I-Shou University

Truth-telling in pediatric oncology remains challenging, and school-aged children's perspectives are seldom directly examined. This study explored diagnostic disclosure experiences and perceived communication preferences among school-aged children with acute lymphoblastic leukemia (ALL).

This study employed a descriptive phenomenological design. Data were collected between August 2019 and May 2020 through semi-structured individual interviews with 15 school-aged children diagnosed with ALL. Interviews were analyzed using Colaizzi's method to identify emerging themes.

Two primary themes were identified: (1) "Vague understanding of illness," reflecting children's experiences of limited or indirect disclosure within a parent-centered communication culture, intuitive awareness, and ambivalence about knowing; and (2) "Children's preferences for child-centered truth-telling," describing children's expressed preferences for information that aligned with their readiness, supported self-care, and was communicated in clear, gentle, and age-appropriate ways.

These findings should be understood as context-specific and exploratory, reflecting school-aged children's perspectives on diagnostic disclosure within a family-centered cultural context.

These findings may inform pediatric healthcare professionals about children's perspectives on diagnostic disclosure and underscore the relevance of developmentally sensitive, child-inclusive communication approaches in pediatric oncology care.

Previous studies reported higher suicide mortality in severe autoimmune diseases (SADs). However, few studies have comprehensively assessed the suicide mortality and accidental mortality across different types of SADs and their associations with comorbid psychiatric disorders.

We utilised the nationwide database of Taiwan from 2003 to 2017, linked with the National Death Registry, to identify 1,164,960 individuals, including 232,992 patients with SADs and 931,968 matched controls. Cox-regression was used to estimate the risks of suicide and accidental mortalities. Subgroup analyses were conducted based on sex, ten specific SAD types, and eight psychiatric comorbidities.

Patients with SAD had a 1.54-fold increased risk of suicide mortality (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.36-1.74) compared to controls. Specifically, individuals with systemic lupus erythematosus (2.04; 1.47-2.83), rheumatoid arthritis (1.57; 1.25-1.96), and Sjögren's syndrome (2.32; 1.69-3.18) exhibited higher suicide mortality compared to the controls. The suicide mortality was further higher among SAD individuals with psychiatric comorbidities, including schizophrenia (2.82; 1.94-4.10), major depressive disorder (4.44; 3.79-5.20), and substance use disorder (2.59; 1.74-3.87). Among female patients, comorbid major depressive disorder (5.15; 4.16-6.39), alcohol use disorder (5.17; 2.61-10.24), and substance use disorder (4.50; 2.53-7.99) showed approximately 5-fold increased risk of suicide mortality compared to the controls.

These findings suggest that patients with SADs are at significantly higher risk of suicide, particularly when psychiatric disorders are present. Routine mental health screening and integrated care may be critical in reducing suicide risk in this vulnerable population.

Despite industrialization and advances in healthcare, the prevalence of inflammatory bowel disease (IBD), which encompasses Crohn's disease (CD) and ulcerative colitis (UC), is increasing in Taiwan. Population-based studies can estimate the incidence or prevalence of IBD; however, there is a lack of information regarding the disease phenotype. Therefore, this study was designed to investigate the epidemiologic trends of IBD in Taiwan to gain a more comprehensive understanding.

Patient data were reviewed from a prospectively registered study by the Taiwan Society of IBD (TSIBD).

We collected data from 2752 patients with IBD, of whom 881 had CD and 1871 had UC. Their average age was 41.99 ± 15.19 years. The CD group had more male patients than the UC group (67.88% vs. 60.72%; p < .001). The rates of appendectomy, bowel resection, and surgery for perianal disease before IBD diagnosis, along with the increased use of steroids, immunomodulators, and biologics, were higher in the CD group. From 2005 to 2023, the ratio of UC to CD cases in Taiwan decreased, the proportions of patients with colonic and penetrating CD also declined, and the proportion of patients with UC exhibiting ulcerative proctitis increased.

In Taiwan, similar to high-income countries, the ratio of UC to CD cases has declined. The reduced of colonic and penetrating CD indicates that diagnostic awareness has improved and colonoscopic examination has become more comprehensive in Taiwan.