investigates possible links between maternal illegal drug use during pregnancy and up to two years before pregnancy with birth weight (BW), and explores the potential role of paternal illegal drug use on low birth weight. A population-based retrospective cohort study was conducted that linked four national databases in Taiwan. A total of 1,698 subjects with a criminal record of schedule I or II illegal drug use within two years before pregnancy were enrolled as the drug-exposed group, and 16,980 matched subjects were enrolled as the unexposed group. Multivariate analysis of BW found a decrease of 108.63 g (95% CI: -172.29, -44.96), 79.67 g (95% CI: -116.91, -42.43), and 69.78 g (95% CI: -106.71, -32.84) in newborns whose mothers used illegal drugs only during pregnancy (period I), only within one year before pregnancy (period II), and only within the second year before pregnancy (period III), respectively. Paternal use of illegal drugs before maternal pregnancy was significantly associated with low birth weight. The paternal effect on low birth weight was opposite the maternal effect. The adverse effect of illegal drug use on birth weight existed even if the mother did not use drugs during pregnancy but had ever used drugs during the two years before pregnancy. Paternal factors' contribution to low birth weight persisted, and the decrement of BW was even greater than the maternal effect within one or two years before pregnancy. Maternal and paternal illegal drug use may have a lasting effect on their offspring's birth weight.

Early sexual initiation and risky sexual practices among alcohol- and tobacco-using young adults in Taiwan: mediation analysis of preceding-sex use of illicit drugs.

BACKGROUND: As early sexual initiation is increasingly common in East Asia, we examined its relations to risky sexual practices in alcohol- and tobacco-using individuals in Taiwan and evaluated whether the associations were mediated through preceding-sex use of illicit drugs. METHODS: Participants, recruited from alcohol- and tobacco-using adults aged 18 to 50 in Taipei through respondent-driven sampling (N = 1115), completed a computer-assisted self-interview covering questions on substance use and sexual experiences. In a subsample of 916 participants who had had sexual experience (median age 27), we examined the relations of early sexual initiation (< 16 years) to multiple sexual partners, casual sex, group sex, and rare condom use. Causal mediation analyses were conducted to examine whether illicit drug use preceding sex mediated these associations. RESULTS: Around 9.3% reported early sexual initiation and the prevalence of risky sexual practices ranged from 7% (group sex) to 47% (rare condom use). Early initiators had a higher prevalence of regular binge drinking, illicit drug use, and risky sexual practices. In the multivariable analyses, higher odds of multiple sexual partners, casual sex, and group sex were consistently associated with early sexual initiation, gender, and their interaction. Mediation through preceding-sex use of illicit drugs was found between early sexual initiation and the three risky sexual practices, with the proportions mediated ranging from 17 to 19%. CONCLUSIONS: Early sexual initiators were more likely to engage in risky sexual practices and preceding-sex use of illicit drugs partially explained this relationship, calling for more attention to this population's sexual health.

Effects of childhood adversity trajectories on mental health outcomes in late adolescence: The buffering role of parenting practices in Taiwan.

BACKGROUND: Childhood adversities (CAs) have been linked with unfavorable development; however, the chronic trajectories of multiple CAs and possible heterogeneous effects are understudied. OBJECTIVES: This study examined the trajectories of multiple CAs and their associations with mental health outcomes in adolescence and investigated the buffering effect of parenting practices. PARTICIPANTS AND SETTING: We used population-representative data from the Taiwan Education Panel Survey (2005 and 2007, n = 10,416). METHODS: This study was based on retrospectively self-reporting of six CAs, namely physical abuse, family economic hardship, parental problematic drinking, parental catastrophic health problems, parental divorce, and parental death, at three developmental periods: early childhood, middle childhood, and early adolescence. Group-based multitrajectory modeling and multiple regressions were used to identify distinct trajectories of multiple CAs and evaluate the association estimates. RESULTS: A total of four trajectory groups were identified: increasing family economic hardship (12.3 %), chronic physical abuse (3.3 %), chronic parental problematic drinking (2.8 %), and low adversity (81.6 %). The chronic physical abuse group had the highest levels of depressive symptoms (ß = 6.61, p < .001) and suicidal ideation (Adjusted Odds Ratio [AOR] = 2.67, p < .001), whereas the chronic parental problematic drinking group had the highest level of substance abuse (AOR = 4.59, p < .001). Positive parental practices buffered the harmful effects of increasing family economic hardship in late adolescence, particularly for depressive symptoms and substance abuse. CONCLUSIONS: Adverse mental health outcomes varied among groups with distinct multiple CA trajectories. The provision of social services to train or support positive parenting practices in families experiencing economic hardship is a potentially valuable resilience strategy.

Suicide attempts and death among heroin-involved women seeking methadone treatment in Taiwan.

BACKGROUND: The present study aims to profile the hazard fluctuation of suicide attempts and deaths among heroin-involved women seeking methadone maintenance treatment (MMT) and to investigate sociodemographic and clinical factors predicting the time to have suicidal behaviors. METHODS: We identified a retrospective cohort comprising 2780 women receiving methadone treatment in the period of 2012-2016. Healthcare records were obtained from Taiwan's National Health Insurance Research Database, and suicide deaths were ascertained from the national death register. Competing risk survival analyses were used to estimate the risk of suicide attempts and deaths within one year and three years of MMT enrollment. RESULTS: A total of 1.2 % of MMT-treated women ever visited hospital for suicide attempt, and 0.5 % died by confirmed suicide. The risk of treated suicide attempt reached its peak at the end of the 8th month after methadone initiation, whereas the risk of confirmed suicide death was relatively stable during the first one and a half years. A history of treated depressive disorders appears to be the strongest risk predictor for treated suicide attempts (Adjusted Hazard Ratio [aHR] = 3.45; 95 % CI = 1.66-7.19) and confirmed suicide death (aHR = 3.47; 95 % CI = 1.20-10.0). Retaining in methadone treatment may significantly lower the hazard of probable suicide death by 52 %. CONCLUSIONS: Women with heroin use disorders should receive careful attention for suicide risk at intake assessment and over the course of treatment and recovery. Preventive strategies should target unmet clinical and social needs and evaluate gender-specific barriers for treatment engagement.

Residential Socioeconomic Environments and Areca Nut Use in Taiwan: A Comparison with Alcohol and Tobacco Use in Multilevel Analysis.

BACKGROUND: While the association between residential socioeconomic environments and the use of globally common substances such as alcohol and tobacco has been well documented in Western countries, it remains little known about regionally important substances, such as areca nut in Asia. Objective: This study was aimed to develop residential environmental indicators in the context of Taiwan and examine their associations with areca nut use, in comparison to alcohol and tobacco use. Methods: Data were drawn from 13,392 adults across 168 townships in the 2014 National Survey on Substance Use in Taiwan. Residential socioeconomic environment variables were derived from the census and analyzed using factor analysis. Multilevel logistic regression models were used to examine the association of individual- and residential-level factors with the use of areca nut (use/nonuse), alcohol (harmful use, low-risk use, or nonuse), and tobacco (nicotine dependence, regular active use, or nonuse). Results: A three-factor structure of socioeconomic environments derived from 16 residential-level variables consisted of Rural Disadvantage, Affluence, and Family Fragmentation. Multilevel analyses showed that areca nut use was associated with both individual-level (male sex, age group 35-44 years, being divorced/widowed/separated, low educational attainment, and the occupational group of labors) and residential-level (Rural Disadvantaged and Family Fragmented) variables; such a profile was most similar to that of nicotine dependence. Conclusions: A three-factor structure could be derived for the residential-level socioeconomic environments in the Taiwanese context. Rural Disadvantaged and Family Fragmented were associated with areca nut use, which have implications for interventions targeted at the community level.