Association of psychological distress with psychological factors in rescue workers within two months after a major earthquake.

BACKGROUND AND PURPOSE: Studies of the health of rescue workers after a major disaster have frequently focused on posttraumatic stress disorder. This study aimed to determine the characteristics of psychological distress and its psychosocial predictors in rescue workers within a 2-month period after an earthquake that struck central Taiwan on September 21, 1999. METHODS: A total of 1,104 rescue workers serving in the earthquake were enrolled in the study. Psychological distress was measured using the Brief Symptom Rating Scale (BSRS), personality traits using the Maudsley Personality Inventory (MPI), and family function using APGAR (adaptability, partnership, growth, affection, and resolve) indexes. These measurements were performed within 2 months of the earthquake. Univariate and multivariate analyses were applied to examine the association between psychological distress and various psychosocial factors. RESULTS: BSRS assessment revealed severe psychological distress in 137 (16.4%) subjects. The most common symptom dimension was phobic-anxiety (18.7%), followed by hostility (17.6%), obsessive-compulsive symptoms (16.2%), depression (14.9%), paranoid ideation (14.2%), interpersonal sensitivity (13.3%), psychoticism (11.9%), anxiety (10.8%), additional symptoms (8.5%), and somatization (6.2%). Pre-disaster major life events (R2 = 0.03) and most of the factor scores of the MPI (including moodiness, anxiety-prone, outgoing, conscientiousness, activity, and sociability factors; R2 = 0.25) predicted the severity of psychological distress. Time of arrival at the scene, previous exposure, age, and family function had no or trivial predictive power. CONCLUSION: The results of this study indicated that prevalence of general psychological distress is high among rescue workers in the first 2 months after a major earthquake. Personality traits and pre-disaster life adjustment had a dominant predictive power for psychological distress. Immediate psychosocial intervention should be considered to ameliorate the distress related to disaster rescue work.     

LDLR and ApoB are major genetic causes of autosomal dominant hypercholesterolemia in a Taiwanese population.

BACKGROUND/PURPOSE: Autosomal dominant hypercholesterolemia (ADH) is an autosomal dominant inherited disease characterized by an increase in low-density lipoprotein cholesterol levels and premature coronary heart disease, which can be caused by mutations in genes encoding the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9). There is scant information with regard to the role played by each gene in the Taiwanese ADH population, especially the newly discovered PCSK9 gene. METHODS: We used coupling heteroduplex analysis based on a denaturing high performance liquid chromatography system and DNA sequencing to screen for the LDLR gene, APOB gene and PCSK9 gene in 87 ADH cases recruited from 30 unrelated Taiwanese families. RESULTS: We did not find any mutation-causing variant of the PCSK9 gene in our cases and thus excluded PCSK9 as the major culprit mutation in these families. On the other hand, we identified six previously reported LDLR gene mutations (C107Y, D69N, R385W, W462X, G170X, V408M), two novel LDLR gene mutations (FsG631 and splice junction mutation of intron 10), and one known mutation (R3500W) and one novel missense mutation (T3540M) in the APOB gene that were present in 55 members from 18 ADH families (60%). R3500W, rather than R3500Q, could be the principle mutation responsible for familial defective apolipoprotein B in Taiwanese. CONCLUSION: The results of our study reveal a characteristic mutation pattern of ADH in Taiwan, mainly in the LDLR and APOB genes. However, PCSK9 gene mutation may not be a major cause of ADH in our study population.     

Pulmonary tuberculosis in the Taiwanese prison population.

BACKGROUND AND PURPOSE: Tuberculosis (TB) in prison is a serious public health problem that is fueled by overcrowding, poor nutrition and unsatisfactory medical services. To evaluate the magnitude of the TB epidemic in Taiwanese prisons, we analyzed the results of a screening program for TB among inmates. METHODS: A mass radiography screening was performed in 24 prisons and five jails from July 1998 through June 1999. The National TB Register was notified and treatment with a rifampin-based short-course anti-TB regimen was given for all cases identified in the screening. The outcome of treatment of TB inmates was determined from records of the National TB Register. RESULTS: A total of 51,496 inmates were screened. Pulmonary TB was diagnosed in 107 (258.7 per 100,000 population) inmates. Among them, 88 (82.2%) were newly diagnosed TB patients, 12 (11.2%) had a history of anti-TB treatment and were re-treated after screening, and seven (6.6%) had previously diagnosed TB and were receiving treatment at the time of screening. Of the 107 inmates with TB, 86 (80.4%) completed treatment, 17 (15.9%) were lost to follow-up due to release from prison, and four (3.7%) died (three of TB). During a mean of 26.2 +/- 4.4 months (range, 19.7-39.0 mo) post-registration follow-up, three patients who had completed treatment relapsed. CONCLUSIONS: The high prevalence of TB in prisons indicates that prison administrators and the national TB program in Taiwan need to strengthen their activity to control this disease. The establishment of a surveillance section of the national TB program to systematically collect data on TB in prisons may facilitate efforts to monitor and control TB both in prisons and the general population. Our findings also indicate that TB control in prisons should give top priority to improving mycobacteriology laboratory services to ensure the quality of sputum examinations.     

Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population.

BACKGROUND/PURPOSE: We know of no validated Taiwanese-language instrument to measure a utility of the patient's health. Our aim was to evaluate the reliability and validity of a Taiwanese version of the EuroQol instrument (EQ-5D) in a Taiwanese population. METHODS: Questionnaires containing the Taiwanese versions of the EQ-5D and the Short-Form 12 Health Survey (SF-12) were sent to 12,923 people in Taiwan in December 2002. Concurrent validity of the EQ-5D was analyzed by assuming that subjects with problems in any EQ-5D dimensions had decreased SF-12 scores. Discriminant validity of the EQ-5D was analyzed by assuming that subjects with the following characteristics had lowered EQ-5D indexes and scores on the EQ-5D visual analog scale (VAS): more chronic diseases than others, serious illness, more hospitalizations in the past year than others, poor general health, and more outpatient visits than others. Test-retest reliability was analyzed in a subgroup of respondents who were evaluated twice within a month by using the intraclass correlation coefficient and the kappa method. RESULTS: The general survey response rate was 12.7% (1644 of 12,923). SF-12 scores were lower in subjects reporting problems on EQ-5D dimensions than in others without such problems (p < 0.01). Subjects with more health problems than others had lower EQ-5D indexes and VAS scores (p < 0.01). The physical dimension of the EQ-5D was more strongly correlated with the SF-12 Physical Component Summary than with the Mental Component Summary; this finding satisfied the a priori hypothesis. For test-retest reliability of items on the EQ-5D, kappa values ranged from 0.49 to 1 (p < 0.001). CONCLUSION: The Taiwanese EQ-5D instrument appears to be a moderately valid and reliable tool for measuring the health status of the general population in Taiwan.     

Prenatal diagnosis of six major cardiac malformations in Europe--a population based study

AIM: To present data on prenatal diagnosis of six major cardiac malformations in low-risk European populations. METHODS: Data from 12 Eurocat registries on congenital malformations. All registries have multiple sources of information and use the same methods of data collection and coding. The six cardiac malformations included were hypoplastic left heart, tricuspid atresia, single ventricle, Tetralogy of Fallot, transposition of great arteries and common A-V-canal. RESULTS: There were significant differences in the proportion of cases diagnosed prenatally, with the highest detection rate in France (91% for single ventricle in Paris) and the lowest detection rate in countries without prenatal ultrasound screening (no cases diagnosed prenatally in the Danish registry area). Prenatal detection rate was significantly higher for the three malformations affecting the size of the ventricles (hypoplastic left heart, tricuspid atresia, single ventricle) compared to the other three malformations (46% versus 24%, p<0.001). Time of diagnosis was late, with only one third diagnosed before 24 weeks of gestation. The risk of fetal death seems to be low. CONCLUSION: There are significant regional differences in prenatal detection rate of major cardiac malformations in Europe.     

Human leukocyte antigen polymorphisms in the Taiwanese population.

Polymorphisms of human leukocyte antigens (HLA) are important in transplantation medicine, anthropologic studies, and paternity testing. We investigated the polymorphisms of HLA classes I and II in the Taiwanese population by means of serologic typing and polymerase chain reaction (PCR) analysis with sequence-specific primers. We calculated the HLA-A, -B, and -C gene frequencies in 673 Taiwanese subjects and the HLA-DRB1, and HLA-DQB1 gene frequencies in 204 subjects with available DNA samples. Haplotype frequencies and linkage-disequilibrium were analyzed on the basis of these data. The common HLA class I antigens were A11 (gene frequency, 34.9%), A2 (29.3%), A24 (15.8%), and A33 (9.8%); B60 (21.9%), B46 (13.1%), B58 (9.7%), and B13 (8.5%); and Cw1 (18.8%), Cw7 (15.3%), and Cw10 (10.7%). The common HLA-DRB1 and HLA-DQB1 alleles were DRB1*12 (15.2%), DRB1*09 (15.2%), DRB1*08 (12.0%), and DRB1*04 (12.0%); and DQB1*0301 (23.5%), DQB1*0303 (15.2%), DQB1*0601 (14.5%), and DQB1*02 (10.8%). The common two-locus haplotypes were A2-B46 (frequency, 9. 7%), A11-B60 (9.6%), and A33-B58 (6.8%); DRB1*09-DQB1*0303 (14.9%), DRB1*12-DQB1*0301 (14.2%), and DRB1*08-DQB1*0601 (10.7%). This study is the first to report the gene frequencies of HLA-DQB1 alleles and the common HLA-DR-DQ haplotypes among Taiwanese. Comparison of our results with those from two other Chinese populations in mainland China reveals that Taiwanese are more closely related to southern Han than to northern Han Chinese.     

Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population

IntroductionErectile dysfunction (ED) is usually associated with systemic disorders. This population‐based study supports and expands on previous research. It also presents data in a Taiwanese male population where existing data on this topic remain sparse.AimThe aim of this study is to analyze the prevalence and risk of 36 medical comorbidities in patients with ED compared with the general population.MethodsA total of 2,213 patients with ED and 11,065 matching controls were selected from the Taiwan National Health Insurance Research Dataset. We chose 22 comorbidities from the Elixhauser comorbidity index, 10 highly prevalent medical conditions in an Asian population, and four male gender‐specific comorbidities for analysis.Main Outcome MeasurementConditional logistic regression analyses conditioned on age group and monthly income were performed to investigate the risk of various comorbidities for patients with and without ED, after adjusting for the geographic region and level of urbanization of the patient's community.ResultsPatients with ED were at an increased risk for multiple systemic comorbidities. Conditional regression analyses showed that patients with ED were at a higher risk for hypertrophy of the prostate (odds ratio [OR] = 12.87), chronic prostatitis (OR = 9.36), alcohol abuse (OR = 3.60), drug abuse (OR = 2.62), urinary incontinence (OR = 2.58), ankylosing spondylitis (OR = 2.19), peripheral vascular disorder (OR = 1.98), ischemic heart disease (OR = 1.94), psychoses (OR = 1.97), depression (OR = 1.88), uncomplicated diabetes (OR = 1.91), complicated diabetes (OR = 1.84), hepatitis B or C (OR = 1.71), hyperlipidemia (OR = 1.69), and chronic pulmonary disease (OR = 1.55) than patients without ED.ConclusionThe results show that patients with ED have a higher prevalence of multiple noncardiovascular comorbidities than the general population in Taiwan. Chung S‐D, Chen Y‐K, Kang, J‐H, Keller JJ, Huang C‐C, and Lin H‐C. Population‐based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population. J Sex Med **;**:**–**.     

Familial occurrence of gestational hypertensive disorders in a Brazilian population.

OBJECTIVE: To verify the occurrence of preeclampsia/eclampsia (PE/E) or gestational hypertension (GH) in first-degree relatives of Brazilian pregnant women. METHODS: A total of 485 women were enrolled in the study, and 226 were selected (75 with PE/E, 49 with GH, and 102 women with normal pregnancies). Statistical analysis was performed using Fisher's exact test. RESULTS: The frequency of families with mothers and/or sisters with PE/E was higher among the PE/E group compared to the GH and the control groups, and was statistically significant (p < 0.05). CONCLUSION: Women with PE/E have more female first-degree relatives with PE/E as observed in a Brazilian population.     

Intermediate-term outcome of psychiatric inpatients with major depression.

BACKGROUND/PURPOSE: A wide range of recovery rates has been reported during the 1st year of follow-up inpatients with depression, and there is a lack of consensus regarding which clinical and psychosocial variables are associated with prognosis. This study investigated the outcome of inpatients with a major depressive episode at 10-22 months (mean +/- SD = 14.0 +/- 3.4 months) of follow-up and the associated psychosocial and clinical variables. METHODS: The demographic and clinical characteristics of 67 inpatients with a DSM-IV major depressive episode were assessed at admission, discharge and 1 year after the initial assessment. A logistic regression model was used to examine the predictive factors of depressive status at follow-up. RESULTS: At the 1-year follow-up, 12 patients could not be located, one refused further interview and one had committed suicide 1 month after discharge. Eighty percent of patients had follow-up examinations. Out of 67 patients, 31 (47%) underwent a DSM-IV diagnosis (29 with major depression and two with minor depression) and 22 (33%) recovered. Low socioeconomic status (p = 0.05), long duration of illness before admission (p = 0.03) and number of previous hospitalizations (p = 0.04) were predictive factors for a depressive morbidity at 10-22 months. CONCLUSION: At follow-up, almost half of the discharged depressive patients were still depressed. Screening for predictive factors of chronic depressive morbidity facilitates better outcome by considering the heterogeneity of psychopathology that can lead to failure in the treatment plan.     

上海市浦东新区产后半年内妇女生命质量评价

目的 了解上海市浦东新区产后半年内妇女的生命质量状况. 方法 于2011年1月1日至6月30日应用健康调查量表(SF-36量表)对435例在浦东新区妇幼保健院、高桥社区卫生服务中心和陆家嘴社区卫生服务中心随访的产后半年内妇女进行生命质量评价,与浦东新区社区26～35岁女性(对照组)生命质量进行比较.并将产后半年内妇女按照分娩后时间分为产后8～42、43～119和120～180 d共3组,比较3组生命质量状况.采用t检验、方差分析进行统计学分析.结果 (1)浦东新区产后半年内妇女生命质量8个维度得分中,生理功能(79.0±19.0)分、生理角色限制(47.5±12.2)分、躯体疼痛(74.0±18.7)分、总体健康(73.9±13.1)分、活力(69.8±16.2)分、社会功能(78.3±20.1)分、情感角色限制(63.4±21.7)分、总评分(74.2±11.7)分,均低于对照组(分别为94.6、85.7、78.4、71.0、75.0、86.9、83.5和80.5分),差异均有统计学意义(t分别为 17.105、-18.914、4.893、3.688、-6.642、8.881、10.076和-11.225,P均＜0.05);仅心理健康(78.3±15.0)分与对照组(77.8分)比较差异无统计学意义(t=0.629,P＞0.05).(2)产后8～42、43～119和120～180 d的3组妇女8个维度得分中,生理功能[(73.1±19.1)分、(86.3±17.1)分和(89.1±12.9)分]、生理角色限制[(32.4±18.6)分、(57.7±19.1)分和(79.9±12.0)分]、躯体疼痛[(70.7±18.0)分、(75.6±19.0)分和(81.6±17.3)分]、社会功能[(76.3±19.6)分、(78.2±21.7)分和(83.9±19.3)分]、情感角色限制[(58.5±12.9)分、(71.4±18.3)分和(70.1±19.5)分]、总评分[(72.2±11.1)分、(76.1±12.8)分和(78.0±11.1)分]比较,差异均有统计学意义(F分别为37.744、60.640、13.137、5.185、4.577和10.548,P均＜0.05).产后120～180 d妇女生命质量评分中生理功能、活力、情感角色限制与总评分均低于对照组,差异均有统计学意义(t分别为-4.174、-2.353、-3.341和-2.166,P均＜0.05). 结论 产后妇女在社区人群中属于脆弱人群,其生命质量至产后120～180 d仍未能完全恢复.全社会应给予产后妇女更多长期的帮助和支持.     

Glucose and insulin levels after six months of treatment with a triphasic oral contraceptive containing ethinyl estradiol and norethindrone

A prospective study of carbohydrate metabolism was done on 33 women who used a triphasic oral contraceptive (OC) containing ethinyl estradiol and norethindrone for six months. A three-hour oral glucose tolerance test was administered before and after the OC usage, and both the blood glucose and insulin levels were determined. A significant decrease in the fasting glucose level was found with treatment. All other glucose values and insulin levels were unchanged.     

Bethlem myopathy in a Taiwanese family.

We report three cases of Bethlem myopathy from three consecutive generations of a Taiwanese family, including one woman aged 70, one man aged 40, and a boy aged 8. The clinical features of the patients included autosomal dominant inheritance, childhood or adolescent onset, mainly proximal and extensor involvement, early diffuse joint contractures, and absence of cardiac involvement. These features fulfilled the diagnostic criteria for Bethlem myopathy. Though the clinical course of the disease was once thought to be benign, our female patient became wheelchair-bound at the age of 53. This suggests that the disease process in Bethlem myopathy is slow but ongoing.     

Characteristics of sexual assault in women with a major psychiatric diagnosis

OBJECTIVE: In a previous study of women who had been sexually assaulted, we reported a 26% prevalence of a major psychiatric diagnosis. The purpose of this study was to better characterize sexual assaults in women with a major psychiatric diagnosis. STUDY DESIGN: All female patients >or=15 years old with a complaint of sexual assault underwent a standardized history and physical examination by an upper-level resident in obstetrics and gynecology. Data were abstracted and verified. A psychiatric diagnosis was determined by history and by use of computer-linked medical records. Chi-square or Fisher exact test was used for categoric analysis. RESULTS: Of the 819 women who were examined, 211 women (26%) had a major psychiatric diagnosis. In these 211 women, the prevalence of solely mood, thought, or substance use disorders were 26%, 14%, and 16%, respectively, whereas 44% had >or=2 diagnoses. Having a psychiatric diagnosis was associated with increasing age (P =.001), homelessness (P =.001), and incarceration (P =.001). In comparison with women with no psychiatric diagnosis, sexual assaults in these 211 women occurred more frequently outdoors (P =.007), by a stranger (P <.001), or by >or=2 assailants (P =.02). Being assaulted with a weapon (P =.04) and being hit (P =.01) were more prevalent in assaults against women with a psychiatric diagnosis, as was anal contact (P =.03), contact to >or=2 body orifices (P =.001), and body trauma (P =.01). CONCLUSION: Sexual assaults in women with a major psychiatric diagnosis are common. These assaults are more violent and result in body trauma more frequently than do sexual assaults in women without a psychiatric diagnosis. Prevention and treatment strategies should target this vulnerable population.     

Drugs in pregnancy. Prescribing for psychiatric disorders in pregnancy and lactation.

The most recent Confidential Enquiry into the causes of maternal deaths during the perinatal period in England and Wales (1994-1996) revealed that psychological illness was at least as important as hypertensive disorders. It is therefore important for obstetricians to be aware of a variety of psychiatric conditions as well as the psychotropic medication prescribed and sequelae of continuation or withdrawal of these drugs. Best management, of this particularly vulnerable group of women, requires close liaison with the psychiatric team. This chapter considers four groups of women most likely to be prescribed psychoactive drugs during the perinatal period: (i) women with mental illness wishing to conceive, (ii) women with mental illness who conceive while taking medication, (iii) those who become mentally ill while pregnant, and (iv) those who become unwell postnatally. Guidelines for treatment are discussed.     

Prevalence of psychiatric disorders in gynecologic outpatients

OBJECTIVE: This study was undertaken to determine the point prevalence of psychiatric disorders in an unselected gynecologic population. STUDY DESIGN: Participants were 1013 consecutive women attending 2 outpatient gynecology clinics in northern Sweden between November 16 and December 15, 1998. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as a diagnostic tool for evaluating mood, anxiety, and eating disorders. RESULTS: Overall, 897 patients (88.5%) filled in the diagnostic tool's patient questionnaire. Psychiatric disorders were present in 30.5% of the patients. Mood disorders were most common; major depression was prevalent in 10.1% of patients and minor depression was seen in 12.4% of patients. Anxiety disorders were also common and were encountered in 12.1% of patients. Among patients with a diagnosis, only 21.4% had some form of treatment. CONCLUSIONS: The prevalence of mood and anxiety disorders in an outpatient gynecology clinic is high. The majority of women with a diagnosis based on the diagnostic tool did not have a previous diagnosis and were untreated.     

Trisomy 21 screening based on first and second trimester in a Taiwanese population

Objective

This study investigates the performance of first- and second-trimester screening tests for detecting fetal trisomy 21 in a Taiwanese population.

Factors influencing the quality of intimate relationships six months after delivery--first-time parents' own views and coping strategies

The aim of this study was to describe and analyze first-time parents' experiences of factors that affect the quality of their intimate relationship and the way they cope with their situation six months after delivery. The method used was inductive qualitative content analysis of two open questions in a larger questionnaire. The data is based on 535 respondents' statements. The factors affecting the quality of the intimate relationship were available or missing and could be classified into four categories. 1. 'Coping by adjustment to parental role', e.g., mutual support as new parents, 2. 'The couple's 'intimacy', i.e., togetherness and love, 3. 'Coping by communication', i.e., verbal and non-verbal mutual confirmation, and 4. 'Coping with external conditions', e.g., by seeking social support. The results are described in a model, which could constitute a basis for the promotion of health in family health care, with the aim, if possible, of preventing unnecessary separations/divorces after couples become parents.     

Prenatal diagnostic rates and postnatal outcomes of fetal orofacial clefts in a Taiwanese population

Objective

To report the incidence, prenatal diagnostic rate, and postnatal outcomes of fetal orofacial cleft at a tertiary referral center in Taiwan.

Methods

The demographic data, maternal and fetal characteristics, and postnatal outcomes for fetuses with cleft lip and/or cleft palate (CL/P) born between January 1998 and December 2008 at Chang Gung Memorial Hospital, Taipei, were reviewed retrospectively, and diagnostic rates were evaluated according to cleft type.

Results

Among 26 499 deliveries, 84 were affected with CL/P. The mean maternal age and gestational age at detection of CL/P were 30.37 years (range 21-41 years) and 24.7 weeks (range 18-33 weeks), respectively. Thirty-one fetuses had associated structural anomalies, 5 of which involved chromosomal aberrations. CL/P was diagnosed prenatally for 74 (88%) fetuses. After consultations, 17 pregnancies (20%) were aborted. The postnatal survival rate was 95.5% (64/67 infants). The type of cleft had a significant influence on correct prenatal diagnosis (P < 0.001).

Conclusion

For fetuses diagnosed prenatally with an orofacial cleft, access to an experienced craniofacial team, well-planned delivery, and pediatric intensive care led to favorable postnatal outcomes after lethal malformations were excluded through detailed sonographic and chromosomal evaluations.