The impact of sleep disturbances on suicide risk among people living HIV: An eleven-year national cohort

OBJECTIVES

The suicide rate among individuals who experience sleep disturbances is five times higher than in the general population. Up to 70 % of people living with HIV (PLHIV) experience sleep disturbances. This study's purpose was to determine whether this population has higher rates of suicide compared to those without sleep disorders. Possible risk factors were also explored.

METHODS

A secondary analysis of nationwide data on all males and females over 15 years old with HIV living in Taiwan was conducted from January 1, 2005, to December 31, 2016. Sleep disturbances were identified through recorded diagnoses and medical treatments. Cox proportional hazard models and hazard ratios (HRs) and mediation analysis were employed to estimate the association between sleep disturbances and suicide risk during the follow-up period.

RESULTS

Of the 5680 PLHIV, 72 suicide events were reported. The suicide incidence rate among PLHIV suffering from sleep disturbances was 769 per 100,000 person-years. Sleep disturbances were associated with a significantly increased risk of suicide (AHR = 1.75, 95 % CI 1.02-3.02, p = 0.0429). A premium-based monthly salary of <24,000 (NT $) was also associated with an increased hazard of suicide (AHR = 4.14, 95 % CI 1.60-10.75, p = 0.0035). The pathway effect analysis using potential outcomes showed that depression did not mediate the effect of sleep disturbance on suicide.

CONCLUSIONS

Sleep disturbances were associated with higher suicide rates, even after adjusting for pre-existing depression. These findings suggest that paying attention to suicidal ideation among PLHIV suffering from sleep disturbances is necessary.

Herpes zoster associated with stroke incidence in people living with human immunodeficiency virus: a nested case-control study

BACKGROUND

The incidence of stroke is increasing among younger people with human immunodeficiency virus (HIV). The burden of stroke has shifted toward the young people living with HIV, particularly in low- and middle-income countries. People infected with herpes zoster (HZ) were more likely to suffer stroke than the general population. However, the association of HZ infection with the incidence of stroke among patients with HIV remains unclear.

METHODS

A nested case-control study was conducted with patients with HIV registered in the Taiwan National Health Insurance Research Database in 2000-2017. A total of 509 stroke cases were 1:10 matched to 5090 non-stroke controls on age, sex, and date of first stroke diagnosis. Logistic regression models were used to estimate the odds ratio and 95% confidence intervals (CI) of stroke incidence.

RESULTS

The odds ratio of stroke was significantly higher in the HIV-infected population with HZ (adjusted odds ratio [AOR]: 1.85, 95% CI: 1.42-2.41). A significantly increased AOR of stroke was associated with hypertension (AOR: 3.53, 95% CI: 2.86-4.34), heart disease (AOR: 2.32, 95% CI: 1.54-3.48), chronic kidney disease (AOR: 1.82, 95% CI: 1.16-2.85), hepatitis C virus infection (AOR: 1.49, 95% CI: 1.22-1.83), hyperlipidemia (OR: 1.41, 95% CI: 1.12-1.78), and treatment with protease inhibitors (AOR: 1.33, 95% CI: 1.05-1.69).

CONCLUSIONS

Our findings suggest that HZ concurrent with HIV may increase the risk of stroke. The incidence rates of stroke were independent of common risk factors, suggesting strategies for early prevention of HZ infection among people living with HIV.

Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review

Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.

Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up

BACKGROUND

Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period.

METHODS

Women with major BC surgeries were invited to complete the World Health Organization Quality of Life-Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients.

RESULTS

After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibited a high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8 years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC.

CONCLUSION

The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5 years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.

Higher Risk of Acute Respiratory Distress Syndrome and Risk Factors among Patients with COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression

OBJECTIVE

To estimate the global risk and risk factors associated with acute respiratory distress syndrome (ARDS) among patients with COVID-19: Design: A systematic review, meta-analysis and meta-regression.

SETTING AND PARTICIPANTS

Hospitals or nursing homes and patients with acute respiratory distress syndrome after COVID-19.

METHODS

The literature review was systematically conducted on Embase, MEDLINE, CINAHL, and Web of Science, in addition to manual searches and reference list checking from 1 January 2019 to 2 March 2022. The search terms included coronavirus, acute respiratory syndrome, acute respiratory distress syndrome and observational studies. Three reviewers independently appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022311957). Eligible studies were meta-analyzed and underwent meta-regression.

RESULTS

A total of 12 studies were included, with 148,080 participants. The risk ratio (RR) of ARDS was 23%. Risk factors were age ≥ 41-64 years old (RR = 15.3%, 95% CI =0.14-2.92, p = 0.03); fever (RR = 10.3%, 95% CI = 0.03-2.03, p = 0.04); multilobe involvement of the chest (RR = 33.5%, 95% CI = 0.35-6.36, p = 0.02); lymphopenia (RR = 25.9%, 95% CI = 1.11-4.08, p = 0.01); mechanical ventilation with oxygen therapy (RR = 31.7%, 95% CI = 1.10-5.25, p = 0.002); European region (RR = 16.3%, 95% CI = 0.09-3.17, p = 0.03); sample size ≤ 500 (RR = 18.0%, 95% CI = 0.70-2.89, p = 0.001).

CONCLUSIONS AND IMPLICATIONS

One in four patients experienced ARDS after having COVID-19. The age group 41-64 years old and the European region were high-risk groups. These findings can be used by policymakers to allocate resources for respiratory care facilities and can also provide scientific evidence in the design of protocols to manage COVID-19 worldwide.

Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression

OBJECTIVE

The association between human immunodeficiency virus (HIV)/AIDS and suicidality is not well understood, partly because of variability in results. This meta-analysis aimed to investigate the predictive value of HIV/acquired immune deficiency syndrome for incident suicidality.

METHODS

A literature review was conducted of articles published between January 1, 2010, and October 31, 2021. The following databases were searched: Embase, MEDLINE, CINAHL, Web of Science, and Scopus. The search terms included human immunodeficiency virus (HIV), suicidal behavior, auto mutilation, and self-injurious behavior. Observational studies were screened following a registered protocol, and eligible ones were meta-analyzed and followed by meta-regression.

RESULTS

A total of 43 studies were included in this systematic review, and a meta-regression included 170,234 participants. The pooled prevalence estimates of suicidal ideation, attempted suicide, and deaths by suicide were 22.3%, 9.6%, and 1.7%, respectively. The following significant risk factors for suicide ideation were found: substance use, depression, low quality of life, low social support, without HIV status disclosure, living alone, low level of memory problems, family history of suicide, and stage III of HIV. Risk factors for suicide attempts were depression and family history of suicide. An elevated risk for suicide-related death was found for people living with HIV (PLHIV) who had a psychiatric disorder and in studies conducted in hospital-based settings (versus national database studies or HIV clinic settings).

CONCLUSIONS

The risk of suicidality is high among PLHIV within all six World Health Organization regions during the modern antiretroviral therapy era. Assessment of socioeconomic and psychological factors is recommended for further management to prevent suicide among PLHIV. The present findings are useful for design of intervention protocols and development of clinical practice guidelines intended to manage the well-being of PLHIV worldwide.

Is nurse-led case management effective in improving treatment outcomes for cancer patients? A systematic review and meta-analysis

AIMS

To identify and synthesize the outcomes of nurse-led case management interventions for improving cancer treatment.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

PubMed, MEDLINE, CINAHL, EMBASE, Cochrane Library and CEPS were searched for articles published from inception till June 2019, and search was finalized in January 2020.

REVIEW METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The quality of evidence was assessed using Joanna Briggs Institute Critical Appraisal Tools. Outcomes were analysed by using a pool of data of 95% confidence intervals (CIs), p value and fitting model based on heterogeneity of test results.

RESULTS

Eleven articles were included in the meta-analysis. When compared with the regular care group, the nurse-led case management group had: 1) shorter time from diagnosis to treatment by 9.07 days, 2) an improved treatment completion rates (OR = 2.45) and 3) more number of patients received hormone therapy.

CONCLUSION

The synthesized results presented that nurse-led case management is more effective than regular care in improving treatment timeliness, treatment completion rates and hormone therapy rates.

Higher Risk of Depression After Total Mastectomy Versus Breast Reconstruction Among Adult Women With Breast Cancer: A Systematic Review and Metaregression

This systematic review with a meta-regression was conducted to determine the risk of depression after mastectomy compared to breast reconstruction among women with breast cancer 1 year after surgery. A literature search was conducted according to PRISMA guidelines using 4 databases: Medline (Ovid), Embase, Cinahl, and the Cochrane Library for the period January 2000 to March 2019. Studies that measured the status of depression within 1 year and immediately after surgery were included. Outcomes related to depression were analyzed by using a pool of event rates and a risk ratio of 95% confidence interval (CI), P value, and a fitting model based on the results of a heterogeneity test of mastectomy and BR. The statistical analysis was conducted using Comprehensive Meta-analysis 3.0 software. Nine studies met the inclusion criteria. There were 865 cases of mastectomy only, with a 22.2% risk of depression (95% CI, 12.4-36.2). In 869 women who underwent BR, the risk of depression was 15.7% (95% CI, 8.8-26.2). The depression risk ratio for mastectomy compared to BR was 1.36 (95% CI, 1.11-1.65). Patients with delayed reconstruction exhibited lower levels of depression (risk ratio 0.96, 95% CI 0.57-1.01). The Beck Depression Inventory (BDI) scale showed high sensitivity, and the Hospital Anxiety Depression Scale (HADS) with a cutoff of > 7 could measure even low to moderate depressive symptoms. One in 4 women with breast cancer had symptoms of depression after mastectomy; both surgeries were associated with depression in women 1 year after surgery. Our results will permit the development of proactive treatment plans before and after surgery to mitigate risk and prevent depression through the use of sensitive depression scales like BDI.

Reduced economic burden of AIDS-defining illnesses associated with adherence to antiretroviral therapy

OBJECTIVES

We assessed the economic burden of AIDS-defining illnesses (ADIs), which was further stratified by adherence to antiretroviral therapy (ART).

METHODS AND MATERIALS

A nationwide longitudinal cohort of 18,234 incident cases with HIV followed for 11years was utilized. Adherence to ART was measured by medication possession ratio (MPR). Generalized estimating equations modeling was used to estimate the cost impact of ADIs.

RESULTS

Having opportunistic infections increased the annual cost by 9% (varicella-zoster virus infection) to 98% (cytomegalovirus disease), while the annual costs increased by 26% (Kaposi's sarcoma) to 95% (non-Hodgkin's lymphoma) in the year when AIDS-related cancer occurred. ADIs occurred more frequently in the years with low adherence for ART compared to the high-adherence years (e.g., 0.1≤MPR<0.8 vs. MPR≥0.8, event rate of cytomegalovirus disease 4.03% vs. 0.51%). The annual baseline costs in the years with MPR<0.1, 0.1≤MPR<0.8, and MPR≥0.8 were $250, $4,752, and $8,990 (in 2018 USD), respectively. The economic impact of ADIs in the years with low adherence (MPR<0.1) was larger than that in the high-adherence years (MPR≥0.8) (e.g., MPR<0.1 vs. MPR≥0.8, annual cost increased by 244% vs. 9% when candidiasis occurred).

CONCLUSIONS

Adherence to ART may increase the baseline medical costs but mitigate the incidence and economic burden of ADIs.

[Improving the Follow-Up Completion Rate of Community-Dwelling Individuals Who Screened Positive for Colorectal Cancer]

BACKGROUND & PROBLEMS

Early screening and early treatment of colorectal cancer increases the 5-year-survival rate of early stage cancer by 90%. However, a lack of knowledge regarding screening opportunities among community residents affects their willingness to seek medical help and delays treatment. The World Health Organization estimated that deaths from colorectal cancer in the next 20 years will increase from 8.2 million people to 13 million people annually. However, systemic screening and follow-up services will promote early detection and treatment and should effectively decrease colorectal cancer-related mortality.

PURPOSE

The aim of this study is to increase the follow-up completion rate of community participants who tested positive during a screening for colorectal cancer.

RESOLUTIONS

The resolution measure produced stool occult blood screening education leaflets, promoted health lectures on the topic of cancer screening, planned a training course for cancer-prevention education, constructed a participant tracking and notification system in the outpatient information system for positive participants, set up a procedure for positive participant follow-up, and designed a cooperative model for community health promotion.

RESULTS

The follow-up completion rate of participants who tested positive during colorectal cancer screen tests increased to 74.1%, and the accuracy rate of colorectal screening knowledge rose to 93.9%.

CONCLUSIONS

Implementation of the project increased the follow-up effectiveness of participants who tested positive during the screening. We hope that medical facilities cooperate with communities in order to facilitate health promotion and increase the number of residents with correct cancer-prevention concepts.

Coexistence of exchange bias and magnetization pinning in the MnO(x)/GaMnAs system

Coexistence of exchange bias (H(E)) and magnetization (M) shift was observed in as-grown and field-annealed MnO(x)/Ga(0.95)Mn(0.05)As bilayers. It was found that H(E) initially decreases with the annealing time t(a) and then increases when t(a) > 30 min, while the M shift remains almost unchanged with t(a). X-ray photoelectron spectroscopy (XPS) analysis reveals that MnO(x) is composed of MnO and Mn(3)O(4), and the volume amount ratio of Mn(3)O(4) to MnO increases with increasing t(a). A simple model based on a uniform MnO-Mn(3)O(4) interface with constant 'pinned' uncompensated interfacial spins is proposed to account for the observed exchange-biased phenomena in the bilayers.

Ternary transition metal phosphides: High-temperature superconductors

Two systems of ternary transition metal phosphides with the ordered Fe(2)P-type hexagonal structure are reported. They have the general formula MRuP and MOsP, in which M can be Ti, Zr, or Hf. An onset of the superconducting transition temperature as high as 13.0 K is reported for the ZrRuP compound.

Spin and orbital magnetic moments of Fe3O4

We present measurements of the spin and orbital magnetic moments of Fe3O4 by using SQUID and magnetic circular dichroism in soft x-ray absorption. The measurements show that Fe3O4 has a noninteger spin moment, in contrast to its predicted half-metallic feature. Fe3O4 also exhibits a large unquenched orbital moment. Calculations using the local density approximation including the Hubbard U method and the configuration interaction cluster-model suggest that strong correlations and spin-orbit interaction of the 3d electrons result in the noninteger spin and large orbital moments of Fe3O4.

Cervical schwannoma: a case report and eight years review

Schwannomas are peripheral nerve tumours of nerve sheath origin. We report one case of cervical schwannoma originating from the brachial plexus. A 56-year-old man presented with a slow-growing mass on the right side of his neck that had been noted for more than 10 years. During operation, a well-encapsulated mass was seen beneath the brachial plexus with adhesion to the plexus element. It was reported as a schwannoma. Three days after surgery, the patient had a motor deficit of the right upper arm and neurological examination showed a CV nerve deficit. The neurological function recovered completely after three months. In addition, the other five cases of cervical schwannoma seen in our hospital between March 1990 and June 1998 are also reviewed. All patients had surgery. The pre-operative symptoms, impressions, and post-operative neurological status were shown and discussed. Only two cases were diagnosed as neurogenic tumour pre-operatively. Post-operatively, one patient had transient neurological deficit and another one had permanent deficit.

Determinants of parental decisions on 'drop out' from cancer treatment for childhood cancer patients

Little is known about the psychosocial process of parental decisions on 'drop out' from cancer treatment for paediatric patients in Taiwan. This study, based on structured in-depth interviews, attempted to document the determinants of parental decisions on drop out. A total of 19 parents of paediatric cancer patients who dropped out from a cancer treatment for at least a month within 3 years since first treatment were interviewed. Content analysis of qualitative data revealed six categories of determinants associated with parental decisions: suffering severe pain from medical treatments and adverse side-effects; desire for better and less painful treatments; adverse effect of other patients' experiences; searching for possible explanations for disease after prolonged denial of diagnosis; lack of empathy from health care professionals; and misinterpretation of improved prognostics. These findings reflected the deficiency of psychological and emotional support for parents from health care professionals prior to and during cancer treatment.

Relational and physical forms of peer victimization in preschool

Recent studies of peer victimization have demonstrated the importance of studying relational as well as physical forms of peer maltreatment for understanding children's social-psychological adjustment problems. Studies in this area have been limited thus far by a focus on school-age children (9-12-year-olds). Given the significance of early identification of children's social difficulties for intervention and prevention efforts, this research was designed to assess relational and physical peer victimization among preschool-age children (3-5-year-olds). Results indicated that boys were significantly more physically victimized than girls whereas girls were more relationally victimized. Both relational and physical victims experienced greater adjustment problems than did their peers. Relational victimization contributed unique information about adjustment beyond that provided by physical victimization.

Relational and physical forms of peer victimization in preschool

Recent studies of peer victimization have demonstrated the importance of studying relational as well as physical forms of peer maltreatment for understanding children's social-psychological adjustment problems. Studies in this area have been limited thus far by a focus on school-age children (9-12-year-olds). Given the significance of early identification of children's social difficulties for intervention and prevention efforts, this research was designed to assess relational and physical peer victimization among preschool-age children (3-5-year-olds). Results indicated that boys were significantly more physically victimized than girls whereas girls were more relationally victimized. Both relational and physical victims experienced greater adjustment problems than did their peers. Relational victimization contributed unique information about adjustment beyond that provided by physical victimization.

A case-control study of parity, age at first full-term pregnancy, breast feeding and breast cancer in Taiwanese women

A hospital-based case-control study was designed herein to investigate the relationship between parity, breast feeding and breast cancer in Taiwan. Reproductive histories of patients with breast cancer confirmed by either pathology or cytology were assessed by questionnaire and compared with age-matched healthy controls. One hundred and fourteen cases and 228 age-matched controls were recruited for this study. According to those results, women having had more than three full-term pregnancies, age at first full-term pregnancy younger than 30, and breast feeding for more than 3 years displayed significantly protective effects against breast cancer. Following adjustment for ethnicity and menopausal status, women with more than three full-term pregnancies and younger than 30 years old at first full-term pregnancy had a decreased risk of breast cancer. However, duration of breast feeding was not related to breast cancer, after adjustment for ethnicity and menopausal status. The effect of number of full-term pregnancies on the risk of breast cancer was found to be independent of the effect of age at first full-term pregnancy. Moreover, the effect of age at first full-term pregnancy and number of full-term pregnancies was also independent of the effect of breast feeding.