Effectiveness of a Web-Based Intervention for Preventing Substance Use in Young Adults in Taiwan: Quasi-Experimental Study.

BACKGROUND: Substance use has been one of the most alarming public health problems worldwide, particularly among younger generations. OBJECTIVE: This study evaluated the effectiveness of a web-based substance use prevention intervention targeted at adults aged 20-29 years. METHODS: The intervention materials comprised 5 sets of infographics and 1 animation, all of which focused on mixed themes: (1) the concept of substance use and its harmful effects on health; (2) misinformation regarding new psychoactive substances; (3) regulation of illicit drugs, particularly marijuana; (4) the brain disease model of addiction; (5) critical thinking skills that improve health literacy; and (6) decision-making and communication skills that help people refuse illegal drugs. The study assigned eligible participants into experimental and control groups on the basis of the parity of their participant numbers. These participants completed web-based baseline and follow-up questionnaires that assessed their knowledge, behavioral intention, self-efficacy, and life skills related to substance use prevention. Knowledge was assessed using 8 questions concerning understanding of substance use harms and the regulation of illicit drugs. Behavioral intention and self-efficacy were assessed using 5-point Likert-type scales. Participants' ability to apply life skills to avoid substance use was assessed using 3 testing scenarios regarding substance use. The study used generalized estimating equations to examine the intervention's effectiveness. RESULTS: A total of 1065 participants (539 control and 526 experimental) completed the intervention and questionnaires in 2019. The average ages of the experimental and control groups were 25.68 (SD 2.71) and 25.66 (SD 2.69) years, respectively. The study observed no significant differences in the demographic variables between the 2 groups. The results of the generalized estimating equation analyses indicated that the intervention significantly improved participants' knowledge (P<.001), behavioral intention (P<.001), and self-efficacy (P<.001) but not their life skills (P=.61) related to substance use prevention. Participants in the experimental group responded to a satisfaction survey with positive feedback on the intervention. CONCLUSIONS: The web-based intervention was effective in improving participants' knowledge, behavioral intention, and self-efficacy concerning substance use prevention. The findings support continued efforts to use web-based interventions to prevent substance use among young adults.

Using Patient Profiles for Sustained Diabetes Management Among People With Type 2 Diabetes.

INTRODUCTION: Our objective was to evaluate the association between patient profiles and sustained diabetes management (SDM) among patients with type 2 diabetes. METHODS: We collected HbA1c values recorded from 2014 through 2020 for 570 patients in a hospital in Taipei, Taiwan, and calculated a standard level based on an HbA1c level less than 7.0% to determine SDM. We used patients' self-reported data on diabetes self-care behaviors to construct profiles. We used 8 survey items to perform a latent profile analysis with 3 groups (poor management, medication adherence, and good management). After adjusting for other determining factors, we used multiple regression analysis to explore the relationship between patient profiles and SDM. RESULTS: The good management group demonstrated better SDM than the poor management group (ß = 0.183; P = .003). Using the most recent HbA1c value and the 7-year average of HbA1c values as the outcome, we found lower HbA1c values in the good management group than in the poor management group (ß = -0.216 [P = .01] and -0.217 [P = .008], respectively). CONCLUSION: By using patient profiles, we confirmed a positive relationship between optimal patient behavior in self-care management and SDM. Patients with type 2 diabetes exhibited effective self-care management behavior and engaged in more health care activities, which may have led to better SDM. In promoting patient-centered care, using patient profiles and customized health education materials could improve diabetes care.

Exploring experiences of binge-watching and perceived addictiveness among binge-watchers: a qualitative study.

BACKGROUND: Recent advances in technology and the Internet have led to the emergence of a phenomenon known as binge-watching. This qualitative study aims to explore experiences and perceptions of binge-watching behavior. The criteria of behavioral addiction were used to examine the characteristics of binge-watching behavior. METHODS: We recruited 25 self-identified binge-watchers in Taiwan and conducted seven focus-group interviews with them in 2019 and 2020. Before their interview, the participants were asked to complete a brief questionnaire to collect information on their sociodemographic characteristics and binge-watching frequency. RESULTS: The participants defined binge-watching behavior as consecutively watching episodes of shows with continuous content, rather than based on the time spent watching or the number of episodes watched. While they felt it may affect their daily routine, they mentioned almost no impacts on their health. Most participants emphasized the pleasure and social functions of binge-watching. This differs from previous studies, which have suggested an association between binge-watching and negative emotions. Notably, while most participants considered binge-watching to be an addictive behavior, they denied that they themselves were addicted. CONCLUSIONS: Our participants generally reported positive attitudes toward binge-watching. The addictiveness of binge-watching remains controversial. Further studies exploring the possibility of addictive binge-watching and potential mechanisms are warranted.

Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity.

OBJECTIVE: The objective of this study was to examine the relationships between students' perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity. DESIGN: Cross-sectional study. SETTING: Primary, middle and high schools in Taiwan. PARTICIPANTS: A nationally representative sample of 2433 primary school (5th-6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018. RESULTS: Multivariate analysis results showed that after controlling for school level, gender and age, the students' perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools' campaigns promoting the eating of vegetables and fruit were positively associated with students' consumption of vegetables. In addition, schools' initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students' engagement in outdoor physical activities and daily moderate-to-vigorous physical activity. CONCLUSIONS: Students' perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

Baicalein inhibits matrix metalloproteinase 1 expression via activation of TRPV1-Ca-ERK pathway in ultraviolet B-irradiated human dermal fibroblasts.

Increased matrix metalloproteinase 1 (MMP-1) expression is a feature of photo-aged skin. We investigated the effects of baicalein and sulphoraphane on ultraviolet B (UVB) irradiation-induced MMP-1 expression and apoptosis using human dermal fibroblasts. UVB irradiation not only increased MMP-1 expression, but also caused apoptosis. Both baicalein and sulphoraphane protected cells from UVB irradiation-induced apoptosis, but only baicalein inhibited MMP-1 expression. UVB irradiation activated 12-lipoxygenase, and its product, 12-hydroxyeicosatetraenoic acid, activated TRPV1 channels. The resulting UVB irradiation-induced Ca2+ increase was blocked by the 12-lipoxygenase inhibitor baicalein and the TRPV1 blocker capsazepine, but not by the Nrf2 inducer sulphoraphane. UVB irradiation also increased ROS generation and decreased Nrf2 protein levels. UVB irradiation-induced MMP-1 expression was blocked by the Ca2+ chelator BAPTA, by capsazepine and by TRPV1 silencing. However, induction was unaffected by the antioxidant N-acetylcysteine. ERK phosphorylation and JNK phosphorylation were induced by UVB irradiation, but only ERK phosphorylation was Ca2+ sensitive. Increased MMP-1 expression was blocked by PD98059, but not by SP600125. Thus, increased MMP-1 expression is mediated by increased cytosolic Ca2+ and ERK phosphorylation. UVB irradiation-induced ROS generation is also Ca2+ sensitive, and UVB irradiation-induced apoptosis is caused by increased ROS. Thus, baicalein, by blocking the UVB irradiation-induced cytosolic Ca2+ increase, protects cells from UVB irradiation-induced MMP-1 expression and apoptosis. In contrast, sulphoraphane, by decreasing cellular ROS, protects cells from only UVB-induced apoptosis. Thus, targeting 12-lipoxygenase may provide a therapeutic approach to improving the health of photo-aged human skin.

Pneumococcal pneumonia infection is associated with end-stage renal disease in adult hospitalized patients.

Pneumococcal disease leads to renal complications ranging from persistent proteinuria to end-stage renal disease (ESRD) in pediatric patients. However, long-term renal effects after pneumococcal pneumonia infection in adult patients remains largely unknown. To evaluate this we conducted a population-based retrospective cohort study consisting of 18,733 adult patients at the time of pneumococcal pneumonia diagnosis, using claims data from Taiwan's National Health Insurance Research Database (NHIRD) with a comparison cohort of 73,409 age- and gender-matched patients without pneumococcal pneumonia. The overall incidence rate ratio of ESRD was 23% higher in those with pneumococcal pneumonia than in those without pneumococcal pneumonia (5.26 vs. 3.10 per 1000 person-years), with an adjusted hazard ratio of 1.14 (95% confidence interval 1.01-1.29). In addition, the risk of developing ESRD was associated with covariates including age, gender, chronic kidney disease, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and heart failure. The ESRD cumulative incidence curve showed a considerably higher risk of ESRD in those with pneumococcal pneumonia than in those without pneumococcal pneumonia (significant by log-rank test). Thus, pneumococcal pneumonia may be associated with an increased risk of ESRD in adult patients. A long-term follow-up of renal function is recommended for adult hospitalized patients with pneumococcal pneumonia infection.

Association between colonic diverticular disease and colorectal cancer: a nationwide population-based study.

BACKGROUND & AIMS: We investigated whether a diagnosis of colonic diverticular disease is associated with an increased risk for subsequent development of colorectal cancer (CRC) in a nationwide population-based retrospective study. METHODS: We identified 41,359 individuals diagnosed with colonic diverticular disease as inpatients from 2000 through 2009 from the Taiwan National Health Insurance Research Database (study cohort) and collected data for 165,436 randomly selected additional subjects, matched by sex, age, and baseline year (comparison cohort). Data were collected until individuals developed CRC or withdrew from the National Health Insurance system, or until December 31, 2010. Cumulative incidences and hazard ratios (HRs) of CRC development were determined. To assess for ascertainment bias, we conducted an analysis excluding the first 12 months of follow-up evaluation. RESULTS: The risk of CRC was significantly higher in the study cohort than in the comparison cohort (HR adjusted for age, sex, and comorbidities, 4.54; 95% confidence interval, 4.19-4.91; P < .0001). In a sensitivity analysis, we excluded the first 12 months of follow-up evaluation after a diagnosis of colonic diverticular disease; subsequent incidence rates for CRC in the study and comparison cohorts were 15.13 and 15.74 per 10,000 person-years, respectively (adjusted HR, 0.96; 95% confidence interval, 0.83-1.11). CONCLUSIONS: Colonic diverticular disease is not associated with an increased risk of subsequent CRC after the first year of diagnosis of colonic diverticular disease. An increased risk was observed in the first year, possibly owing to misclassification and screening effects.

Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study.

OBJECTIVE: Studies on the association between rheumatoid arthritis (RA) and deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) are scarce. This study identifies the effects of RA on the risks of developing DVT and PE in a nationwide prospective cohort study. METHODS: We studied the entire Taiwan population from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with RA using the catastrophic illness registry of the Taiwan National Health Insurance Research Database (NHIRD). We also selected a comparison cohort that was randomly frequency-matched by age (each 5-year span), sex and index year from the general population. We analysed the risks of DVT and PE using Cox proportional hazards regression models, including sex, age and comorbidities. RESULTS: From 23.74 million people in the cohort, 29 238 RA patients (77% women, mean age of 52.4 years) and 1 16 952 controls were followed 1 93 753 and 7 92 941 person-years, respectively. The risk of developing DVT and PE was 3.36-fold and 2.07-fold, respectively, in patients with RA compared with patients without RA, after adjusting for age, sex and comorbidities. The multiplicative increased risks of DVT and PE were also significant in patients with RA with any comorbidity. CONCLUSIONS: This nationwide prospective cohort study demonstrates that DVT and PE risks significantly increased in patients with RA compared with those of the general population.

Nationwide population-based cohort study on the association of acute coronary syndrome in patients with malignancies.

AIMS/INTRODUCTION: Patients with malignancy are suggestive of having a tendency toward an association with vascular thrombosis risk. The aim of this study was to evaluate the possible relationship between malignancy and the risk of acute coronary syndrome (ACS) in Taiwan. MATERIALS AND METHODS: We used data from the National Health Insurance (NHI) system of Taiwan to assess the issue. Cox proportional hazards regression analysis was conducted to estimate the effects of malignancy on the risk of ACS. RESULTS: ACS risk in patients with malignancies was marginally significantly greater when adjusted for age, sex (hazard ratio (HR) = 1.09, 95 % confidence interval (CI) = 0.99-1.20), and comorbidities (HR = 1.03, 95 % CI = 0.93-1.13). A subgroup analysis indicated that patients with prostate cancer and head and neck cancer (HEENT) had a significantly higher risk of ACS (HR = 1.30, 95 % CI = 1.01-1.67; HR = 3.03, 95 % CI = 1.47-6.50). CONCLUSIONS: We suggest careful surveillance of ACS symptoms and regular electrocardiography during follow-up of these patients. However, further large-scale studies for patients with prostate and HEENT cancer and cancer survivors (especially from post-hormone or radiotherapy) are needed.

Increased subsequent risk of acute coronary syndrome for patients with depressive disorder: a nationwide population-based retrospective cohort study.

AIM: The purpose of this study was to explore the possible association between subsequent acute coronary syndrome (ACS) risk and depressive disorder. METHODS: We used data from the National Health Insurance system of Taiwan to address the research topic. The exposure cohort contained 10 871 patients with new diagnoses of depressive disorders. Each patient was randomly frequency-matched for sex and age with four participants from the general population who did not have any ACS history before the index date (control group). Cox's proportion hazard regression analyses were conducted to estimate the relation between depressive disorders and subsequent ACS risk. RESULTS: Among patients with depressive disorders, the overall risk for developing subsequent ACS was significantly higher than that of the control group (adjusted hazard ratio: 1.88, 95% confidence interval: 1.63-2.17). Further analysis revealed that the higher risk was observed in patients who were male, were of older age, or whose diagnosis was combined with other comorbidities. CONCLUSIONS: The findings from this population-based retrospective cohort study suggest that depressive disorder is associated with an increased subsequent ACS risk.

Benzodiazepine use and risk of stroke: a retrospective population-based cohort study.

AIM: The aim of this study was to investigate the possible association between benzodiazepine (BZD) use and risk of incident stroke by utilizing data from 2000 to 2003 from the National Health Insurance system of Taiwan. METHODS: Study subjects consisted of 38,671 patients with new BZD use and 38,663 people without BZD use who were frequency-matched for age, sex and baseline comorbidity with BZD users. All subjects had no history of stroke. Each study patient's case was followed until a new diagnosis of stroke was made or until the patient was censored by loss to follow up, death, or termination of insurance. The study lasted until the end of 2009. A Cox proportional hazards regression model was used to estimate the incidences and hazard ratios (HR) of stroke. RESULTS: The HR of hemorrhagic stroke was significantly lower in the BZD group when compared with the non-BZD group. For patients aged 20-39 years, the HR of ischemic stroke was significantly higher in the BZD group when compared with the non-BZD group. Compared to the non-BZD group, patients with a lower annual dosage (<1 g) or duration (<30 days) of BZD use had a lower risk of stroke in the elder group (P < 0.0001) and patients with a higher annual dosage (≥ 4 g) or duration (≥ 95 days) of BZD use had a higher risk of stroke in all age groups (P < 0.0001). CONCLUSIONS: Our findings may suggest neuroprotection under lower-dosage BZD use and neurotoxicity under higher-dosage BZD use.

Pulmonary embolism in chronic obstructive pulmonary disease: a population-based cohort study.

BACKGROUND: To evaluate the incidence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) in Taiwan. METHODS: This was a retrospective population-based cohort study using data retrieved from Taiwan's National Health Insurance Research Database (2000 to 2008), which contains 99% of Taiwanese healthcare data. The evaluations included 355,878 COPD patients and 355,878 non-COPD patients for comparison. RESULTS: The incidence of PE in the COPD cohort was 12.31 per 10,000 person-years (1.37/10,000 persons/y), which was approximately 4-times higher than in the comparison cohort (0.35/10,000 persons/y). In the COPD cohort, risk of PE was higher in the young age group (20-59 y, HR 4.64, 95% CI 3.06-7.03) than in other age groups. Risk of PE was higher in patients with COPD combined with hypertension, coronary artery disease, and cancer, or those with previous operation (HR 4.16, 4.75, 4.56, and 4.50 respectively) than in those with COPD and no comorbidity. CONCLUSIONS: The overall incidence of PE is lower in Taiwan than in western countries. However, the prevalence of PE in COPD patients is higher than in non-COPD patients and increases with age. It is crucial to incorporate PE into the differential diagnosis of COPD exacerbation for clinical physicians.

Urinary tract infection increases subsequent urinary tract cancer risk: a population-based cohort study.

This study examines the possible association between urinary tract infection (UTI) and urinary tract cancer (UTC). Data from the National Health Insurance system of Taiwan were used for the analysis. The UTI cohort included 70 116 patients who were diagnosed and recruited between 1997 and 2010. Each patient was randomly frequency-matched with two people without UTI from the general population based on their age, sex, and month of UTI diagnosis. Cox's proportional hazard regression analysis was used to estimate the effects of UTI on UTC risk until the end of follow-up on December 31, 2010. Patients with UTI had a significantly higher risk of developing UTC than healthy people (adjusted hazard ratio, 4.66; 95% confidence interval, 3.55-6.10). Further analyses indicated that risks are potentially related to the level of the lesion site. This study indicated that patients with UTI had a higher risk of developing UTC.

Urinary tract stone raises subsequent risk for urinary tract cancer: a population-based cohort study.

OBJECTIVE: To evaluate the association between urinary tract stone (UTS) and urinary tract cancer (UTC) in Taiwanese patients, as the results of epidemiological studies about the relationship between UTS and the development of UTC remain inconclusive. PATIENTS/SUBJECTS AND METHODS: We conducted a population-based cohort study using data from the Taiwanese National Health Insurance system. The UTS cohort included 21 862 patients, and each patient was randomly frequency-matched for age, sex, and index year with two insured members of the general population who did not have UTS. Cox proportional hazard regression analysis was performed to estimate the effect of UTS on the risk of UTC. RESULTS: Patients with UTS were at a significantly higher risk of developing UTC compared with the comparison group (adjusted hazard ratio 4.66; 95% confidence interval 2.97-7.30). Women were at higher risk than men. Further analyses showed that the level of UTC was associated with that of UTS, and that the risk for UTC became more divergent for the two groups over time. CONCLUSIONS: Taiwanese patients with UTS, particularly women, had a higher risk for developing UTC than patients without UTS. The risk became more marked over time for this group.

Does use of tetracyclic antidepressant-mirtazapine reduce cancer risk in depression patients?

PURPOSE: We conducted a nested case-control study to evaluate the association between risk of cancer and mirtazapine use in depression patients in Taiwan. METHODS: We obtained data from the Taiwan National Health Insurance Research Database to conduct a population-based nested case-control study. The study cohort included 16 897 patients diagnosed with depression between January 1, 2000 and December 31, 2008. We identified 530 cancer patients as the study group and matched 4 non-cancer subjects with each cancer patient by incident density, age, and sex. Odds ratios and 95% confidence intervals were estimated using multivariate conditional logistic regression analysis. RESULTS: Use of mirtazapine for depression did not have significant effect on overall cancer incidence (odds ratio: 1.03, 95% confidence interval: 0.72-1.48). Further analysis of annual mirtazapine dosages and the duration of mirtazapine use revealed no significant effect on cancer risk. CONCLUSION: The findings of this population-based nested case-control study suggest that mirtazapine use may not provide a tumor suppression effect in humans such as that seen in the animal model. Future large-scale and in-depth investigations in this area are warranted.

A nationwide population-based retrospective cohort study: decreased risk of stroke in cervical cancer patients after receiving treatment.

OBJECTIVE: To evaluate risk of stroke in patients with cervical cancer using population-based data. METHODS: Claims collected in the Taiwan National Health Insurance database were used to identify 20,286 cervical cancer patients receiving diagnosis and treatment during 2000-2008. A reference group of 81,144 non-cancer participants, matched for age, cervical cancer-month and cervical cancer-year, was used for comparison. Risk of stroke was further assessed at follow-up until the end of 2009. RESULTS: Patients with cervical cancer had a 42 % lower risk of developing stroke compared with the cancer-free reference population. Increased risk of stroke was observed in patients receiving radiotherapy compared with the surgery treatment group (HR = 1.88, 95 % CI = 1.52-2.32). CONCLUSION: Results from this large retrospective cohort study indicate a lower risk of developing stroke in cervical cancer patients after receiving treatment compared with a reference population free of cancer after adjusted for age, sex, urbanization level, and stroke risk factors including hypertension and diabetes. Supplementation of estrogen after cancer treatment could explain this finding. Further prospective randomized controlled analysis is needed to confirm these findings and to elucidate the underlying biological mechanisms.

Adolescent Use of Dating Applications and the Associations with Online Victimization and Psychological Distress.

In this study, we examined the relationships between the use of online dating applications (apps), online victimization, and psychosocial distress among adolescents. This study was conducted in 2020. A sample of 2595 seventh-grade students from 30 Taiwanese middle schools was surveyed. We conducted a self-administered survey. Overall, 15% of the adolescents reported using online dating apps in the past year, while 78% reported having seen dating app advertisements on the internet in the past year. Multivariate analysis results indicated that adolescents' exposure to the marketing of dating apps and poor academic performance were both associated with the use of online dating apps. Adolescents who used dating apps were more likely to experience online privacy victimization, cyberbullying victimization, and online sexual harassment. The use of dating apps by adolescents, online privacy victimization, cyberbullying victimization, and online sexual harassment were associated with higher levels of depression, anxiety, and stress. In conclusion, adolescent use of dating apps is related to online victimization and psychological distress.

Modest association between health literacy and risk for peripheral vascular disease in patients with type 2 diabetes.

Objective: Health literacy plays a crucial role in managing chronic health conditions. Previous studies have revealed the positive relationship between health literacy and diabetes knowledge but few studies have focused on peripheral vascular disease (PVD) in diabetes in relation to health literacy in diabetes management. This study investigated the relationship between the risk for PVD and health literacy level with other determining factors among patients with type 2 diabetes. Method: We conducted a survey on health literacy using the Mandarin Multidimensional Health Literacy Questionnaire in the department of metabolism and endocrine systems at a regional hospital in northern Taiwan from December 2021 to May 2022 and obtained data from the hospital's health information system (HIS) from 2013 to 2020 to identify occurrences of PVD (n = 429). We performed logistic regression analysis to identify the relationship between PVD events and health literacy levels (overall and in five separate subdimensions) adjusted with other variables. Results: A longer duration of diabetes increased the risk for PVD events (P = 0.044 and 0.028). In terms of health literacy, the overall level was not significant; however, the dimension of higher levels of health literacy in acquiring health information increased the risk for PVD events (P = 0.034). Other variables were not significantly associated with the risk for PVD events. Conclusion: This study examined the risk for PVD events in terms of the duration of diabetes and provided evidence across the range of dimensions of health literacy concerning the ability to control diabetes. Those with a higher level of health literacy may be more aware of their disease situation, seek and cooperate with their healthcare providers earlier, and have more opportunities to be made aware of their health status from regular checkups than those with inadequate health literacy. These results may help providers make available more self-management tools that are adequate and sustainable for diabetes patients with poor health literacy.

Associations of Problematic Binge-Watching with Depression, Social Interaction Anxiety, and Loneliness.

BACKGROUND: Binge-watching refers to the watching of several episodes of a TV series or program in rapid succession. This study aims to investigate the associations of binge-watching behavior with depression, social interaction anxiety, and loneliness risks among adults in Taiwan. METHODS: A cross-sectional online survey was conducted in October 2018, in which data from 1488 participants were collected using a self-administered questionnaire comprising four valid and reliable scales: the Center for Epidemiologic Studied Depression Scale (CES-D), the Chinese version of the Social Interaction Anxiety Scale (SIAS-C), the UCLA Loneliness Scale (version 3), and the Problematic Series Watching Scale (PSWS). RESULTS: Among the surveyed participants, the mean age was 28.3, and most participants were women who had completed undergraduate education. Multiple regression analysis demonstrated that, after adjustments for sociodemographic characteristics and self-reported health statuses, the score on the problematic binge-watching scale was positively associated with the scores on the depression, social interaction anxiety, and loneliness scales (p < 0.001 for each model). CONCLUSIONS: Problematic binge-watching was associated with increased depression, social interaction anxiety, and loneliness risks among adults in Taiwan. Additional studies on the relationship between problematic binge-watching and mental health problems, as well as its potential mechanism, are warranted.

Survival and Treatment of Lung Cancer in Taiwan between 2010 and 2016.

BACKGROUND: Lung cancer is the leading cause of cancer-related death, and its incidence is still growing in Taiwan. This study investigated the prognostic factors of overall survival between 2010 and 2016 in Taiwan. METHODS: Data from 2010 to 2016 was collected from the Taiwan Cancer Registry (TCR). The characteristics and overall survival of 71,334 lung cancer patients were analyzed according to the tumor, node, metastasis (TNM) 7th staging system. Univariate and multivariate analysis were performed to identify the prognostic factors. RESULTS: The five-year overall survival (n = 71,334) was 25.0%, and the median survival was 25.3 months. The five-year overall survival of patients receiving any kind of treatment (n = 65,436; 91.7%) and surgical resection (n = 20,131; 28.2%) was 27.09% and 69.93%, respectively. The clinical staging distribution was as follows: stage IA (9208, 12.9%), stage IB (4087, 5.7%), stage IIA (1702, 2.4%), stage IIB (1454, 2.0%), stage IIIA (5309, 7.4%), stage IIIB (6316, 8.9%), stage IV (41458, 58.1%). Age, sex, Charlson comorbidity index, cell type, clinical T, clinical N, clinical M, grading and treatment strategy are independent prognostic factors in the multivariate analysis. CONCLUSION: The outcome for lung cancer patients was still poor. The identification of prognostic factors could facilitate in choosing treatment strategies and designing further randomized clinical trials.