Prevalence, correlates, and risk perception of HIV infection among heroin users in Central Taiwan.

We investigated the prevalence and correlated factors of human immunodeficiency virus (HIV) among heroin users attending methadone maintenance treatment (MMT) programs in Central Taiwan, and explored the degree of risk perception of HIV infection among the participants. Our study participants were 781 heroin users seeking treatment at the MMT program at Tsaotun Psychiatric Center in Taiwan. The presence of HIV antibodies was identified by microparticle enzyme immunoassay and confirmed by western blot. Multivariate logistic regression was used to identify the independent correlates of HIV infection. The mean age of the sample was 36.1 years [standard deviation (SD) = 7.6]; of the patients, 710 (90.9%) were men. The prevalence of HIV infection among our study population was 20.7%. Multivariate logistic regression analysis revealed that HIV infection was independently associated with the age of the patients of initial heroin use, heroin injection use, nondrug-related criminal convictions, needle-sharing behaviors, and sharing injection paraphernalia. A strong agreement existed between self-reported HIV serostatus and the results of laboratory analyses, with 88.8% of patients reporting their condition correctly. We found a high rate of HIV infection among patients in the MMT program. Factors associated with HIV infection were mostly related to drug-use behaviors. These findings stress the importance of education regarding drug-risk behaviors.

Chronic obstructive pulmonary disease: a risk factor for type 2 diabetes: a nationwide population-based study.

BACKGROUND: Type 2 diabetes mellitus (DM) is a common medical disorder and a leading cause of morbidity and mortality worldwide. We investigated whether chronic obstructive pulmonary disease (COPD) was the risk factor for type 2 diabetes in an Asian population. MATERIALS AND METHODS: From Taiwan's National Health Insurance Research Database, we collected data from 16,088 patients, including 8044 COPD patients and 8044 age- and gender- matched control subjects. Cox proportional hazard regression was performed to evaluate independent risk factors for type 2 diabetes in all patients and identify risk factors in patients with COPD. RESULTS: During the 5.5-year follow-up, patients with COPD were found to have a significantly higher rate of incident type 2 diabetes than the control group (P < 0.001). COPD was significantly associated with type 2 diabetes hazard ratio (HR : 1.41, 1.23-1.63, P < 0.001) after adjusting sex, age, residential area, insurance premium, steroid use, hypertriglycemia, hypertension, coronary artery disease (CAD) and cerebrovascular disease. Cox regression analysis showed that hypertension (HR : 1.55, 1.33-1.80, P < 0.001) and hypertriglycemia (HR : 1.48, 1.15-1.90, P = 0.002) were important risk factors for type 2 diabetes in patients with COPD. CONCLUSIONS: Patients with COPD have a higher risk of type 2 diabetes compared with control subjects after adjusting for confounding factors such as sex, age, residential area, insurance premium, steroid use, hypertriglycemia, hypertension, CAD and cerebrovascular disease. Continuous surveillance of signals of dysglycemia may be incorporated into care programmes for patients with COPD.

Suicide and other-cause mortality among heroin users in Taiwan: a prospective study.

AIMS: The present study investigates one-year incidence of mortality from suicide and other causes among heroin users in Taiwan. DESIGN: A prospective national register-based cohort study. SETTING: All heroin users who attended the methadone maintenance treatment (MMT) programs in all treatment centers in Taiwan. PARTICIPANTS: The sample comprised 10,842 heroin users attending MMT. Between Jan 2006 and Dec 2007, cases were identified through the multiple-center register system and followed until Dec 2008 for date and cause of death on the Taiwan national mortality database. MEASUREMENTS: Standardized mortality ratios within one year of starting MMT were calculated as a ratio of actual versus expected numbers of deaths in the general population in Taiwan. Cox regression models were fitted to estimate the effects of gender, age, education and marital status as well as heroin related behaviors. FINDINGS: In total, 256 cases died, 67 through suicide. The mortality rate (per 100 person-years) in the first year of all-cause and suicide was 1.71 and 0.45 respectively, representing 7.5- and 18.4-fold age- and gender-standardized mortality ratio (SMR) compared to the general population. Besides, the mortality rate in the first year of overdoses, murder, HIV, somatic was 0.19, 0.02, 0.07, and 0.75 respectively, representing 68.4-, 27.7-, 76.8-, and 4.3-fold SMR increases to the general population. Older age and unemployment were independent risk factors for mortality. Females had higher standardized mortality ratio than males for suicide and all-cause mortality. CONCLUSIONS: Results showed higher risk of suicide and other-cause mortality among heroin users in MMT than general population. Suicide is an important contributor to overall excess mortality among heroin users in MMT, and especially among women. Suicide prevention and physical health monitoring are important components of MMT programs.

Risk and predictors of suicide and non-suicide mortality following non-fatal self-harm in Northern Taiwan.

OBJECTIVE: To investigate the risk and predictors of suicide and non-suicide mortality after self-harm in a Taiwanese population. METHOD: Between July 2006 and June 2008, 3,299 individuals who harmed themselves were recruited to a population-based self-harm register in Taoyuan County, Taiwan. They were followed until December 2008, with record linkage for date and cause of death in a national mortality database. RESULTS: In total, 115 individuals died, 52 through suicide. The risks of suicide and non-suicide mortality in the first year were 1.5 and 2.2%, respectively, representing an approximately 75-fold and 5-fold age- and gender-standardized increase compared with the general population in Taiwan. Male gender, rural residence, more lethal methods of self-harm and self-cited stressors for the index self-harm episode (unemployment, and chronic somatic illness) were independent risk factors for suicide mortality. Male gender, older age, rural residence and more lethal methods of self-harm were also independent risk factors for non-suicide mortality. The association between of unemployment as a cited reason for self-harm and later suicide was strongest in men and in those aged more than 45 years. CONCLUSIONS: Relatively high rates of suicide and non-suicide mortality were found following self-harm. Suicide prevention needs to take into account of risk factors for fatal repetition of self-harm.

Mortality and suicide after self-harm: community cohort study in Taiwan.

BACKGROUND: Little is known about outcomes after self-harm in East Asia. AIMS: To investigate mortality after self-harm in a Taiwanese population. METHOD: Between 2000 and 2003, 1083 individuals who self-harmed were identified through a population self-harm register in Nantou County, Taiwan, and followed until 2007 for date and cause of death on a national mortality database. RESULTS: In total, 145 individuals died, 48 through suicide. The risks of all-cause and suicide mortality in the first year were 4.7% and 2.1% respectively, representing 8- and 131-fold age- and gender-standardised increases. Male gender and older age were independent risk factors for both suicide and non-suicide mortality. Use of more lethal methods in the index episode was associated with higher mortality but this was accounted for by gender. CONCLUSIONS: Results in this sample support the recommendation that people with a history of recent self-harm should be a major target for suicide prevention programmes.

Development of a Chinese version of the Suicide Intent Scale.

This study established the psychometric properties of the Chinese version of the Suicide Intent Scale (SIS) in a clinic- and community-based sample of 36 patients and 592 respondents, respectively. Results showed that the Chinese SIS demonstrated good inter-rater and test-retest reliability. Factor analysis generated three factors (Precautions, Planning, and Seriousness) explaining 92.9% of the total variance with high internal consistency. It was moderately correlated with depressive symptoms. Results suggest that the Chinese SIS is a reliable and valid instrument for use in assessing the extent of suicidal intention among subjects with deliberate self-harm in ethnic Chinese populations.

The influence of media reporting of the suicide of a celebrity on suicide rates: a population-based study.

BACKGROUND: The impact of media reporting of suicides of entertainment celebrities may affect suicide rates due to an imitation effect. We investigated the impact on suicides of the media reporting of the suicide of a male television celebrity. METHODS: All suicides during 2003-2005 in Taiwan (n = 10,945) were included in this study. A Poisson time series autoregression analysis was conducted to examine whether there was an increase in suicides during the 4-week period after extensive media reporting of the celebrity suicide. RESULTS: After controlling for seasonal variation, calendar year, temperature, humidity and unemployment rate, there was a marked increase in the number of suicides during the 4-week period after media reporting (relative risk = 1.17, 95% CI 1.04-1.31). The increase was in men (relative risk = 1.30, 95% CI 1.14-1.50) and for the individuals using the same highly lethal method (hanging) as the TV actor did (relative risk = 1.51, 95% CI 1.25-1.83). However, the age groups in which the increase occurred were younger than the age of the celebrity. CONCLUSIONS: The extensive media reporting of the celebrity suicide was followed by an increase in suicides with a strong implication of a modelling effect. The results provide further support for the need for more restrained reporting of suicides as part of suicide prevention strategies to decrease the imitation effect.