A prospective study of nightmare disorder among Chinese adults in Hong Kong: Persistence and mental health outcomes.

OBJECTIVES: Previous studies showed that nightmares are prevalent and are associated with negative health outcomes. However, no empirical data is available demonstrating the extent to which nightmare disorder persists over time. Current literature provides a limited understanding of the trajectory and wider mental health outcomes of nightmare disorder. This longitudinal study examined the persistence and mental health outcomes of nightmare disorder. METHODS: A total of 230 Hong Kong Chinese adults completed standardized assessments twice with an interval of about 6 months. RESULTS: Over half (66.7%) of the participants with probable nightmare disorder at baseline remained to meet the DSM-5 criteria for the disorder at follow-up. Participants with probable nightmare disorder at baseline were significantly more likely to screen positive for PTSD (82.1% vs 18.3%) (p < .001) (p < .001), and they reported higher rates of mental health service usage at both timepoints (p = .001 to .003). Baseline nightmare disorder severity was negatively associated with subsequent self-rated mental health (ß = -.151, p = .010) and self-esteem (ß = -.141, p = .009) and it also predicted subsequent PTSD symptoms (ß = .122, p = .012). CONCLUSIONS: This study provides first empirical data showing that nightmare disorder could be persistent over time. Nightmare disorder symptoms are associated not only with PTSD symptoms but also with a broader range of mental health issues. This study points to the public health importance of identifying and managing nightmare disorder symptoms in the community. Additionally, the presence of nightmare disorder symptoms may be a helpful indicator for identifying post-traumatic stress.

Clinical Features of a Chinese Sample with Self-Reported Symptoms of Pathological Dissociation.

People with pathological dissociation should receive proper clinical attention and timely support. Recent studies have shown that pathological dissociation is common in the Chinese context. However, little is known about the clinical features of Chinese people with pathological dissociation. This paper reports the first data regarding trauma histories, mental health symptoms, clinical diagnoses, service usages, stigma and psychosocial needs in a convenience sample of Chinese people who screened positive for pathological dissociation on a self-report measure (N = 72). This sample was characterized by a history of trauma and high levels of trauma-related symptoms and depression. Medication treatments were the most common interventions for them; many participants did not receive psychotherapy. We found no clinical differences between participants who had and had not received psychotherapy for post-traumatic/dissociative symptoms. This implies that many participants did not have the chance of receiving specific psychotherapy even though their trauma histories and clinical symptoms were as severe as those who were receiving specific psychotherapy. Stigma and unmet psychosocial needs were common in this sample and should receive more attention in the field. Implications for research and practice are highlighted. More dissociation-informed services are required for Chinese-speaking populations.

A mental health needs assessment of children and adolescents in post-conflict Liberia: results from a quantitative key-informant survey.

Between 1989 and 2004, Liberia experienced a devastating civil war that resulted in widespread trauma with almost no mental health infrastructure to help citizens cope. In 2009, the Liberian Ministry of Health and Social Welfare collaborated with researchers from Massachusetts General Hospital to conduct a rapid needs assessment survey in Liberia with local key informants (n = 171) to examine the impact of war and post-war events on emotional and behavioral problems of, functional limitations of, and appropriate treatment settings for Liberian youth aged 5-22. War exposure and post-conflict sexual violence, poverty, infectious disease and parental death negatively impacted youth mental health. Key informants perceived that youth displayed internalizing and externalizing symptoms and mental health-related functional impairment at home, school, work and in relationships. Medical clinics were identified as the most appropriate setting for mental health services. Youth in Liberia continue to endure the harsh social, economic and material conditions of everyday life in a protracted post-conflict state, and have significant mental health needs. Their observed functional impairment due to mental health issues further limited their access to protective factors such as education, employment and positive social relationships. Results from this study informed Liberia's first post-conflict mental health policy.

Comparison of health-promoting behavior between Taiwanese and American adolescents: a cross-sectional questionnaire survey.

OBJECTIVES: The main aim of this study was to compare the health promotion practices of Taiwanese (n=265) and American (n=285) adolescents, using the revised Adolescent Health Promoting scale. METHODS: A comparative and descriptive design was used. Categorical data analysis was applied to explore the association of culture differences and adolescent health-promoting behaviors. RESULTS: Findings indicated significant differences between Taiwanese and American adolescents in some demographic characteristics: American participants had higher self-perceived health status (p<0.001), parental educational level (p<0.001), overweight percentage (p<0.001), and rate of living only with the mother (p<0.001) than the Taiwanese participants. Taiwanese adolescents had a higher frequency of health-promoting behavior than Americans in terms of healthy diet behavior, stress management, health responsibility, and social support (p<0.01), but less frequently engaged in exercise and life appreciation (p<0.001). Because many of the demographic characteristics between the two countries, such as the parent's educational level, differ significantly, a comparison can be difficult. However, healthy behavior is an important measure of demand for preventive health services. CONCLUSIONS: The findings should sound an alarm for all public health professionals to take heed of what is happening to our youth based on culture differences. School and family health promotion counseling should be encouraged for adolescents to improve their lifestyle habits. Based on the findings, school health promotion programs should focus on factors for which there may be significant local ethnic differences. For the locales in this study, Taiwanese adolescents need encouragement to improve their exercise and life appreciation behaviors. For American adolescents, healthy diet, stress management, health responsibility, and social support should be emphasized.

Irregular breakfast eating and health status among adolescents in Taiwan.

BACKGROUND: Regular breakfast eating (RBE) is an important contributor to a healthy lifestyle and health status. The aims of the present study were to evaluate the relationships among irregular breakfast eating (IRBE), health status, and health promoting behavior (HPB) for Taiwanese adolescents. METHODS: A cross-sectional, descriptive design was used to investigate a cluster sample of 1609 (7th-12th grade) adolescents located in the metropolitan Tao-Yuan area during the 2005 academic year. The main variables comprised breakfast eating pattern, body weight, and health promoting behaviors. Data were collected by a self-administered questionnaire. RESULTS: A total of 1609 participants were studied, 64.1% in junior high school and 35.9% in high school, boys (47.1%) and girls (52.9%) ranging in age from 12-20 years. Of the total participant population, 28.8% were overweight and nearly one quarter (23.6%) reported eating breakfast irregularly during schooldays. The findings indicated that adolescents with RBE had a lower risk of overweight (OR for IRBE vs. RBE = 1.51, 95% CI: 1.12, 2.04), and that the odds of becoming overweight were 51% greater for IRBE than for RBE even after controlling for demographical and HPB variables. IRBE also was a strong indicator for HPB. However, the profile of the high-risk IRBE group was predominantly junior high schoolchildren and/or children living without both parents. CONCLUSION: This study provides valuable information about irregular breakfast eating among adolescents, which is associated with being overweight and with a low frequency of health promoting behavior. School and family health promotion strategies should be used to encourage all adolescents to eat breakfast regularly.

Cross-validation and discriminant validity of Adolescent Health Promotion Scale among overweight and nonoverweight adolescents in Taiwan.

This study used cross-validation and discriminant analysis to evaluate the construct and discriminant validity of Adolescent Health Promotion (AHP) scale between the overweight and nonoverweight adolescents in Taiwan. A cross-sectional survey method was used and 660 adolescents participated in this study. Cluster and discriminant analyses were used to analyze the data. Our findings indicate that the AHP is a valid and reliable scale to discriminate between the health-promoting behaviors of overweight and nonoverweight adolescents. For the total scale, cluster analyses revealed two distinct patterns, which we designated the healthy and unhealthy groups. Discriminate analysis supported this clustering as having good discriminant validity, as nonoverweight adolescents tended to be classified as healthy, while the overweight tended to be in the unhealthy group. In general, overweight adolescents practiced health-related behaviors at a significantly lower frequency than the nonoverweight. These included exercise behavior, stress management, life appreciation, health responsibility, and social support. These findings can be used to further develop and refine knowledge of adolescent overweight and related strategies for intervention.

Adequate sleep among adolescents is positively associated with health status and health-related behaviors.

BACKGROUND: Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6-8 hours per night regularly) is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents. METHODS: A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior. RESULTS: A total of 656 boys (53.2%) and girls (46.8%), ranging in age from 13-18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54%) reported that they slept less than the suggested 6-8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1) life appreciation; (2) taking responsibility for health; (3) adopting healthy diet; (4) effective stress management; (5) regular exercise; and (6) total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS. CONCLUSION: These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate sleep may be a screening indicator for an unhealthy lifestyle and poor health status. The results might be useful for future research into the development of intervention strategies to assist adolescents who are not receiving enough hours of sleep.

Health-related behavior and adolescent mothers.

OBJECTIVE: To explore health-related behaviors among adolescent mothers living in the rural area of Taoyuan, Taiwan. DESIGN: A cross-sectional descriptive design and nonrandom survey method were used. SAMPLE: The sample consisted of 37 adolescent mothers, identified by public health nurses. MEASUREMENTS: Standardized interview and Adolescent Health Promotion (AHP) questionnaire. RESULTS: Findings revealed a pattern of economic disadvantage. Nearly half of the participants still lived with their biological parents. Two-thirds needed economic support from their parents (generally coming from their biological mother). Thirty-five percent of participants reported never using contraceptives, two-thirds had never had a Pap smear, and 44% did not breast-feed their infants. Nearly 60% of the children were cared for by the biological mothers of the participants. Adolescent mothers with high school education, and who were employed, married, and received parental economic support had better health-related behaviors than adolescent mothers without these characteristics. CONCLUSIONS: Although the study sample has geographic limitations, future international studies with similar populations of adolescent mothers in rural settings will help public health nurses understand adolescent mothers' stressors and needs which in turn affect their health-related behaviors. Intervention strategies are needed to encourage behaviors to keep this population healthy.

Increased expression of manganese-superoxide dismutase in fibroblasts of patients with CPEO syndrome.

Alterations in the expression of free radical scavenging enzymes and production of reactive oxygen species (ROS) in tissue cells may contribute to the pathogenesis of mitochondrial diseases such as chronic progressive external ophthalmoplegia (CPEO) syndrome. Since the mitochondria with impaired respiratory function in affected tissues generate more ROS via electron leakage, we examined the expression levels of free radical scavenging enzymes in primary culture of muscle fibroblasts of eight patients with CPEO syndrome. The results showed that the enzyme activity and protein levels of Mn-SOD of the fibroblasts from CPEO patients were significantly increased but those of Cu,Zn-SOD, catalase and glutathione peroxidase (GPx) were not increased compared with controls. A similar pattern was observed in the mRNA levels of Mn-SOD and GPx in muscle fibroblasts of all CPEO patients. The activity ratios of Mn-SOD/catalase and Mn-SOD/GPx in muscle fibroblasts of the CPEO patients were increased 1.7-3.4 and 1.8- to 5.3-fold, respectively, compared to those of the controls. Moreover, by using flow cytometry we found that the production of O2(*-) and H2O2 in the fibroblasts was about 2 times higher than those of controls. The 8-OHdG/dG ratios in total DNA of muscle biopsies from three CPEO patients were much higher than those of age-matched controls as determined by high performance liquid chromatography (HPLC). In the light of these findings, we suggest that the increase in expression of Mn-SOD, ROS production and oxidative damage in affected tissues may play an important role in the pathogenesis and progression of the CPEO syndrome.

Adolescent health promotion scale: development and psychometric testing.

The purpose of this study was to assess the psychometric properties of a newly devised instrument, the Adolescent Health Promotion scale (AHP), a 40-item Likert-type self-report instrument used to detect unhealthy lifestyles in adolescents. Content validity was considered to be supported based on the findings of previous studies and the observations of a panel of 14 content experts. This study examined the construct validity and reliability of the instrument. The psychometric properties of the AHP, including item analysis, factor analysis, and reliability measures, were assessed based on the responses of 1,128 Taiwanese adolescents. Kaiser-Meyer-Olkin (KMO) measures and Bartlett's sphericity test showed that the samples met the criteria for factor analysis. Factor analysis yielded a six-factor instrument that explained 51.14% of the variance in the 40 items. The six factors were social support, life appreciation, health responsibility, nutritional behaviors, exercise behaviors, and stress management. The Cronbach alpha reliability coefficient for the total scale was 0.932, and alpha coefficients for the subscales ranged from 0.75 to 0.88. The results of this study indicate that the AHP has good construct validity and reliability in Taiwanese and that its use by school health nurses to assess adolescent health promotion programs is warranted.