Gratification and its associations with problematic internet use: A systematic review and meta-analysis using Use and Gratification theory

Problematic Internet Use (PIU) has been a growing issue for two decades, and many researchers have sought to explain its occurrence. Use and Gratification Theory (UGT) has guided empirical studies investigating the associations between gratification and PIU. However, their results appear equivocal. This study aimed to synthesize research findings applying UGT and pinpoint the associations between different gratifications and PIU. Effect sizes were pooled to obtain an overall effect size. Gratifications were then classified into four types (i.e., content, social, self-presentation, and process) according to the suggestions of previous studies and the measurement of included studies. Based on 216 effect sizes from 57 samples with 38,492 participants (mean age = 24.3; 55.1 % female), random effect model analyses yielded a medium effect size (r = 0.303, p <.001, 95 % CI [0.263, 0.343]), indicating a positive association between general gratification and PIU. Subgroup analyses revealed that all four gratifications were positively associated with PIU; self-presentation showed the largest effect size, followed by process gratification.This study enhances the conceptual relevance of UGT in understanding PIU and highlights the importance of process and self-presentation gratification as predictors for PIU in certain contexts, such as among university students and in Asian countries.

Comparative efficacy of brolucizumab, half-dose photodynamic therapy, and aflibercept in managing chronic central serous chorioretinopathy

PURPOSE

To compare the efficacy of brolucizumab, half-dose PDT, and aflibercept in treating chronic central serous chorioretinopathy (CSC).

METHODS

A retrospective cohort study with chronic CSC patients who underwent intravitreal injection of one shot of brolucizumab or aflibercept in the first 3 months, followed by pro re nata regimens or a single session of half-dose PDT, was retrospectively reviewed. The primary outcome measure was the proportion of eyes that achieved complete absorption of retinal fluid without requiring any rescue treatment. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and central choroidal thickness (CCT).

RESULTS

A total of 54 consecutive patients were included in this study with 18 patients in each group. At months 1 and 2, the brolucizumab group exhibited the highest rate of complete retinal fluid resolution (61% and 77%), followed by the half-dose PDT group (56% and 72%), and lowest in the aflibercept group (28% and 33%), with statistically significant differences noted at month 2 (P = 0.012). The brolucizumab group also demonstrated the most significant reduction in CCT at months 1 and 2 among the three groups (P = 0.007 and 0.001). Recurrence of retinal fluid in the brolucizumab groups was predominantly observed at month 3. Conversely, the half-dose PDT group exhibited the most favorable anatomical results starting from month 3. Notably, mild vitritis was observed in one case from the brolucizumab group.

CONCLUSIONS

Single injection of brolucizumab demonstrates trends of faster regression of persistent residual retinal fluid, greater CCT and CRT decline, and matched BCVA compared to half-dose PDT in the short term.

Mentorship for young gay men in Hong Kong: A pilot mixed-methods randomized controlled trial

This study examined whether mentorship could promote young gay men's identities and well-being, and whether a mentor's sexual orientation matters. A randomized control trial compared outcomes across three conditions: Arm A (a mentee matched with a sexual minority mentor), Arm B (a mentee matched with a heterosexual mentor), and a control arm receiving psychoeducation only. A community sample of 60 mentees aged 18-25 years was randomly allocated to the three arms and completed questionnaires at baseline, 3 months into the intervention, and at the end of the 6-month program. Fifteen mentees recounted their mentoring experiences through in-depth interviews. Linear mixed effects models showed that for both intervention and control conditions, internalized homonegativity declined while resilience, loneliness, and body acceptance improved over time. No time and group interactions were found. Meanwhile, a mentor's sexual orientation did not drive differential quality and outcomes of mentorship. Interviewees cited various benefits of mentorship, including providing companionship, enriching connection with lesbian, gay, bisexual (LGB) communities, and adding knowledge and perspectives of LGB lives and identities. Although quantitative data did not support any exclusive benefits of mentorship, most mentees recognized mentorship as a vital source of affirmation and companionship. Implications for research and mentoring programs are discussed.

Parental Depression and Self-Stigma Among Chinese Young People Living With Depression: A Qualitative Study

Self-stigma is detrimental to psychosocial well-being and the recovery journey among people living with depression. However, there has been limited research exploring the experience of stigma internalization when depression runs in families. This study aims to address this gap by (1) characterizing the manifestations of self-stigma among individuals living with depression whose parent(s) also have depression and (2) exploring the potential mechanisms underlying the impact of parental depression on self-stigma. Essential principles of the constructivist grounded theory approach were adopted to collect data through in-depth interviews with 27 participants aged 15-30, living in Mainland China. Many participants perceived depression running in their family as an endless disaster and an incurable illness. These beliefs further led to stigmatizing emotions (such as suppression, anger, and guilt) and behaviors (such as concealment and social withdrawal). Participants also highlighted ambivalent intergenerational relationships, tense family atmospheres, lower parental emotional involvement and support, and a lack of family flexibility due to parental depression. Furthermore, parental depression impacted participants' self-stigma by interfering with family relationships, family functioning, and parenting styles. It also shaped their perceptions of family, illness attribution, and public stigma. Additionally, parental depression had an impact on participants' social functioning, self-esteem, and personality, making them more susceptible to self-stigma. This study emphasizes the crucial role that the family plays in the internalization of stigma among individuals living with depression. It suggests that family dynamics, rather than family structure or economic backgrounds alone, shape this process.

Incidence, Risk Factors and Management of Postoperative Complications in Horizontal Strabismus Surgery

OBJECTIVE

To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery.

DESIGN

Retrospective Cohort study.

PARTICIPANTS

The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up.

METHODS

Retrospective review of strabismus operation patients' medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management.

RESULTS

Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003).

CONCLUSION

Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.

Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina Society

Rhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.

Increased risk of glaucoma development in patients with central serous chorioretinopathy: results of a 11-year population-based cohort study

PURPOSE

To investigate whether patients with central serous chorioretinopathy (CSC) have increased risk of developing glaucoma.

METHODS

Patients diagnosed with CSC between 1 January 2008 and 31 December 2018 were included in this study using data from the Taiwanese National Health Insurance Research Database (NHIRD). The CSC cohort was matched with a non-CSC cohort using the propensity score matching method, based on sex, age (in 10-year intervals), index date year, comorbidities, and steroid use, resulting in equal numbers of patients in both cohorts. Patients were followed up until 31 December 2019 or until they were withdrawn from the NHIRD. The incidence of glaucoma was compared between the two cohorts using the Cox regression model, and the risk of developing glaucoma was estimated using the Kaplan-Meier method.

RESULTS

After adjusting for sex, age, comorbidities, and steroid use, the CSC cohort showed a significantly higher risk of developing glaucoma compared to those without CSC (adjusted HR = 3.99; 95% CI = 3.44-4.62). The cumulative incidence of glaucoma in the CSC cohort was also significantly higher than in the non-CSC cohort (log-rank test, p < 0.001). Among the glaucoma subtypes, normal tension glaucoma had the highest risk (adjusted HR = 5.79; 95% CI = 3.41-9.85), followed by primary open-angle glaucoma (adjusted HR = 2.77; 95% CI = 2.12-3.62).

CONCLUSIONS

In conclusion, our study shows that CSC patients are at a higher risk of developing glaucoma, especially NTG. Awareness and regular glaucoma screenings are essential for patients with CSC.

[Clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities]

Objective: To investigate clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities. Methods: A retrospective observational study was conducted. From October 2018 to June 2021, Suzhou Ruihua Orthopedic Hospital admitted 12 patients (11 males and 1 female, aged 24-64 years) who met the inclusion criteria, and did not have the lateral circumflex femoral artery during anterolateral thigh flap resection, or changed to medial femoral perforator as a source of blood supply due to small perforator to repair the wound with flap transplantation. The wounds were on the upper limbs in 7 cases and on the lower limbs in 5 cases. The wound area after debridement was 8.0 cm×5.0 cm-24.0 cm×6.5 cm, and the applied flap area was 9 cm×6 cm-25 cm×7 cm. During transplantation, the perforating branch or source artery of the flap was anastomosed end to end with the vascular pedicle of the recipient area. Subcutaneous beauty suture was performed on all the donor wounds. After operation, the survival of the flap and vascular crisis were observed; and the wound healing at the donor site was observed. During follow-up, the texture of the flap and complications at the donor site were observed. At the last follow-up, the effect of flap repair was evaluated by using the modified self-made comprehensive efficacy rating table. Results: After operation, all the flaps of patients survived without vascular crisis; the wounds in the donor site healed smoothly. During follow-up of 6 to 26 months, the flaps had good texture; only linear scars remained in the donor area without scar contracture, pain or other discomfort. At the last follow-up, the total score of flap repair effect of 12 patients was 75-95, with an average of 87, of which 5 cases were rated as excellent, 6 cases as good, and 1 case as fair, and the proportion of excellent and good patients was 11/12. Conclusions: The application of anterolateral thigh flap with blood supply from the medial femoral perforator to repair wounds on extremities is an alternative method for the vascular variations such as no descending branch, oblique branch, or small perforator of the lateral circumflex femoral artery during the resection of the anterolateral thigh flap. This operation has the advantages of simple operation, small trauma, and others, which effectively ensures the smooth operation.

[Effects of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers]

Objective: To investigate the therapeutic efficacy of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers. Methods: A retrospective observational study was conducted. From January 2021 to January 2022, 15 patients with two adjacent wounds of the fingers who met the inclusion criteria were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 10 males and 5 females, aged 25 to 51 years. The area of single wound after debridement was from 2.5 cm×2.0 cm to 7.5 cm×2.5 cm. All the wounds were repaired by the bilobated superficial peroneal artery perforator flap from the lower leg. The single lobe area of bilobated flap was from 3.0 cm×2.0 cm to 8.0 cm×3.0 cm. The wounds in all the donor sites were sutured directly. During the operation, the number of resected flaps, the number and type of carried perforators were recorded, and the calibers of perforator and superficial peroneal artery and the length of vascular pedicle were measured. The survival of flap and the wound healing in the donor and recipient sites were recorded after operation. The recovery of donor and recipient sites were recorded during follow-up. At the last follow-up, the repair effect of flap was evaluated by the comprehensive evaluation scale, and the sensory function of flap was evaluated by the sensory function evaluation standard of British Medical Research Association. Results: During the operation, 15 bilobated flaps were successfully resected, carrying 36 superficial peroneal artery perforators, all of which were septocutaneous perforators with the caliber of 0.2-0.8 mm. The caliber of superficial peroneal artery was 0.4-1.1 mm and the length of vascular pedicle was 3-8 cm. After operation, all the flaps survived with no vascular crisis occurred, and the wounds in donor and recipient sites healed well. During the follow-up of 6 to 12 months, the color and texture of flaps were similar to those of normal tissue in the hand and the appearance of flap was good in 10 cases; the other 5 cases underwent the stage Ⅱ flap thinning and plastic surgery 6 months after operation due to the bloated appearance of flaps. There was only linear scar in the donor site of lower leg, with no obvious scar hyperplasia or pigmentation, and there was no obvious adverse effect on the sensation or motor function of the distal limbs in the donor area. At the last follow-up, the repair effect of flap of 15 patients was excellent in 11 cases and good in 4 cases, and the sensory function of the flap was evaluated as grade S2 in all cases. Conclusions: The bilobated superficial peroneal artery perforator flap has high proportion of septocutaneous perforator, and the blood supply is sufficient and reliable. Using this flap to repair two adjacent wounds of the fingers causes minimal damage to the donor area, only one group of blood vessels is needed to be anastomosed to repair two wounds, the difficulty of microoperation is reduced, and good flap repair effect and sensory function can be obtained.

[Morphological study on the transverse branch of lateral femoral circumflex artery based on digital subtraction angiography]

Objective: To summarize the morphological characteristics of the transverse branch of lateral femoral circumflex artery (LFCA) using digital subtraction angiography (DSA) and explore its clinical significance. Methods: A retrospective observational study was conducted. From October 2020 to May 2021, 62 patients with soft tissue injuries in the extremities were hospitalized in Suzhou Ruihua Orthopedic Hospital, including 40 males and 22 females, aged from 20 to 72 years. DSA was performed in the lateral femoral region of patients before the anterolateral thigh flap transplantation, and in combination with imaging scale to observe and measure the general condition of the blood vessels and the occurrence (with the occurrence rate being calculated), source artery, location of the origin point, direction of course, and the location of the perforating point of the cutaneous perforator of the transverse branch of LFCA, and in addition to classify the morphological characteristics of the transverse branch. Results: DSA detection showed that the femoral artery, the deep femoral artery, and the branches of LFCA were clearly distinguishable in 62 patients. Transverse branches of LFCA were observed in 59 patients, including 52 cases with a single transverse branch, and 7 cases with double transverse branches. The occurrence rate of transverse branches was 95.2% (59/62). A total of 66 transverse branches of LFCA were observed, of which 3 originated from the deep femoral artery, and 63 originated from the LFCA. The origin point of the transverse branch was 6.5-12.7 cm away from the anterior superior iliac spine. The transverse branch which was approximately perpendicular to the long axis of the body, originated outwards, ran between the ascending branch of LFCA and the oblique branch of LFCA, and branched along the way, with the trunk running under the greater trochanter. The perforating point of the cutaneous perforator of the transverse branch was 8.0-18.0 cm away from the anterior superior iliac spine. In the classification of morphological characteristics of the transverse branch of LFCA, the most common type was the one that originated from the same trunk with other branches of LFCA, accounting for 50.0% (31/62), followed by the one that originated from the singular trunk of LFCA (12 cases) or deep femoral artery (3 cases), accounting for 24.2% (15/62); the special type accounted for 21.0% (13/62), including 7 cases of double transverse branches and 6 cases of the transverse branch originated from the same trunk with multiple other branches of LFCA; those with small/absent transverse branch only accounted for 4.8% (3/62). Among the above-mentioned common trunk relationship of two branches, those with shared trunk of ascending and transverse branches were most frequently observed, accounting for 77.4% (24/31); those with shared trunks of the transverse and oblique branches (5 cases) and the transverse and descending branches (2 cases) accounted for 22.6% (7/31) altogether. Conclusions: A high incidence rate of the transverse branch of LFCA is observed through DSA. The transverse branch originates from the lateral femoral artery approximately perpendicular to the long axis of the body, mainly from the same trunk with another main branch of LFCA, especially the ascending branch. This positioning analysis can provide an important reference for the design and resection of anterolateral femoral flaps.

Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis

BACKGROUND

People living with depression are subjected to widespread stigmatization worldwide. Self-stigma may negatively affect patients' treatment, recovery, and psychological well-being. This review aims to summarize and synthesize the evidence on the prevalence, risk, and protective factors of depression self-stigma.

METHODS

Four online databases, PubMed, PsycINFO, Web of Science, and Embase, were searched to identify eligible studies. Fifty-six studies involving a total of 11,549 samples were included in the final analysis. Four reviewers independently screened the literature, extracted data, and assessed the risk of bias in eligible studies. Pearson's r was chosen as the effect size metric of risk and protective factors.

RESULTS

The results showed that the global prevalence of depression self-stigma was 29 %. Levels of self-stigma varied across regions, but this difference was not significant. Two demographic factors were identified: ethnicity (r = 0.10, p < 0.05) and having a partner/married (r = -0.22, p < 0.001). Five risk factors were identified: depression severity (r = 0.33, p < 0.01), public stigma (r = 0.44, p < 0.001), treatment stigma (r = 0.46, p < 0.001), perceived stigma (r = 0.37, p < 0.001), and enacted stigma (r = 0.71, p < 0.001). Five protective factors were identified: quality of life (r = -0.38, p < 0.001), social relationship (r = -0.26, p < 0.05), self-esteem (r = -0.46, p < 0.001), extroversion (r = -0.32, p < 0.001), and social functioning (r = -0.49, p < 0.001).

LIMITATIONS

Heterogeneity was observed in some of the results. Causality cannot be inferred due to the predominance of cross-sectional designs among the included literature.

CONCLUSIONS

Risk and protective factors of depression self-stigma exist across many dimensions. Future research should examine the inner mechanisms and effectiveness of interventions to reduce stigma.

Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema after Ranibizumab Injections

Background and Objectives: The identification of possible biomarkers that can predict treatment response among DME eyes is important for the individualization of treatment plans. We investigated optical coherence tomography (OCT)-based biomarkers that may predict the one-year real-life outcomes among diabetic macular edema (DME) eyes following treatment by intravitreal ranibizumab (IVR) injections. Materials and Methods: A total of 65 eyes from 35 treatment-naïve patients with DME treated with ranibizumab injection were recruited. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP), and OCT scans were retrospectively recorded at baseline before treatment and at 3 months, 6 months, and 12 months after treatment. The OCT scans were evaluated for biomarkers of interest, which included central retinal thickness (CRT), amount and locations of hyperreflective foci (HRF), subretinal fluid (SRF), intraretinal cysts (IRC), large outer nuclear layer cyst (LONLC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudates (HE), epiretinal membrane (ERM), and vitreomacular interface (VMI). Correlations between these OCT biomarkers and outcome measures (visual and structural) were statistically analyzed. Results: A total of 65 eyes from 35 patients with DME were enrolled. The mean age was 64.2 ± 10.9 years old. Significant improvement in terms of mean BCVA (p < 0.005) and mean CRT was seen at final follow-up compared to baseline. The biomarkers of DRIL, LONLC, and SRF were found to be predictive for at least 50 μm CRT reduction after treatment (with odds ratio of 8.69, 8.5, and 17.58, respectively). The biomarkers of IRC, LONLC, and SRF were predictive for significant improvement in terms of BCVA and CRT after treatment. Finally, the number of HRF was predictive for both BCVA improvement and a CRT reduction of less than 100 μm after treatment. No serious complications were reported during the study. Conclusion: Our study demonstrated the utility of OCT biomarkers as therapeutic predictors of ranibizumab treatment among DME eyes.

[Curative effects of the superficial peroneal artery perforator flap carrying multiple perforators in repairing hand and foot wounds]

Objective: To investigate the curative effects of the superficial peroneal artery perforator flap carrying two and more homologous perforators in repairing hand and foot wounds. Methods: A retrospective observational study was conducted. From January to September 2021, 23 patients with hand and foot wounds combined with bone or tendon exposure who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 16 males and 7 females, aged 23 to 68 years. After expansion of the wound, the wound area was 3.0 cm×2.0 cm to 11.0 cm×4.0 cm. All the wounds were repaired with the superficial peroneal artery perforator flap carrying two and more homologous perforators. The area of the resected flap was 4.0 cm×2.0 cm to 12.0 cm×5.0 cm. All the wounds in donor areas were sutured directly. During the operation, the resection of the flap, the number and caliber of carried perforators, the caliber of superficial peroneal artery, the length of vascular pedicle, and the number of accompanying veins of the superficial peroneal artery were recorded. The survival of the flap, the occurrence of complications, and the wound healing in the donor area were observed after operation. The recovery of the donor and recipient areas was followed up. At the last follow-up, the comprehensive evaluation scale was used to evaluate the curative effect of flap repair, and the sensory grading scale was used to evaluate the sensory function of the recipient area. Results: Totally 24 flaps were successfully resected in surgical operations, carrying 56 superficial peroneal artery perforators in total, with the caliber of perforators of 0.20-0.70 mm. The calibers of all perforators carried by 7 flaps were smaller than 0.40 mm. Nineteen flaps carried 2 perforators each, 3 flaps carried 3 perforators each, 1 flap carried 4 perforators, and 1 flap carried 5 perforators. During the operation, the superficial peroneal artery was resected with a caliber of 0.40-1.50 mm, the vascular pedicle was 2-6 cm in length, and each superficial peroneal artery had two accompanying veins. After operation, all the flaps survived smoothly, no vascular crisis or distal necrosis occurred, and the wounds healed well in the donor area. During the follow-up of 6 to 10 months after operation, the color, texture, and elasticity of the recipient area were good. Among them, 6 recipient areas were thinned and reshaped because of bloating. There was only linear scar and no obvious scar hyperplasia or pigmentation in the donor area, without significant change in sensory or motor function. At the last follow-up, the curative effect evaluation of flap repair was excellent in 22 flaps and good in 2 flaps, and the sensory function evaluation of the recipient area was grade S3 in 1 area and grade S2 in 23 areas. Conclusions: The superficial peroneal artery perforator flap with two and more homologous perforators has sufficient and reliable blood supply and is effective in repairing hand and foot wounds. It provides an ideal solution for the clinical problem in which the original operation scheme is abandoned due to the existence of only multiple slender perforators of caliber smaller than 0.40 mm, and only a single perforator in the operative field that cannot satisfy the needs of the flap blood supply and recipient area.

Does Same-Sex Marriage Legalization Make Gay Men Want to Have Children? Findings from a Panel Study in Taiwan

Introduction

This study capitalized on prospective legal change in Taiwan to capture changes in gay men's desires and attitudes toward parenthood as a function of the legalization of same-sex marriage (SSM).

Methods

A panel of 731 gay men (mean age = 26.8 years ± 5.81) completed an online survey between 2019 and 2020, shortly before and 1½ years after the legalization of SSM, to report their parenting desire, marital status, and attitudes toward parenthood and marriage.

Results

This study found that fewer participants in the follow-up survey expressed a parenting desire (59.0% vs. 74.2%), and the perceived importance of parenthood dropped mildly (3.48 to 3.26, Cohen's d = 0.269). Those who expressed a consistent parenting desire attached greater importance to SSM. The perceived importance of SSM was modestly and positively related to the perceived importance of having a child.

Conclusion

Although the decrease in parenting desire and its perceived importance may be attributable to a lack of access to family-building options (e.g., surrogacy and adoption) and the COVID-19 pandemic, our findings illustrate that parenthood might become a next step for some Taiwanese male same-sex couples who married or considered marriage.

Policy Implications

The study findings provide information for policymakers to gauge the possible number of sexual minority men who might want to have a child and consider resource allocation and deliberation on policy changes related to reproduction.

Sexual Orientation Microaggression Experiences and Coping Responses of Lesbian, Gay, and Bisexual Individuals in Taiwan: A Qualitative Study

This qualitative study explored the sexual orientation microaggression (SOM) experiences and coping strategies of lesbian, gay, and bisexual (LGB) individuals in Taiwan. In total, 30 LGB individuals (17 women and 13 men; 17 homosexual and 13 bisexual individuals) who experienced SOMs participated in qualitative, semistructured interviews, during which their SOM experiences were assessed. Through the interviews, several types of SOMs were identified, corresponding to three main types of microaggression (microassaults, microinsults, and microinvalidations) previously identified in Western studies. The participants reported various coping responses to SOMs, ranging from active responses to choosing not to respond, to protecting themselves or to minimizing the negative consequences of confrontation. The results provide mental health professionals with insight regarding the contexts of and coping responses to the SOMs experienced by LGB individuals.

[Anatomical characteristics and clinical application of anterolateral thigh perforator flap pedicled with oblique branch trunk of lateral circumflex femoral artery in the muscular septum]

Objective: To explore the anatomical characteristics of the anterolateral thigh perforator flap pedicled with oblique branch trunk of lateral circumflex femoral artery in the muscular septum and the clinical effect of this flap in repairing skin and soft tissue defects in the extremities. Methods: A retrospective observational study was conducted. From December 2020 to April 2021, 59 patients with skin and soft tissue defects in the extremities admitted to the Department of Hand Surgery of Suzhou Ruihua Orthopaedic Hospital met the inclusion criteria, including 46 males and 13 females, aged 20 to 81 years. The wound area after debridement ranged from 8 cm×5 cm to 38 cm×20 cm. According to the condition of the wound, the perforators in the anterolateral femoral region on the unaffected side were located by color Doppler ultrasound. The anterolateral thigh perforator flap with the oblique branch of lateral circumflex femoral artery as the source artery was designed, and the wound was repaired by unilateral flap or series combination of bilateral flaps (with the area of unilateral flap ranging from 7 cm×5 cm to 37 cm×11 cm). The wound of the donor site was sutured directly. The following items were recorded, including the number of perforators in the anterolateral femoral region marked before operation, the course characteristics of oblique branch trunk of lateral circumflex femoral artery and its perforators, and the number, origin, and type of perforators observed during operation, the flap repair mode and the flap harvest time. After operation, the survival condition of the flap, the wound healing time in the recipient site, and the suture healing in the donor area were observed, and the recovery of the donor and recipient areas was followed up. At the last follow-up, the sensation function evaluated by sensory rating scale of British Medical Research Association and two-point discrimination of the area transplanted with flap were recorded, and the improved comprehensive curative effect evaluation scale of flap was used to evaluate the repair effect of the flap. Results: A total of 156 perforators were marked in the anterolateral femoral region before operation, and 144 perforators were observed during the operation, of which 98 came from the oblique branch of the lateral circumflex femoral artery, and the first perforator of the oblique branch was the intermuscular septal perforator. Once formed, most oblique branch trunk of lateral circumflex femoral artery in the muscular septum could be divided into the deep branch and the superficial branch at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral edge of the patella, the deep branch mainly ran in the muscle of vastus intermedius and vastus lateralis, and rarely developed the skin perforators, while the superficial branch mainly ran in the muscular septum between the rectus femoris and the vastus lateralis, and grew out the perforators to the proximal skin of the anterolateral femoral region. Fifty-six patients were repaired with unilateral flap and 3 patients with bilateral flap in series combination, with the harvesting time of the unilateral flap ranged from 9 to 99 min. Three patients developed arterial crisis within 48 hours after operation and survived after timely exploration; the flap of 1 patient developed necrosis 11 days after operation and was repaired by abdominal split-thickness skin graft; the other flaps survived smoothly. The wound healing time in the recipient area was 10 to 42 days after operation, and the sutures in the donor area healed well. During the follow-up of 6 to 10 months, 8 patients underwent thinning and plastic surgery 6 months after operation because of bloating in the flap transplantation area, while the other patients had a good shape of the flap transplantation area, with no deep tissue infection such as osteomyelitis, with soft texture, good elasticity, no pain, and good blood circulation; all the donor areas were left with linear scars, normal blood circulation in the distal extremities, no limitation of knee joint motion or quadriceps muscle strength. At the last follow-up, the sensation function was restored in the flap transplantation area of the affected limb, including 14 cases of S1 grade and 45 cases of S2 grade; there was only one point of two-point discrimination; the curative effect evaluation of flap repair included excellent in 24 cases, good in 35 cases, and general in 3 cases. Conclusions: The anterolateral thigh perforator flap pedicled with oblique branch trunk of lateral circumflex femoral artery in the muscular septum has the advantages of relatively concealed donor area, large cutting width, and simple operation during surgery. It protects the donor area to the greatest extent while repairing skin and soft tissue defects in the extremities, and is a useful supplement to the classic anterolateral thigh perforator flap.

Invasive Exploitation and the Multiplicative Hypothesis: Polyvictimization and Adolescent Depression Symptoms in Nepal

Adverse effects of childhood maltreatment experience and adolescent depression symptoms are theorized to be more profound for adolescents who have suffered multiple maltreatments (polyvictimization). New theoretical insights into the study of polyvictimization suggest that it must be studied using a multiplicative logic, particularly when maltreatment is characterized by invasive exploitation. This study, for the first time, examined the concept of invasive exploitation in the context of polyvictimization and its association with adolescent depression symptoms. The study used a random, three stage probability proportional to size (PPS) cluster sample of 565 mother-adolescent dyads in Kathmandu, Nepal, and also examined the protective effects of maternal empathy. We hypothesized that (a) singly, the empirical categories of maltreatment (neglect, physical abuse, and child sexual abuse) would associate positively with adolescent depressive symptoms and (b) main effects held constant, the interaction effects of a child sexual abuse X neglect and a child sexual abuse X physical abuse would be positive. Regression with clustering corrections found that neglect (B = 3.17, p < .01) and sexual abuse (B = 3.48, p < .05) positively associated with adolescent depression symptoms. Results support the multiplicative invasive exploitation polyvictimization hypothesis (child sexual abuse X neglect interaction; B = 6.14, p < .05). The positive neglect X sexual abuse interaction is consistent with the theory that sexual abuse is distinct as invasive exploitation, and demonstrates that the multiplicative hypothesis can be fruitfully applied to the study of polyvictimization. Interventions targeting polyvictims with experience of invasive exploitation and studies aiming to provide deeper insights into sexual abuse as invasive exploitation are needed.

Intersecting self-stigma among young Chinese men who have sex with men living with HIV/AIDS: A grounded theory study

Young men in China who have sex with men (MSM) are disproportionately infected with HIV. While scholars have drawn attention to the intersecting stigma against individuals with multiple stigmatized identities, little is known about how HIV-positive MSM navigate stigmatized identities and cope with intersecting self-stigma. This qualitative study explored how young Chinese MSM living with HIV/AIDS respond to their stigmatized identities and developed a typological framework to elucidate their experiences of intersecting self-stigma in the Chinese context. Between August and October 2020, semistructured interviews were conducted online with 24 young Chinese MSM living with HIV/AIDS aged 18-30. Guided by the analytic strategies of constructivist grounded theory, initial, focused, and theoretical coding were employed to analyze the data. Four profiles around the experience of intersecting self-stigma emerged. The first profile described participants self-stigmatizing their MSM identity more than their HIV/AIDS identity; the second profile captured those who reported stronger HIV/AIDS self-stigma. The third and fourth profiles were characterized by those who either self-stigmatized or accepted both intersecting identities, respectively. This study contributes to understanding the intricate nuances of the responses of Chinese HIV-positive MSM to their MSM identity and HIV-positive status in China's social and institutional contexts. Theoretical, policy, and practice implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gay Community Stress Scale with Its Cultural Translation and Adaptions in Taiwan

The present study aimed to adapt the Gay Community Stress Scale (GCSS) into the traditional Chinese version for measuring gay community stress experienced. Additionally, we examined its psychometric propensities among gay and bisexual men (GBM) in Taiwan. In total, 736 GBM participated in this study and completed the 35-item traditional Chinese version of the GCSS (29 items from the original GCSS and six items from the results of the focus group interviews among GBM in Taiwan); the Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG); the State-Trait Anxiety Inventory (STAI); and the Center for Epidemiological Studies Depression Scale (CES-D). Exploratory factor analysis results suggest a five-factor structure (i.e., Sex, Status, Competition, Exclusion, and Externals) for the 32-item traditional Chinese version of the GCSS among Taiwanese GBM; three items were deleted due to low factor loadings (i.e., <0.3). The five-factor "Externals" were not observed in the original GCSS. Moreover, the concurrent validity of the traditional Chinese version was supported by the positive correlations with MISS-LG, STAI, and CES-D. In conclusion, the traditional Chinese version of the GCSS showed relatively satisfactory psychometric properties. However, further research is needed to investigate the reasons for the possible etiology account for the different factor structures between the traditional Chinese version and the original GCSS.

Cultural consideration for cognitive-behavioural therapy for sexual minority young people in Chinese societies: Perspectives from practitioners and target users

Although cognitive-behavioural therapy has demonstrated effectiveness in improving mental health outcomes for sexual minority young people (SMYP), existing interventions are primarily designed and evaluated in Western contexts, and their acceptability and responsiveness to culturally relevant issues in the Chinese contexts is uncertain. This study aimed to address this gap by exploring how a manualised community-based cognitive-behavioural intervention (AFFIRM) could be culturally reconsidered for SMYP in Taiwan and Hong Kong and suggest recommendations for future adaptation. Following an empirical, community-based participatory approach, qualitative data were collected between August and September 2018 through five focus groups with 15 SMYP and 18 frontline practitioners in Taiwan and Hong Kong. Thematic analysis revealed that at the surface structural level, translation and examples, and promotion strategies can be fine-tuned to better fit the Chinese context. On the deep structural level, self-differentiation and a pragmatic plan to come out to parents were identified as two concerns of cultural importance for Chinese SMYP. This study exemplifies an empirical, collaborative approach to identifying areas of cultural adaptation for mental health intervention for SMYP in the Chinese cultural milieu. The rationale and strategy for adapting existing intervention protocols to accommodate divergent cultural values are described.

Correlates of Taiwanese Gay and Bisexual Men's Family-Building Preferences: A Mediation Analysis

This study investigated the role of filial piety, internalized homophobia, and desire for genetic relatedness with one's child in gay and bisexual men's family-building choice. A sample of 1,023 Taiwanese gay and bisexual men with a desire to have a child was recruited to complete an online survey that included the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and questions about desire for genetic relatedness with a child and acceptance of adoption and surrogacy. Mediation models, with desire for genetic relatedness as a mediator, were tested. The results show that those who chose surrogacy-only were older and had higher socio-economic status than those who selected adoption-only and both options. Filial piety and internalized homophobia were positively associated with the acceptance of surrogacy-only over adoption-only and both options. Desire for genetic relatedness mediated these relationships. This finding elucidates how sociocultural factors shape family-building preferences among gay and bisexual men.

Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants

Purpose

To identify optical coherence tomography (OCT) biomarkers that may predict functional and anatomical outcomes in diabetic macular edema (DME) patients treated with intravitreal dexamethasone (DEX) implant.

Materials and Methods

Sixty-four eyes from 50 patients with DME were enrolled. Best-corrected visual acuity (BCVA) and OCT biomarkers including central retinal thickness (CRT), subretinal fluid (SRF), intraretinal cysts (IRC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudate (HE), hyperreflective foci (HRF), epiretinal membrane (ERM), and vitreomacular interface (VMI) changes were evaluated at baseline and at 3, 6, and 12 months after treatment. Multiple logistic analysis was performed to evaluate each OCT biomarker as a predictive factor for functional and anatomical improvement at the end of treatment.

Results

The presence of SRF at baseline was associated with a favorable outcome, with CRT improving by more than 100 μm after treatment from multivariate logistic regression analysis [odds ratio 6.16 (1.75-21.6)]. In addition, baseline SRF predicted a greater CRT improvement from multiple regression analysis (model R-square 0.11, p = 0.006). The reduction of DRIL, SRF, LONLC, IRC, and EZD were correlated with better CRT improvement (more than 100 μm) (P < 0.05). SRF and EZD recovery can also predict better visual prognosis (P < 0.05).

Conclusion

OCT biomarkers can be used to predict who may benefit the most after DEX treatment. We suggest that the DEX implant should be considered as a first line treatment in DME patients with SRF.

Effects of sexual orientation concealment on well-being among sexual minorities: How and when does concealment hurt?

As a common experience for sexual minority individuals, sexual orientation concealment has complex implications. Self-determination theory (SDT) and previous studies suggest a mediation path where hiding sexual orientation is associated with well-being through eroding lesbian, gay, bisexual-specific authenticity and inducing loneliness. However, this relationship has rarely been examined using longitudinal data. This study also built on minority stress theory to determine whether the psychological process of concealment operates differently as a function of perceived acceptance in different contexts. A community sample of 636 sexual minority individuals in Hong Kong (48.3% men, 50.5% women, and 1.3% transgender and nonbinary individuals; mean age = 25.36 years) was recruited through lesbian, gay, bisexual, and transgender (LGBT) social media, nongovernmental organizations, and social venues to complete a baseline and 1-year follow-up survey. The results showed that loneliness mediated the relationship between concealment and well-being. Moreover, the mediation path from concealment to well-being via loneliness was moderated by the perceived LGBT-friendliness of the family. The negative association between concealment and well-being was only significant when the family was perceived as supportive of sexual and gender minorities. The study findings elucidated the complex mechanisms involved in the adverse outcomes of sexual orientation concealment and highlighted the importance of loneliness and family context when working with sexual minority clients on their concerns over sexual orientation concealment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"Strong Together": Minority Stress, Internalized Homophobia, Relationship Satisfaction, and Depressive Symptoms among Taiwanese Young Gay Men

Taiwan's legalization of same-sex marriage affords legal status for romantic relationships between sexual minority individuals. Yet, little is known about the role of intimate relationships in the experiences of minority stress and mental health among gay men. This study tested a model where internalized homophobia mediated the association between distal minority stress and depressive symptoms and relationship satisfaction was posited as a moderator. Data came from a sample (n = 557) of Taiwanese young gay men who were in a romantic relationship. Respondents completed the scales of distal minority stress, internalized homophobia, relationship satisfaction, and depressive symptoms. Mediation and moderation analyses were performed on the macro PROCESS. The Johnson-Neyman (J-N) technique was used to interpret the moderating effect of relationship satisfaction. Results show that both distal minority stress and internalized homophobia were positively associated with depressive symptoms. Internalized homophobia partially mediated the association between distal minority stress and depressive symptoms. Relationship satisfaction had a moderating effect. The effect of distal minority stress was lower among those who reported high satisfaction in their current romantic relationship. This study suggested that a satisfying relationship provides protection for gay men's mental health. Clinicians should attend to relationship issues when working with sexual minority clients.

Comparison of Choroidal Thickness, Foveal Avascular Zone, and Macular Capillary Density in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Ranibizumab or Aflibercept-A Prospective Study

This prospective comparative case series aims to compare best-corrected visual acuity (BCVA), retinal microvasculature, and retinal structural changes in patients treated with either ranibizumab or aflibercept for macular edema (ME) secondary to treatment-naïve branch retinal vein occlusion (BRVO) by optical coherence tomography angiography (OCTA). Ten patients were enrolled with macular capillary density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and foveal avascular zone (FAZ) measured in both eyes before and after treatment. Final central retinal thickness and BCVA improved significantly (p < 0.05), and densities of SCP and DCP of BRVO sectors were significantly lower at baseline than fellow eye counterparts and remained persistently lower during treatment, particularly in the aflibercept group (p < 0.05). SCP density, DCP density of both BRVO sectors (p = 0.0001, p < 0.0001), and non-BRVO sectors (p < 0.0001, p < 0.0001) were significantly correlated with final BCVA for diseased eyes. Using multivariate general linear model analysis, and including OCTA parameters only, but not all of the available clinical data, DCP density of BRVO sectors in both eyes was the most predictive factor for final visual outcome (probability p < 0.0001). OCTA offered further qualitative and quantitative evaluation of treatment-naïve BRVO. Judging by OCTA parameters, not only in the diseased eye but also in the fellow eye, DCP density of BRVO sectors was the most predictive factor of final visual outcome.

[Construction of a risk assessment indicator system for re-establishment of imported malaria]

OBJECTIVE

To create a risk assessment indicator system for re-establishment of imported malaria.

METHODS

The risk assessment indicator system for re-establishment of imported malaria was preliminarily constructed through literature review and thematic discussions. A total of 26 malaria control experts were selected to carry out a two-round Delphi consultation of the indicator system. The active coefficient, authority coefficient and coordination coefficient of the experts and the coefficient of variation on each indicator were calculated for indicator screening and the weight of each indicator was calculated. The reliability of the indicator system was evaluated using Cronbach's coefficient α, and the content validity of the indicator system was evaluated using the authority coefficient of the expert, while the structural validity of the indicator system was evaluated using Kaiser-Meyer-Olkin (KMO) test and factor analysis.

RESULTS

Two rounds of Delphi expert consultations were completed by 23 malaria control experts, and a risk assessment indicator system for re-establishment of imported malaria was constructed, including 3 primary indicators, 7 secondary indicators, and 21 tertiary indicators. The active coefficient (100.00% vs. 88.46%; P < 0.01) and coordination coefficient of the expert (0.372 vs. 0.286; P < 0.01) were significantly greater in the second round of the Delphi expert consultation than in the first round. After the second round of the Delphi expert consultation, the authority coefficient of the experts ranged from 0.757 to 0.930 on each indicator, and the coefficients of variation were 0.098 to 0.136, 0.112 to 0.276 and 0.139 to 0.335 for the primary, secondary and tertiary indicators, respectively. The overall Cronbach's coefficient α of the indicator system was 0.941, and there were significant differences in the KMO values for primary (KMO value = 0.523; χ² = 18.192, P < 0.05), secondary (KMO value = 0.694, χ² = 51.499, P < 0.01) and tertiary indicators (KMO value = 0.519; χ² = 477.638, P < 0.01), while the cumulative contribution rate of six principal components in the tertiary indicators was 84.23%. The normalized weights of three primary indicators of the source of infection, transmission condition and control capability were 0.337, 0.333 and 0.329, and the three secondary indicators with the greatest normalized weights included the number of imported cases and malaria parasite species (0.160), introduction of imported cases in China and medical care seeking (0.152), vector species and density (0.152), while the five tertiary indicators with the greatest normalized weights included the malaria parasite species of imported cases (0.065), vector populations (0.064), and the time interval from onset to medical care seeking (0.059), number of imported cases (0.056), and the time interval from medical care seeking to definitive diagnosis (0.055).

CONCLUSIONS

A risk assessment indicator system for re-establishment of imported malaria is successfully created, which provides insights into the assessment of the risk of re-establishment of imported malaria and management of key high-risk factors in malaria-eliminated areas.

Sexual Minority Stress, Adverse Childhood Experiences, and Obesity Among Gay Men in Taiwan: Findings from a Panel Study

Purpose: Obesity is linked to personal behaviors and external stressors. Despite emerging evidence that sexual minority stress (SMS) and adverse childhood experiences (ACEs) are associated with the risk of obesity, little is known about their independent and interactive effects on sexual minority men. This study investigated these relationships using panel data. Methods: Self-identified gay and bisexual adult men in Taiwan were recruited through Facebook advertisements to complete an online questionnaire. This study reports only on data from the gay subsample (n = 731, mean age = 28.05 years, standard deviation = 5.75 years) as the bisexual subsample (n = 132) was insufficient for comparative statistical analysis. Over two time points, respondents reported their body weight and height, experiences with SMS, and ACEs on an online survey platform. Data analysis was conducted using multiple logistic regression to determine the individual and interactive effects of the ACE score, ACE components, and SMS on the odds for obesity. Results: Almost 16% of the respondents met the criterion for obesity (body-mass index ≥27). In the adjusted models, neither SMS nor ACEs had significant associations with the likelihood of obesity. Only the interaction term of SMS and childhood sexual abuse was significant, indicating that victims of sexual abuse have an increased likelihood of obesity that SMS may intensify. Conclusions: This study shows that gay men who experience childhood sexual abuse and SMS accumulatively faced an increased risk of obesity. Healthy weight promotion for these men should address these stressors.

Effects of Same-Sex Marriage Legalization for Sexual Minority Men in Taiwan: Findings From a Prospective Study

Objective: On May 24, 2019, same-sex marriage (SSM) was legalized in Taiwan. Increasing research in western countries has yielded longitudinal evidence about the psychosocial benefits of SSM for sexual minority individuals, but they have rarely included sexual minority-specific measures or considered participants’ relationship status. This study aimed to examine the short-term effects associated with the legalization of SSM for gay and bisexual men in Taiwan.

Methods: A panel sample of 731 gay and 132 bisexual men participated in baseline (May 2019) and follow-up (October 2020) online surveys to report their depressive symptoms, distal sexual minority stress, internalized homophobia, and outness status.

Results: The results demonstrated significant reductions in depressive symptoms and distal sexual minority stress along with increased rates of coming out to friends, family, and parents. These changes were similar for partnered and un-partnered individuals. Fixed-effect regression analysis indicated that the decline in distal sexual minority stress and internalized homophobia contributed to the decline in depressive symptoms.

Conclusion: This study preliminarily supports the positive effects of SSM in promoting sexual minority men’s mental health and disclosure in Taiwan.

The incidence of uveitis after systemic lymphoma in Taiwan: An 18-year nationwide population-based cohort study

Although uveitis can be an intraocular presentation of systemic lymphoma, it may be associated with direct lymphomatous infiltration and immune-mediated alterations. There have been no published studies describing the incidence of uveitis after systemic lymphoma. We conducted a nationwide cohort study to investigate the incidence of uveitis after systemic lymphoma diagnosis in Taiwan. Data were collected from the Taiwan National Health Insurance system and included patients newly diagnosed with systemic lymphoma between 2000 and 2017. We observed the risk of uveitis among study population since the index date until December 2017. The 1:8 of systemic lymphoma patient and paired comparison was identified by time distribution matching and individual paired with sex and age. Subsequent propensity score matching (PSM) was used to select the 1:1 of systemic lymphoma patient and paired comparison by greedy algorism with caliper of 0.05. The multiple Cox proportional hazard regression model was used to compare the developmental risk of uveitis (time-to-uveitis) between the systemic lymphoma and non-systemic lymphoma, while controlling for selected covariates. After time distribution matching, we selected 6846 patients with systemic lymphoma, and 54,768 comparisons. Among patients with systemic lymphoma groups, there were more men than women (52.94% vs 47.06%) and the mean age was 53.32 ± 21.22 years old. Systemic lymphoma incidence rates (per 10,000 person-months) of uveitis were 1.94 (95% confidence interval [CI], 1.60-2.35) in the systemic lymphoma cohort and 1.52 (95% CI, 1.42-1.63) in the non-systemic lymphoma cohort. Compared with the non-systemic lymphoma cohort, adjusted hazard ratio (aHR) of developing uveitis were 1.24 (95% CI, 1.00-1.52) in people with systemic lymphoma. But not significant in after PSM, aHR of developing uveitis were 1.17 (95% CI, 0.90-1.53). This 18-year nationwide population-based cohort study in Taiwan, showed that the risk of uveitis in patients' systemic lymphoma was not significantly higher than non-systemic lymphoma after PSM. In elderly and rheumatic patients with intraocular inflammation, it is important to first exclude uveitis masquerade syndrome, which could be a harbinger of intraocular involvement from systemic lymphoma. Further large-scale prospective clinical studies to investigate whether systemic lymphoma influences the incidence of uveitis are warranted.

Bilateral optic disc edema as a possible complication of cabozantinib use-a case report

INTRODUCTION

Cabozantinib, which was approved by the Food and Drug Administration (FDA) in 2012, is a tyrosine kinase inhibitor widely used in the treatment of metastatic renal cell carcinoma (RCC) and medullary thyroid carcinoma. To date, no ocular adverse events have been reported by the FDA or on the package label. Here, we described a patient with metastatic RCC who developed bilateral optic disc edema after a 4-month course of cabozantinib.

CASE DESCRIPTION

A 55-year-old ethnic Chinese male with RCC with multiple metastases presented to our department with progressive blurred vision in both eyes for 1 month. He started taking cabozantinib 60 mg once daily 5 months prior to this presentation. Poor visual acuity and bilateral disc edema were then noted. Cabozantinib was discontinued after that, and 3-day pulse steroid therapy with methylprednisolone 1 g/day was given. The optic disc edema subsided gradually with limited improvement in visual acuity.

CONCLUSION

Bilateral optic edema should be considered as a complication associated with cabozantinib. We propose discontinuation of the treatment in cases such as that, and pulse steroid therapy should be considered if there is no contraindication.

Effects of Vision Therapy on Bilateral Amblyopia Unresponsive to Conventional Treatment: A Retrospective Comparative Study

Background: In this study we aim to determines the effect of our vision therapy program for 7- to 10-year-old patients who exhibit bilateral amblyopia that is no longer responsive to conventional treatment. Methods: Children with bilateral amblyopia between the ages of 7 and 10 treated with vision therapy at the China Medical University Hospital between 2016 and 2019 were retrospectively reviewed. Age and visual acuity-matched bilateral amblyopes are included as a control group. The visual acuity for both groups showed no improvement for more than 3 months with part-time patching and full refraction correction. The initial and final visual acuity, stereopsis, and refractive status were analyzed. Results: Here, 15 cases were included as the treatment group and 16 cases as a control group. At the endpoint, the study group shows a significant improvement in BCVA, with a mean of 0.32 ± 0.15 logMAR (3 lines improvement) versus 0.003 ± 0.19 logMAR (nearly no improvement) for the control group (p < 0.001). The benefits of treatment are most obvious in the first 3 months after treatment (p < 0.001) and last until the end point. Stereoacuity also improves from 190.00 ± 163.34 to 85.00 ± 61.24 arc seconds, which is a 55.26% improvement. Conclusions: Vision therapy, comprising orthoptic therapy, perceptual learning and dichoptic training, is a successful program for increasing visual acuity and stereoacuity in 7- to 10-year-old children with bilateral amblyopia that is unresponsive to conventional treatment.

Intersecting Stigma and HIV/AIDS Community Participation Among Young Chinese Men Who Have Sex with Men Living with HIV

Community participation is vital for the recovery and empowerment of men who have sex with men (MSM) living with HIV. Intersectionality also provides an important lens that inequalities operate in an intersectional manner and pose compound challenges to the lives of minority individuals. However, the association between intersecting stigma toward HIV-positive MSM and their community participation is underexplored. The study drew on a sample of young Chinese MSM living with HIV from a community-based online survey that recruited respondents using nonprobability purposive sampling (n = 1004). Structural equation modeling was performed to investigate the associations among perceived stigma against sexual minorities and people living with HIV, HIV-related self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV-related stigma were further examined. Results show that total direct effect was significant [B (SE) = 0.859 (0.233); confidence interval (95% CI) = 0.402-1.316]. Perceived HIV-related stigma was positively correlated with HIV/AIDS community participation, while HIV-related self-stigma was negatively correlated. The mediating role of HIV-related self-stigma was significant in both types of perceived stigma [total indirect effect: B (SE) = -0.935 (0.175); 95% CI = -1.277 to -0.593]. The interaction effect was also significant and negative [B (SE) = -0.117 (0.056), p < 0.001], showing that perceived homosexual stigma could offset the effect of perceived HIV-related stigma on HIV-related self-stigma. The findings illustrate how intersecting stigma is involved in HIV-related self-stigma and community participation and highlight the importance of applying an intersectionality perspective to investigate stigma toward MSM living with HIV and their community participation.

Intravitreal aflibercept combined with transpupillary thermotherapy in the treatment of refractory macular edema due to primary uveal melanoma

We reported a 74 year old Asian female with a uveal tumor with subretinal fluid (SRF) and cystoid macula edema. Since she declined biopsy, multimodal imaging study was performed, including fundus photography, ultrasonography, optical coherence tomography, fluorescein angiography, and magnetic resonance imaging. Uveal melanoma was diagnosed. However, despite aggressive treatment with TTT and three adjuvant intravitreal bevacizumab doses, SRF, and cystoid macula edema were persistent. Therefore, aflibercept was administered, resulting in anatomical and functional improvement within 1 month, which lasted for 12 months. Aflibercept offered great efficacy in improving refractory macular edema in this case of primary uveal melanoma. Multimodal imaging can provide us with more diagnostic clues in differentiating the nature of intraocular tumors.

Experience of Sexual Orientation Microaggression among Young Adult Lesbian, Gay, and Bisexual Individuals in Taiwan: Its Related Factors and Association with Mental Health Problems

Experiences of sexual orientation microaggression (SOM) are prevalent in lesbian, gay, and bisexual (LGB) individuals. The aims of this quantitative cross-sectional survey study were to examine the factors, including demographics, sexual orientation characteristics, and perceived social support related to SOM, as well as the relationships of SOM with anxiety, depression, and suicidality among young adult LGB individuals in Taiwan. In total, 1000 self-identified young adult LGB individuals (500 men and 500 women) participated in this study. The experience of SOM was assessed using the Sexual Orientation Microaggression Inventory. We also collected demographic and sexual orientation characteristics; perceived general family support, using the Family APGAR Index; anxiety on the State-Trait Anxiety Inventory; depression on the Center for Epidemiological Studies-Depression Scale; and suicidality on the suicidality module of the Kiddie-SADS. The factors related to SOM and the associations of SOM with anxiety, depression, and suicidality were examined using multivariate linear regression analysis. The results indicated that males experienced greater SOM than females, and that younger age of identification of sexual orientation and perceived lower general family support were significantly associated with greater SOM. Greater SOM was significantly associated with greater anxiety, depression, and suicidality. The experiences of SOM in LGB individuals with mental health problems warrant assessment and intervention that take the related factors into account.

Measurement Invariance of the Sexual Orientation Microaggression Inventory across LGB Males and Females in Taiwan: Bifactor Structure Fits the Best

The present study examined the factor structure and concurrent validity of the traditional Chinese version of the Sexual Orientation Microaggression Inventory (SOMI) among lesbian, gay, and bisexual (LGB) individuals in Taiwan. In total, 1000 self-identified LGB individuals completed the SOMI, HIV and Homosexuality Related Stigma Scale (HHRSS), and Acceptance and Action Questionnaire-II (AAQ). Different factor structures (including one-factor, four-factor, bifactor, and higher-order factor structures) were evaluated using confirmatory factor analysis. The bifactor structure significantly outperformed all others on the SOMI. The bifactor structure with one general factor and four trait factors was found to be measurement invariant across biological sex with satisfactory fit indices. The SOMI general factor was significantly associated with HHRSS-Homosexuality score and AAQ score. The findings indicate that the SOMI is a psychometrically sound instrument for Taiwan sexual minority groups. More specifically, SOMI can be used to accurately assess microaggression among LGB individuals. The measure on microaggression may also provide insights for healthcare providers about LGB individuals' sexuality-related stigma. Moreover, healthcare providers and relevant stakeholders can use the SOMI to understand how LGB individuals perceive and feel microaggression.

Endoscopy-assisted extraction of orbital and nasal foreign body

Penetrating orbital injury with a foreign body is a complex problem that requires an interdisciplinary therapeutic approach. Conventionally, an external approach using either transconjuntival or transseptal entry is used by an ophthalmologist. However, there is a risk of damage to the optic nerve and orbital tissue using only the traditional approach. This study concerns a 36-year-old male who has an intra-orbital foreign body (OrbFB). Timely three-dimensional reconstruction computed tomography scan demonstrated an 8-cm-long intra-OrbFB adjacent to the optic nerve penetrating to the contralateral nasal cavity. Endoscopic inspection confirmed a chopstick fragment. Assisted by transnasal endoscopy, the chopstick penetrating from the orbit to the nasal cavity was smoothly removed. Nasal endoscopy is useful for an ophthalmologist in removing foreign body in the orbit.

Two new black fly species of the Simulium ( Simulium) rufibasis subgroup (Diptera: Simuliidae) from Taiwan

Simulium ( Simulium) rufibasis Brunetti originally described from India was once considered a geographic generalist widely distributed in the Oriental Region. In this study, the species previously regarded as S. (S.) rufibasis in Taiwan was morphologically re-evaluated and found to be distinguished in the male and pupa from true S. (S.) rufibasis from India. This new species is described as S. ( S.) hehuanense sp. nov. based on a female, a male and their pupal exuviae in Taiwan. This new species is placed in the S. rufibasis subgroup of the S. tuberosum species-group, and is similar to S. (S.) yamatoense Takaoka, Adler & Fukuda from Japan and Korea, but it is barely distinguished by the slenderer forebasitarsi of the female and male. Another new, related species, S. (S.) xiulinense sp. nov., is described based on a male and its pupal exuviae. This new species is distinguished from S. (S.) hehuanense sp. nov. by the number of male upper-eye (large) facets in 20 or 21 vertical columns and 22 horizontal rows (19 vertical columns and 19 horizontal rows in the latter species), and presence of a pair of dorsolateral shiny spots on male abdominal segment 5 (absence in the latter species). Both new species inhabit streams at high elevations (ca, 2,600 m). They differ from S. (S.) sp. (probably S. (S.) arisanum Shiraki) from Taiwan, of the same subgroup, which breeds in streams at low elevations (433-685 m), by the pupal head and thorax covered with tubercles (bare in the latter species).

Astigmatism Management with Astigmatism-Correcting Intraocular Lens Using Two Toric Calculators - A Comparative Case Series

Background

To compare refractive outcomes after phacoemulsification and toric IOL implantation using two different toric calculators for initial astigmatism assessment in a real-world setting.

Methods

This was a retrospective, comparative, interventional case series. Patients over 30-year-old who underwent phacoemulsification and toric IOL implantation (AcrySof^® Toric IOL) by the same surgeon between 2017 and 2018 were included. Eyes with irregular astigmatism, previous corneal refractive surgery, intraocular surgery, corneal pathology, macular pathology and pupil abnormalities were excluded. IOL toricity was determined by using a calculator provided by the AcrySof Toric calculator before 2018 and Barrett Toric Calculator after 2018. Patient demographics, corneal topography, vector and preoperative and postoperative refraction were collected and analyzed at three months postoperative.

Results

Thirty-two eyes of 32 patients were included in the final analysis. 0.1D for surgically induced astigmatism was used. Group 1 included 14 eyes assessed with the original (AcrySof) toric IOL calculator, and group 2 included 18 eyes assessed with the Barrett toric IOL calculator. In group 1, postoperative astigmatism less than −1.00D, −0.75 D, and −0.5D was achieved in 88.2%, 76.1% and 53.7% of eyes, respectively, while, in group 2, 89% eyes achieved postoperative residual astigmatism less than 0.5D and all eyes achieved postoperative residual astigmatism less than 0.75D. The proportion of patients with lower postoperative astigmatism was significantly higher in Group 2 (p< 0.05 by chi-square test), a pattern that still held when we divided patients into multiple groups. Vector analysis with the Alpins methods also supported better outcomes in the Barrett group (0.71 D vs 0.35 D).

Conclusion

The Barrett Toric calculator resulted in better results in the prediction of residual astigmatism than original (AcrySof) toric calculators.

Risk factors for repeated dexamethasone intravitreal implant therapy for macular edema due to treatment-naïve branch retinal vein occlusion

Background

This study evaluated the effects of dexamethasone intravitreal implant on treatment-naïve branch retinal vein occlusion (BRVO)-induced macular edema (ME), and the risk factors for earlier repeated treatment.

Methods

Patients treated from 2013 to 2016 were enrolled. The patients’ demographics, medical history, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) were recorded. Risk factors for repeated treatment were identified using a Cox proportional hazard model and logistic regression.

Results

29 patients (mean age: 58.64 ± 13.3 years) were included; 44.8% received only one injection, while 55.2% received two or more. The mean initial CRT was 457.8 ± 167.1 μm; the peak CRT and final CRT improved significantly to 248.9 ± 57.9 μm and 329.2 ± 115.1 μm, respectively. The peak BCVA improvement and final improvement were 29.5 ± 23.5 approximate ETDRS letters and 19.8 ± 24.4 letters, respectively, with 62.1% of patients improving by more than 15 letters. Older age, higher initial CRT, and diabetes were the risk factors for multiple injections.

Conclusion

Dexamethasone intravitreal implant results in significant peak CRT and BCVA improvements, while older age, higher initial CRT, and diabetes are risk factors for repeated injections. The optimal retreatment schedule for these patients should be further explored.

A Minority Stress Response Model of Health Behaviors in Gay and Bisexual Men: Results from a Taiwanese Sample

Purpose: Health disparities among sexual minority men remain and continue to demand novel interventions. Other than risk reduction, a promising approach is to identify pathways to health-promoting behaviors. In this study, depressive symptoms, internalized homophobia, and sense of community connectedness were hypothesized to result from the experience of harassment and rejection, and in turn either promote or inhibit an individual's tendency toward health-promoting behaviors. We accounted for subgroup differences by examining the hypothesized model in gay and bisexual men separately. Methods: This was a cross-sectional survey study. One thousand three hundred eighty-one gay (81.5%) and bisexual (18.5%) Taiwanese men 18-49 years of age (mean = 26.56, standard deviation = 6) were recruited through a social media advertisement and completed an online survey. Structural equation modeling was employed to simultaneously examine multiple hypothesized paths. Results: Harassment and rejection were associated with greater depressive symptoms, internalized homophobia, and sense of community connectedness, which in turn yielded direct or indirect associations with health-promoting behavior among gay men. For bisexual men, depressive symptoms remained an important mechanism linking harassment and rejection and health-promoting behavior, whereas the roles of internalized homophobia and sense of community connectedness appeared less obvious. Conclusion: These findings cast new light on the behavioral implications of minority stress and elucidate the possible underlying mechanisms. The study suggests that more effort should be invested to understand and promote the drivers of health-promoting behavior to reduce health disparities in this population.

Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing

Background

Falls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults.

Methods

Data from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1–4 medications, 5–9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs.

Results

The prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1–4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1–4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications.

Conclusions

The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.

Perceived Attitudes Toward Lesbian, Gay, and Bisexual (LGB) Issues and Mental Health Among Taiwanese LGB Adults: The Mediating Role of Self-Acceptance

Research on structural stigma has associated the poor mental health status among lesbian, gay, and bisexual (LGB) people with discriminatory institutions. Yet, less is known about the role of LGB adults' perceptions of social attitudes toward LGB issues. Moreover, the psychological mediation framework posits LGB people's self-acceptance as a mediator between a stigmatizing environment and individual mental health. This study investigated: (a) how perceived attitudes toward LGB issues from different social realms (society, heterosexual friends, and family members) were associated with LGB people's mental health; and (b) whether self-acceptance mediated the effects of perceived attitudes. In this cross-sectional study, 1527 Taiwanese LGB adults (812 men; 715 women) aged between 20 and 62 years were recruited via Facebook to complete an online survey. The majority of respondents self-identified as homosexual (1129) and 399 as bisexual. The survey consisted of assessment of respondents' mental health and questions to rate individual self-acceptance and perceptions of social attitudes. Path analysis showed that self-acceptance partially mediated the association between mental health and perceived societal acceptance of homosexuality and fully mediated the effect of perceptions of friends' acceptance of homosexuality on mental health. Self-acceptance fully mediated the effects of perceived support for same-sex marriage from friends and families. This research yielded evidence about the interplay between perceived social stigma, self-acceptance, and mental health, particularly in the context of public debate about same-sex marriage. The effects of public discourse about sexual diversity and marriage equality on LGB adults' mental health should be addressed by affirmative policies and practices.

[Clinical characteristics of 83 patients with thrombotic thrombocytopenic purpura]

Objective: To analyze the clinical characteristics, treatment and prognosis of patients with thrombotic thrombocytopenic purpura (TTP) . Methods: 83 patients with TTP from May 1998 to May 2019 were analyzed retrospectively. Results: Among the 83 patients, there were 27 males and 56 females, with a median age of 39 (10-68) years. 41 cases (49.4%) showed pentalogy syndrome and 79 cases (95.2%) showed triad syndrome. 78.0% (46/59) of the patients had a PLASMIC score of 6 or higher. TTP gene mutations was detected in 5 of 10 patients. The activity of von Willebrand factor-cleaving protease (ADAMTS13) , which was detected in 10 patients before plasma exchange (PEX) , was less than 10% in 9 patients. 83 patients were treated with PEX/plasma infusion and glucocorticoid, 35 of which were treated combined with rituximab and/or immunosuppressant. The median follow-up was 34 (1-167) months, the effective rate was 81.9%, the remission rate was 63.9%, the relapse rate was (35.7 ±7.1) %, and the 3-year overall survival (OS) rate was (78.6 ±4.6) %. The effective rate (72.9%vs 94.3%, P=0.019) and OS rate[ (63.8±7.5) %vs (94.3±3.9) %, χ(2)=8.450, P=0.004] in the group treated with PEX/PI and glucocorticoid alone were lower than those in the group treated combined with rituximab and/or immunosuppressant. COX multivariate analysis showed that age (HR=1.111, 95%CI 1.044-1.184, P=0.001) and alanine transaminase (ALT) /aspartate aminotransferase (AST) (HR=1.353, 95%CI 1.072-1.708, P=0.011) were independent risk factors for OS. Conclusion: Most patients with TTP have triad syndrome, accompanied by a decrease in ADAMTS13 activity. Plasma infusion and glucocorticoid combined with rituximab, immunosuppressive therapy could improve overall survival. The prognosis of patients with older age and high ALT/AST ratio is poor.

How Intersectional Are Mental Health Interventions for Sexual Minority People? A Systematic Review

Purpose: Complex and widespread stigma exposes sexual minority people to disproportionate risks for adverse mental health. Intersectionality theory calls for consideration of the unique experiences of living with multiple forms of inequality. Yet, concerns remain regarding the extent to which intersectionality theory has been integrated into mental health interventions for sexual minority populations. This systematic review aims to assess the degree to which available mental health interventions account for intersecting forms of marginalization and to identify methods that facilitate the application of intersectionality. Methods: A search for peer-reviewed English language journal articles was conducted using PsycINFO and PubMed to locate reports of mental health interventions for sexual minority groups. A coding framework was designed to evaluate how interventions incorporated intersectionality theory. Results: Of 1877 potentially eligible articles, forty-three were included in the analysis. They were each classified as low, medium, or high with regard to intersectionality. Thirteen (30.2%) were rated as low on intersectionality for only recruiting a homogeneous group of participants in the interventions; 23 (53.4%) were classified as medium for including additional identities in recruitment without responding to possible intersectional disadvantages; 7 (16.3%) were rated as high with adequate consideration of the complex effects of intersecting positions. In addition, the review identified community-based participatory research as a common and instrumental method to ensure intersectionality. Conclusions: This review highlights the limitations of interventions for sexual minority people in addressing intersectionality. Guidelines are needed for clinical practice and evaluation to adequately incorporate intersectionality theory.

Preference about Laws for the Legal Recognition of Same-Sex Relationships in Taiwanese People Before and After Same-Sex Marriage Referenda: A Facebook Survey Study

This study examined the factors related to the preference about laws to legalize same-sex relationships in participants of the first wave of a survey (Wave 1, 23 months before the same-sex marriage referendum) and the second wave of a survey (Wave 2, 1 week after the same-sex marriage referendum) in Taiwan. The data of 3286 participants in Wave 1 and 1370 participants in Wave 2 recruited through a Facebook advertisement were analyzed. Each participant completed an online questionnaire assessing their attitude toward the legal recognition of same-sex relationships, preference about laws to legalize same-sex relationships (establishing same-sex couple laws outside the Civil Code vs. changing the Civil Code to include same-sex marriage laws), belief in the importance of legalizing same-sex relationships, and perceived social attitudes toward the legal recognition of same-sex relationships. The results revealed that those who did not support legalizing same-sex relationships were more likely to prefer establishing same-sex couple laws outside the Civil Code than those who supported the legalization. The form of law preferred to legalize same-sex relationships significantly changed between Wave 1 and Wave 2. Multiple factors, including gender, age, sexual orientation, belief in the importance of legalizing same-sex relationships to human rights and the social status of sexual minorities, and perceived peers’ and families’ attitudes toward the legal recognition of same-sex relationships, were significantly associated with the preference of laws, although these associations varied among heterosexual and non-heterosexual participants and at various stages of the survey.

[Eltrombopag for the treatment of primary immune thrombocytopenia in 23 pediatric patients]

目的

评估艾曲泊帕治疗儿童原发免疫性血小板减少症（ITP）的疗效和不良反应。

方法

回顾性分析2015年5月至2019年3月接受艾曲泊帕治疗的23例儿童ITP患者临床资料。

结果

23例患者中，男11例，女12例，中位年龄11（2~17）岁。新诊断ITP 4例（17.39%），持续性ITP 8例（34.78%），慢性ITP 11例（47.83%）。艾曲泊帕中位起始剂量为25.0（12.5~50.0）mg/d。基线中位血小板计数为14（2~82）×10⁹/L，治疗后第2周（23例）、第4周（23例）、第3个月（16例）、第6个月（11例）的中位血小板计数分别为40（4~170）×10⁹/L、20（4~130）×10⁹/L、60（4~110）×10⁹/L、70（18~160）×10⁹/L，均高于基线水平（z=-3.440，P=0.001；z=-1.964，P=0.049；z=-4.339，P<0.001；z=-5.794，P<0.001）。7例（30.43%）患者的起效时间≤7 d，10例（43.48%）患者的起效时间≤2周，总有效率为60.87%（14/23）。<6岁（6例）、6~12岁（10例）、13~17岁（7例）组的总有效率分别为33.33%（2/6）、60.00%（6/10）、85.71%（6/7），组间比较差异均无统计学意义（P>0.05）。23例患者基线WHO出血评分0、1、2级分别有4、12、7例，治疗后分别为13、7、3例，出血症状得到明显改善（χ²=7.558，P=0.006）。治疗过程中发生转氨酶、胆红素增高各4例，轻度恶心、呕吐及头晕各1例，对治疗均未造成影响。

结论

艾曲泊帕作为二线用药治疗儿童ITP疗效及耐受性均较好。

Filial piety, internalized homonegativity, and depressive symptoms among Taiwanese gay and bisexual men: A mediation analysis

A theme emerging from the current literature is that Chinese gay and bisexual men are likely to struggle to accept themselves because of the cultural emphasis on filial piety. However, our understanding of this culturally particular process remains partial because most research has operationalized filial piety as either a component of Chinese values or an aggregate construct itself. To pinpoint this mechanism, this study deconstructed filial piety into pragmatic obligations and compassionate reverence to test a mediation model in which internalized homonegativity served as a mediator between filial piety and depressive symptoms among Taiwanese gay and bisexual men. With the aid of Facebook advertisements, a total of 1,381 respondents (Mean age = 26.56, SD = 6) were recruited to complete a web-based survey comprising the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and the Patient Health Quesionanire-9. Structural equation modeling was performed to test the mediation paths. Results showed that pragmatic obligations are directly and negatively associated with depressive symptoms without yielding significant correlation with internalized homonegativity. A full mediation path was found in that compassionate reverence is positively correlated with internalized homonegativity and in turn associated with higher depressive symptoms. Whereas filial piety still assumes salience among Taiwanese gay and bisexual men, this study provides novel evidence for the intricate effect of the value of filial piety on Taiwanese gay and bisexual men's self-acceptance and mental health. The results highlight the importance of a relational and cultural focus to address mental health disparities among sexual minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effect of Same-Sex Marriage Referendums on the Suicidal Ideation Rate among Nonheterosexual People in Taiwan

: Taiwan held voter-initiated referendums to determine same-sex marriage legalization on 24 November 2018. This study aims to compare suicidal ideation rates in heterosexual and nonheterosexual participants of a first-wave survey (Wave 1, 23 months before the same-sex marriage referendums) and a second-wave survey (Wave 2, one week after the same-sex marriage referendums) in Taiwan and to examine the influence of gender, age, and sexual orientation on the change in suicidal ideation rates in nonheterosexual participants. In total, 3286 participants in Wave 1 and 1370 participants in Wave 2 were recruited through a Facebook advertisement. Each participant completed an online questionnaire assessing suicidal ideation. The proportions of heterosexual and nonheterosexual participants with suicidal ideation were compared between the Wave 1 and Wave 2 surveys. Suicidal ideation rates between participants in the Wave 1 and Wave 2 surveys were further compared by stratifying nonheterosexual participants according to gender, age, and sexual orientation. Nonheterosexual participants in the Wave 2 survey had a higher suicidal ideation rate than those in the Wave 1 survey, whereas no difference was observed in suicidal ideation rates between heterosexual participants in Wave 2 and Wave 1. Nonheterosexual participants who were female, younger, gay, lesbian, and bisexual in Wave 2 had a higher suicidal ideation rate than those in Wave 1. The suicidal ideation rate significantly increased in nonheterosexual participants experiencing the same-sex marriage referendums in Taiwan. Whether civil rights of sexual minority individuals can be determined through referendums should be evaluated.