Aspidistradaibuensis var. longkiauensis, a new variety of Aspidistra (Asparagaceae) from Taiwan, identified through morphological and genetic analyses.

Aspidistra Ker Gawl. is one of the the most diverse and fastest-growing genera of angiosperm. Most Aspidistra species have been discovered in a limited area or a single site through morphological comparison. Because of the lack of population studies, morphological variation within species and the boundaries of some species remain unclear. In recent years, combining genetic and morphological markers has become a powerful approach for species delimitation. In this study, we performed population sampling and integrated morphometrics and microsatellite genetic diversity analyses to determine the species diversity of Aspidistra in Taiwan. We identified three species, namely Aspidistraattenuata Hayata; A.daibuensisHayatavar.daibuensis; A.mushaensisHayatavar.mushaensis; and reduced A.longiconnectiva C.T.Lu, K.C.Chuang & J.C.Wang to the variety level, and described a new variety, A.daibuensisHayatavar.longkiauensis. The description, diagnosis, distribution, and photographs of this new variety as well as a key to the known Taiwanese Aspidistra are provided.

The characteristics of decision making, potential to take risks, and personality of college students with Internet addiction.

This study aimed to identify risk factors involved in Internet addiction. A total of 216 college students (132 males and 84 females) were given the following: (a) the diagnostic interview for Internet addiction, (b) the Iowa gambling test for decision-making deficits, (c) the Balloon Analog Risk Test (BART) to assess risk-taking tendencies, and (d) the Tridimensional Personality Questionnaire (TPQ) for personality characteristics. The results revealed the following: (a) 49% of males and 17% of females were addicted, (b) the addicted students tended to select more advantageous cards in the last 40 cards of the Iowa test, indicating better decision making, (c) no difference was found for the BART, indicating that addicted subjects were not more likely to engage in risk-taking behaviors and (d) TPQ scores showed lower reward dependence (RD) and higher novelty seeking (NS) for the addicts. Their higher performance on the Iowa gambling test differentiates the Internet addiction group from the substance use and pathologic gambling groups that have been shown to be deficient in decision making on the Iowa test. Thus, students that fit these characteristics should be closely monitored to prevent Internet addiction.

Proposed diagnostic criteria and the screening and diagnosing tool of Internet addiction in college students.

The aims of this study were to develop diagnostic criteria of Internet addiction for college students (DC-IA-C) with diagnostic interviews and to establish the optimal cutoff points of the Chen Internet Addiction Scale (CIAS) for the purposes of screening for and making the diagnosis of Internet addiction. A total of 216 college students (132 male and 84 female) were recruited in the study. The results demonstrated that 5/6 cutoff points of criteria A in DC-IA-C had the best diagnostic accuracy (95.9%). Besides, 63/64 and 67/68 cutoff points of the CIAS were evaluated to be the best screening and diagnostic cutoff points, respectively. The DC-IA-C can provide health care professionals with a means to diagnose and communicate about Internet addiction among college students, and the screening and diagnostic cutoff points of CIAS could provide a screening instrument or a discriminative instrument in surveys for Internet addiction among college students.

Nurses' perceptions of environmental pressures in relation to their occupational stress.

AIM: The aim of this paper was to explore nurses' stress experiences of working under the current health care system in Taiwan (the context) using a qualitative approach. BACKGROUND: Although most global health care institutions have been changing in response to the economic contraction, there is a deficit of information in understanding the changes of the ecology of the health care system in Taiwan from nurses' perspectives. DESIGN: Grounded theory. METHODS: A grounded theory approach was used to collect the data from a sample of 28 critical care nurses from seven hospitals in Taiwan. Data were analysed using a multi-step analytic procedure, based on the approaches of Glaser, Chesler and Strauss and Corbin. FINDINGS: The health care system changes were found to increase critical care nurses' occupational stress and work dilemmas. For the purpose of this study, the two categories that emerged in the 'context' component of the paradigm model are investigated. They were: hospital reorganisation and cultural burden of the nurse's role. CONCLUSIONS: The findings indicated that hospital organisational changes and people's own belief of the nurse's role were recognised as the environmental pressures which increase critical care nurses' occupational stress. Cultural background may play an important role in influencing nurses' work atmosphere and their ways of being seen. RELEVANCE TO CLINICAL PRACTICE: Critical care nurses perceived that their hospitals were under huge demands due to the changes in health care policies; these had subsequently caused them a high level of occupational stress. Beliefs in the embedded culture were also identified as significant factors in causing nurses' role stress. These findings could enhance the knowledge of critical care nurses' occupational stress and identify the most appropriate stress management skills available to them. Findings will add to the understanding of Chinese nurses who may work globally.

Brain activities associated with gaming urge of online gaming addiction.

The aim of this study was to identify the neural substrates of online gaming addiction through evaluation of the brain areas associated with the cue-induced gaming urge. Ten participants with online gaming addiction and 10 control subjects without online gaming addiction were tested. They were presented with gaming pictures and the paired mosaic pictures while undergoing functional magnetic resonance imaging (fMRI) scanning. The contrast in blood-oxygen-level dependent (BOLD) signals when viewing gaming pictures and when viewing mosaic pictures was calculated with the SPM2 software to evaluate the brain activations. Right orbitofrontal cortex, right nucleus accumbens, bilateral anterior cingulate and medial frontal cortex, right dorsolateral prefrontal cortex, and right caudate nucleus were activated in the addicted group in contrast to the control group. The activation of the region-of-interest (ROI) defined by the above brain areas was positively correlated with self-reported gaming urge and recalling of gaming experience provoked by the WOW pictures. The results demonstrate that the neural substrate of cue-induced gaming urge/craving in online gaming addiction is similar to that of the cue-induced craving in substance dependence. The above-mentioned brain regions have been reported to contribute to the craving in substance dependence, and here we show that the same areas were involved in online gaming urge/craving. Thus, the results suggest that the gaming urge/craving in online gaming addiction and craving in substance dependence might share the same neurobiological mechanism.

Effects of childhood physical abuse on depression, problem drinking and perceived poor health status in adolescents living in rural Taiwan.

AIMS: The aim of the present study was to investigate the magnitude and independence of the effects of childhood physical abuse on adolescent depression, problem drinking and perceived poor mental health in Taiwanese indigenous and non-indigenous adolescents living in rural areas controlling for individual and familial characteristics. METHODS: A sample of adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. The associations between childhood physical abuse and adolescent depression, problem drinking and perceived poor health status were examined on univariate and multivariate logistic regression. RESULTS: Of the 1684 adolescents who completed the questionnaires, 374 (22.2%) reported that they had experienced physical abuse in childhood. Controlling for individual and familial factors, childhood physical abuse significantly increased the risk of depression, problem drinking and perceived poor health status in the present sample of adolescents on multivariate logistic regression. CONCLUSION: History of childhood physical abuse should be elicited from adolescents in treatment for depression, alcohol abuse or physical discomfort of unknown etiology. This finding may be of clinical benefit in terms of the design and implementation of intervention.

Evaluation of effect of cognitive intervention programs for the community-dwelling elderly with subjective memory complaints.

PURPOSE: To compare the efficacy of cognitive training (CT) and cognitive stimulation (CS) programs for the community elderly with subjective memory complaints (SMC). METHOD: The single-blind non-randomized controlled study was applied. The numbers of CT and CS participants were 14 and 11. The mean ages of CT and CS participants were 68.71 and 70.36. Memory training and problem solving strategies were applied in the CT group. There were ten 2-hourly sessions of CT, held twice weekly. CS group met once weekly in a 1.5-h class for eight classes. Cognitive performance tests of general cognitive performance, verbal memory and executive function were measured before/after the training and at 6 months follow-up. RESULTS: In both training conditions, the general cognitive performance were enhanced. The CT group showed improvement in the verbal memory test. The CS group did not trigger any training effect in the verbal memory test but the executive function. All cognitive progresses remained at follow-up. CONCLUSION: Both cognitive training and cognitive stimulation programs showed training effects and remained until 6 months.

Suicidal thoughts among elderly Taiwanese aboriginal women.

OBJECTIVES: The aims of this study were to investigate prevalence of suicidal thoughts among a population of elderly aboriginal women in Taiwan over a 1-month period and to examine the risk factors for suicidal thinking in terms of individual (self-perceived health, disability and financial difficulty), family (marital discord) and social (medical accessibility) aspects. The mediating effects of depression on the above risk factors were also investigated. Furthermore, we examined the buffer effect on suicidal ideation of emotional social support for dealing with marital discord. METHODS: One thousand three hundred and forty-seven elderly Taiwanese aboriginal women were enrolled. Suicide thoughts within the past month, demographic data, adverse life events, emotional social support and depressive state were assessed. The 1-month prevalence of suicide thoughts was calculated. The risks of suicide thought based on individual, family and community aspects were estimated. RESULTS: The 1-month prevalence of suicidal thoughts among the community-dwelling aboriginal elderly women was 17.8%. Those subjects with poorer self-perceived health, difficulty in accessing medical resources, or experiencing marital discord were at higher risk of having suicidal thoughts. After controlling for depression, the odds ratio of self-perceived health and marital discord remained statistically significant. The odds ratio of interaction of marital discord and emotional social support was 0.41. CONCLUSION: Suicidal thoughts are common among the community-dwelling aboriginal elderly women in Taiwan. Risk factors for suicidal thoughts comprise individual (depression and physical condition), family (marital discord) and community (medical resources) aspects. Better emotional social support can effectively buffer the effect of marital discord.

Childhood physical and sexual abuse: prevalence and correlates among adolescents living in rural Taiwan.

OBJECTIVE: The aims of this cross-sectional survey study were to examine the prevalence and correlates of childhood physical and sexual abuse in adolescents living in the rural areas of Taiwan. METHOD: A sample of indigenous (n=756) and non-indigenous (n=928) adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. Structured questionnaires were used to collect data anonymously. The prevalence of childhood physical and sexual abuse was examined and their correlates were examined using univariate and multivariate logistic regression. RESULTS: A total of 374 (22.2%) adolescents reported experience of physical abuse and 42 (2.5%) reported sexual abuse in their childhood. Multivariate logistic regression analyses revealed that the adolescents who perceived poor family function, frequent family conflicts and whose parents drank habitually were more likely to experience physical abuse. The adolescents who were indigenous and perceived frequent family conflicts were more likely to experience childhood sexual abuse. Further analyses indicated that indigenous boys had a higher risk of being the victims of sexual abuse than non-indigenous boys, while no difference was found between indigenous and non-indigenous girls. CONCLUSION: The results remind clinical workers of the importance of taking abuse histories from adolescents on a routine basis, and this is especially important in the case of dysfunctional families. PRACTICE IMPLICATIONS: Adolescents who live in rural areas have less social and medical resources for early detection and intervention of physical and sexual abuse. Correlates of physical and sexual abuse identified in this study may be helpful for the design and implementation of preventive intervention.

A multilevel analysis of the influence of Apolipoprotein E genotypes on depressive symptoms in late-life moderated by the environment.

OBJECTIVE: This study aimed to clarify the relationship between the APOE alleles and depressive symptoms of older adults, considering individual characteristics and the effect of neighborhood environment. METHODS: Using a multilevel, stratified sampling strategy, 500 elders were recruited from official household records. Depressive symptoms were assessed using the Taiwanese Depression Questionnaire [TDQ]. Cognitive function was assessed by the Short Portable Mental Status Questionnaire [SPMSQ]. Blood samples were collected for the determination of the Apolipoprotein E [APOE] polymorphism. Perceived neighborhood experience was brought together using the Neighborhood Quality Index [NQI]. RESULTS: Three hundred and three subjects (58.8% male, with a mean age of 69.2 [SD=2.7] years) completed all questionnaires and the collection of blood samples. Risk factors for depressive symptoms of elders included lower educational level, cognitive impairment, having 2 or more chronic diseases, and having the APOE epsilon4 allele. In the 2-level model with individual characteristics and neighborhood environmental factors, the effect of the APOE epsilon4 allele on depressive symptoms was significantly attenuated. CONCLUSIONS: The APOE epsilon4 allele is correlated with depressive symptoms among older adults, but moderated by neighborhood environmental factors.

ApoE4 allele is associated with late-life depression: a population-based study.

OBJECTIVE: This study aimed to clarify the relationship between the epsilon4 allele and late-life depression, taking into account lipid profile, vascular diseases, and sociodemographics. METHODS: Using a multilevel stratified random sampling strategy, a total of 500 subjects aged 65 to 74 years were recruited for this cross-sectional study from the official household records of an entire county in southern Taiwan. Depressive symptoms were assessed by the Taiwanese Depression Questionnaire (TDQ). Cognitive function was assessed by the Short Portable Mental Status Questionnaire. Blood samples were collected for the determination of the apolipoprotein E (ApoE) polymorphism and the lipid profile. RESULTS: A total of 283 subjects (58.7% male, with a mean age of 69.2 +/- 2.7 years) completed all questionnaires and collection of blood samples. Using the chi(2) test, the overall difference for frequency of the presence of the epsilon4 allele was significant among the severe group (TDQ score >18), moderate group (TDQ score 9-18), and mild group (TDQ score <9). The proportion of history of heart disease was significantly higher in the severe group than in the mild or moderate group. Kruskal-Wallis statistics revealed that the mean total and low-density lipoprotein cholesterol levels were significantly higher in the severe group than in the moderate or mild group. With our two-level four-class latent class regression model, the presence of the epsilon4 allele was significantly associated with the severely depressed group as compared to the nondepressed group, adjusting for vascular diseases and lipid profile. CONCLUSION: The ApoE epsilon4 allele may be correlated with severe depression in the elderly through ways other than the "vascular depression" hypothesis.

Factors predictive for incidence and remission of internet addiction in young adolescents: a prospective study.

The aim of the study is to determine the incidence and remission rates for Internet addiction and the associated predictive factors in young adolescents over a 1-year follow-up. This was a prospective, population-based investigation. Five hundred seventeen students (267 male and 250 female) were recruited from three junior high schools in southern Taiwan. The factors examined included gender, personality, mental health, self-esteem, family function, life satisfaction, and Internet activities. The result revealed that the 1-year incidence and remission rates for Internet addiction were 7.5% and 49.5% respectively. High exploratory excitability, low reward dependence, low self-esteem, low family function, and online game playing predicted the emergency of the Internet addiction. Further, low hostility and low interpersonal sensitivity predicted remission of Internet addiction. The factors predictive incidence and remission of Internet addiction identified in this study could be provided for prevention and promoting remission of Internet addiction in adolescents.

The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility.

PURPOSE: To: (1) determine the association between Internet addiction and depression, self-reported symptoms of attention deficit and hyperactivity disorder (ADHD), social phobia, and hostility for adolescents; and (2) evaluate the sex differences of association between Internet addiction and the above-mentioned psychiatric symptoms among adolescents. METHODS: A total of 2114 students (1204 male and 910 female) were recruited for the study. Internet addiction, symptoms of ADHD, depression, social phobia, and hostility were evaluated by the self-report questionnaire. RESULTS: The results demonstrated that adolescents with Internet addiction had higher ADHD symptoms, depression, social phobia, and hostility. Higher ADHD symptoms, depression, and hostility are associated with Internet addiction in male adolescents, and only higher ADHD symptoms and depression are associated with Internet addiction in female students. CONCLUSION: These results suggest that Internet addiction is associated with symptoms of ADHD and depressive disorders. However, hostility was associated with Internet addiction only in males. Effective evaluation of, and treatment for ADHD and depressive disorders are required for adolescents with Internet addiction. More attention should be paid to male adolescents with high hostility in intervention of Internet addiction.

Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan.

During the 2003 outbreak, severe acute respiratory syndrome (SARS) spread to more than 30 countries. Not only did it cause severe health problems but it also imposed a great psychological impact on the public. SARS emerged in Taiwan during April 2003. This study investigates the psychosocial impact and the associated factors of depression of the SARS epidemic in Taiwan when the epidemic had just been controlled. A total of 1552 respondents were recruited in the study by random selection from the telephone book. Demographic data, SARS experience, self-perceived health state, neighborhood relationships, and depression were surveyed by telephone interviewing. Respondents were grouped as 'impacted group' and 'non-impacted group' according to whether they or their friends and family had been quarantined, or suspected of being infected. The psychosocial impact and associated factors were compared between the two groups. The 'impacted group' had higher depressive levels, poorer neighborhood relationships, poorer self-perceived health, and a higher economic impact than the 'non-impacted group'. The poorer self-perceived health and economic impact factors were associated with depression. The neighborhood relationship factor was negatively associated with depression for the 'impacted group', but not for the 'non-impacted group'. The 'impacted group' had experienced greater psychosocial impact possibly due to the SARS impact, the economic downturn, poor self-perceived health conditions, and decreased social support systems. An appropriate mental health intervention to improve the self-perceived health condition, to provide instrumental and psychological support for the 'impacted group', and to decrease the stigmatization and discrimination from the public could have buffered the psychological impact from this epidemic disaster.

Intimate partner violence and minor psychiatric morbidity of aboriginal Taiwanese women.

OBJECTIVES: Experiences of abuse increase the risk of psychiatric morbidity in women. This study assesses the prevalence of intimate partner violence and minor psychiatric morbidity and analyzes their association among aboriginal women in Taiwan. METHODS: Using system random sampling, 840 aboriginal women between the ages of 18 and 50 years old were recruited from four townships with aboriginal communities in southern Taiwan. Trained primary care nurses interviewed the participants at home by structured questionnaire. RESULTS: One hundred twenty-six of 840 (15%) of the aboriginal women had experienced physical abuse perpetrated by an intimate partner (her husband or cohabitant) during their lifetime; 10.1% had experienced it during the past 12 months; 4.0% had experienced sexual abuse by the partner; and 6.3% had experienced physical abuse during childhood at the hands of one or both parents. Multiple logistic regression revealed that after adjusting for women's age, alcohol and drug use, religious activity and husband's employment status, the experience of abuse (including partner physical abuse, partner sexual abuse, and childhood physical abuse) was significantly associated with suicidal ideation and depression. CONCLUSIONS: Health care professionals need to provide adequate support and health education, develop interventions, and use referrals in primary care in the community in order to reduce and prevent domestic violence against aboriginal women in Taiwan.

Quality of life, depression, and stress in breast cancer women outpatients receiving active therapy in Taiwan.

The aims of the present study were to compare the quality of life (QoL), depression and stress between patients with malignant breast cancer and those with benign breast tumors. The present study also examined the factors related to QoL among the patients who were receiving active treatment for breast cancer. Among the 97 patients participating in the study, 73 patients were diagnosed as having malignant breast cancer (malignant group) and 24 as having benign tumors (benign group). All the participants completed the World Health Organization Questionnaire on Quality of Life to determine their QoL. The level of depression, stress, and demographic characteristics were also collected. Quality of life, depression and stress were compared between the malignant and benign groups, and the factors related to QoL were also examined. It was found that the malignant group had poorer physical and psychological QoL and higher life stress. Depression was significantly associated with QoL for both the malignant and benign groups, and the stress from health problem was the most significant predictors for QoL among the malignant group. The breast cancer patients suffered more severe psychological difficulty under active treatment than did the benign group patients. This will have great impact on their QoL, as in Western society. Depression and stress need to be recognized and aggressive psychological and/or medical intervention needs to be carried out in order to diminish the impact on QoL.

Employment experience in relation to alcohol, tobacco, and betel nut use among youth in Taiwan.

The aim of this study is to assess the association linking employment experience with alcohol, tobacco, and betel nut involvement among youth in Taiwan. In 2004, an outreach program was conducted during weekdays to recruit youth sample in seven major geographic regions. A total of 5886 youth aged 12-18 years drawn from 26 cities or towns were assessed by a two-page anonymous self-administered questionnaire, including sociodemographic characteristics, employment-, development-, and drug-related experiences. In Taiwan, youthful experience of alcohol, tobacco, and polydrug use varies by employment status, work intensity, and job type. Holding a full-time job and working in certain settings (e.g., grocery, restaurants) were found associated with an excess of drug-using behaviors. With taking age, male gender, family context, disposable allowance, and school attendance into account, working youths were two to four times as likely to have recent drug involvement than their non-working counterparts, especially for tobacco and polydrug (OR=3.32, 95% CI: 2.58-4.27, p<0.001; OR=3.76, 95% CI: 2.76-5.13, p<0.001). Youths in the labor force emerge as a subgroup experiencing greater use of alcohol, tobacco, betel nut, and polydrug. Future prevention programs may target this high-risk group to reduce possible drug-related negative consequences in developmental and health domains in Taiwan.

Physical abuse against pregnant aborigines in Taiwan: prevalence and risk factors.

The purpose of this study was to estimate the prevalence of, and to investigate the risk factors for physical abuse against pregnant aborigines in Taiwan. A cross-sectional survey was conducted. Aboriginal women who had just given birth in hospitals were recruited from January to December 2003. The women were interviewed with a structured questionnaire about the physical abuse and substance use experiences. Participants were 1143 aboriginal women who had just given birth in hospitals. About 175/1143 of the women (15.3%) had ever experienced physical abuse from a husband or intimate partner, and 79/1143 of the women (6.9%) had experienced it during their recent pregnancy. Multiple logistic regression analysis revealed that the women who were more likely to have been physically abused during their pregnancy were: had fewer years of education, husbands who were unemployed, with a patriarchal family situation and had alcohol, cigarette and non-prescription drug use. Based on these results, we suggest that health care professionals provide adequate support and health education, develop interventions, and use referrals in concert with routine prenatal care in order to reduce and prevent the physical abuse of aboriginal women in Taiwan.

Zotepine-induced catatonia as a precursor in the progression to neuroleptic malignant syndrome.

A 39-year-old man with schizophrenia developed severe catatonia, hyperthermia, muscle rigidity, tachycardia, leukocytosis, and elevated muscle enzyme levels while receiving zotepine therapy. Neuroleptic malignant syndrome (NMS) was diagnosed. After withdrawal of zotepine therapy, transfer to a neurologic intensive care unit, provision of supportive care, and administration of adjunctive bromocriptine therapy, the patient's fever and catatonia subsided. Biochemical irregularities spontaneously returned to normal with no complications. Antipsychotic therapy was restarted with risperidone 12 days after the patient's NMS resolved. After more than 1 year of follow-up, he experienced no adverse events. A recent decrease in mortality from NMS is related to increased awareness of this disorder, but not to treatment with specific agents. Clinicians need to recognize NMS early; although rare, it is a potentially fatal complication of antipsychotic treatment.