Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services

<p>Abstract</p> <p>Background</p> <p>The study attempted to explore the quality of life (QoL) of Chinese caregivers with mentally ill relatives. It also aimed to examine the differential roles of caregiving burdens, caregiver characteristics, and satisfaction with psychiatric services in caregivers' QoL.</p> <p>Methods</p> <p>276 caregivers with relatives attending community psychiatric facilities in Hong Kong were invited to fill out a questionnaire. One sample t-tests were conducted to compare the results of this study with that of other Chinese populations in Hong Kong, Taiwan, and mainland China. A hierarchical regression analysis was performed to examine the relative influence of different factors on caregivers' QoL.</p> <p>Results</p> <p>Our sample of caregivers had significantly lower QoL scores than other Chinese populations. Results also suggest that Chinese caregivers who had chronic illness, younger in age, a lower education level, experienced more difficulties in handling negative symptoms, and were more dissatisfied with mental health services had poorer quality of life. Indeed, caregiver characteristics displayed a much stronger association with caregivers' QoL than did caregiving burdens and satisfaction with psychiatric services.</p> <p>Conclusions</p> <p>This study supports the strong association of caregiver characteristics and the QoL of caregivers and establishes the nature of the relationship between satisfaction with mental health services and caregiver QoL. Implications for future research and practice are discussed.</p

Epidemiology and risk factors for Carbapenemase-Producing Enterobacteriaceae carriage in the hospital: a population-based nested case-control study

Objective: This study aims to study the epidemiology of Carbapenemase-producing Enterobacteriaceae (CPE) in Hong Kong. / Methods: This is a longitudinal population-based study reporting monthly CPE incidence rate and a nested case-control study for identifying risk factors for CPE carriage. The cases were patients with at least one CPE positive genotypic test, while the controls were randomly selected from the cohort with negative tests. Up to four controls per case were matched by sex, age group, and admission year-month. The independent risk factors were identified from a conditional logistic regression with potential covariates. / Results: From 1st January 2008 to 31st December 2019, 8,588 patients received CPE genotyping tests, and 2,353 had at least one positive result. Class B carbapenemase was the predominant enzyme in the samples (78.6%). The incidence rate increased from 0.04 in 2015 to 1.62 in 2019 per 10,000 person-year. In the nested case-control study, 1709 cases and 6664 controls were matched. Previous use of any beta-lactam antibiotics [Odds ratio:1.37 (1.22-1.53), p<.001] was found as an independent risk factor for carriage of CPE. / Conclusion: The carriage of CPE was found with an increasing trend in Hong Kong. Previous use of any beta-lactam antibiotics is a risk factor for CPE. / Summary: The incidence rate of Carbapenemase-producing Enterobacteriaceae is increasing in Hong Kong, with the predominant enzyme of class B carbapenemase. With multivariable conditional logistic regression, the previous use of any beta-lactam antibiotics was found as an independent risk factor for CPE carriage

Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services

Abstract Background: The study attempted to explore the quality of life (QoL) of Chinese caregivers with mentally ill relatives. It also aimed to examine the differential roles of caregiving burdens, caregiver characteristics, and satisfaction with psychiatric services in caregivers&apos; QoL. Methods: 276 caregivers with relatives attending community psychiatric facilities in Hong Kong were invited to fill out a questionnaire. One sample t-tests were conducted to compare the results of this study with that of other Chinese populations in Hong Kong, Taiwan, and mainland China. A hierarchical regression analysis was performed to examine the relative influence of different factors on caregivers&apos; QoL. Results: Our sample of caregivers had significantly lower QoL scores than other Chinese populations. Results also suggest that Chinese caregivers who had chronic illness, younger in age, a lower education level, experienced more difficulties in handling negative symptoms, and were more dissatisfied with mental health services had poorer quality of life. Indeed, caregiver characteristics displayed a much stronger association with caregivers&apos; QoL than did caregiving burdens and satisfaction with psychiatric services. Conclusions: This study supports the strong association of caregiver characteristics and the QoL of caregivers and establishes the nature of the relationship between satisfaction with mental health services and caregiver QoL. Implications for future research and practice are discussed

Recurrent hungry bone syndrome in a kidney transplant recipient with a history of parathyroidectomy: A case report

Background: The hungry bone syndrome (HBS) is a well described phenomenon occurring shortly after parathyroidectomy characterized by rapid bone formation with concomitant hypocalcemia, hypophosphatemia and hypomagnesemia requiring intensive management. Recurrent HBS occurring in isolation from parathyroidectomy has not been reported.Case presentation: We describe a case of recurrent HBS in a kidney transplant recipient (KTR) developing years after parathyroidectomy. The KTR was a 49 year-old lady who had undergone successful total parathyroidectomy without re-implantation 14 years prior and cadaveric kidney transplantation 12 years prior. She had a stable creatinine level of 220μmol/L and an estimated glomerular filtration rate (eGFR) of 20 mL/min-1.73m2. She presented to us with severe hypercalcemia, likely a result of excessive calcium and vitamin D supplementation, and acute kidney injury. Serum creatinine, calcium, phosphate, magnesium, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) levels on admission were 743μmol/L, 4.8 mmol/L, 1.8 mmol/L, 0.75 mmol/L, 48IU/L and <0.1 pmol/L, respectively. Vigorous intravenous fluids were given in addition to withdrawal of calcium carbonate and calcitriol. Clinical improvement was evident with falling serum creatinine and calcium levels. However, this was followed 2–3 days after admission by an unexplained rise in ALP from a baseline of 48IU/L to a peak level of 1150IU/L over the next week, accompanied by the development of severe hypocalcemia, hypomagnesemia and a persistent drop in phosphate levels. The patient required large doses of calcium carbonate, calcitriol and magnesium lactate to maintain blood mineral levels. The ALP progressively decreased subsequently and the serum levels of calcium, phosphate and magnesium began to stabilize in the next 2–3 weeks.Conclusion: Recurrent HBS can occur years after parathyroidectomy in KTRs. We hypothesize that hypercalcemia and its rapid correction might have been the trigger in this particular patient. The mechanism is not well understood but might involve bone remodeling pathways that are independent of parathyroid hormone

Treatment of Severe Tumoral Calcinosis with Teriparatide in a Dialysis Patient after Total Parathyroidectomy

Tumoral calcinosis is a rare but debilitating condition that can affect dialysis patients. Optimal management is largely unknown. We report the clinical course, treatment, and outcome of a peritoneal dialysis (PD) patient who developed tumoral calcinosis refractory to conventional treatment but improved with teriparatide therapy. A 26-year-old lady on PD for 2 years presented to us with tumoral calcinosis involving bilateral hands. Response to surgical excision, parathyroidectomy, and conversion to hemodialysis failed to result in sustained remission, and tumoral calcinosis progressed. After total parathyroidectomy, the patient had transient but partial remission in which her calcinosis deposits remained but were asymptomatic without pain or clinical signs of inflammation. However, she later experienced a relapse with involvement of the left elbow, right shoulder, right hip, and right thigh. Tumoral calcinosis remained uncontrolled resulting in debilitation, likely attributable to poor calcium and phosphate control because of adynamic bone disease after parathyroidectomy despite treatment of superimposed tuberculosis and therapy with sodium thiosulphate and pamidronic acid. Clinical improvement was however evident after the use of teriparatide. Asymptomatic hypocalcemia occurred after teriparatide therapy but resolved after 2 months. In conclusion, teriparatide appears to be useful for treating tumoral calcinosis in the presence of adynamic bone disease. Hypocalcemia can occur in the initial months of therapy

Outcomes of Renal Transplantation in Elderly Patients: Experience From Two Centers

BackgroundElderly patients are the fastest growing age group in end-stage renal failure. Data from overseas show that transplantation is a safe and reliable mode of treatment for this group of patients. However, local data about the outcome in these patients are lacking. The aim of this study was to determine and compare the outcomes of renal transplantation among elderly recipients and younger recipients.MethodsUsing the Organ Registry and Transplant System in Kwong Wah Hospital and Princess Margaret Hospital, adult patients who had undergone renal transplantation and who had been followed-up by the two medical units were recruited. They were divided into the control group (age < 60) and the elderly group (age ≥ 60) according to age at transplantation. The following data were collected for cross-sectional analysis: comorbid illnesses, transplantation details, immunosuppressive therapy, incidence and severity of acute rejections, incidence of infection and malignancy, graft and patient survival, and causes of graft loss and death.ResultsA total of 324 episodes of transplantation were recorded (266 controls and 58 elderly). The incidence of acute rejection was higher in the control group (18% vs. 8.6%, p = 0.08). There was a trend towards higher incidence of infection and malignancy in the elderly group, though the difference did not reach statistical significance. The graft survival rate was similar in the two groups, while the 5-year patient survival rate was worse in the elderly group (92.1% vs. 79.3%, p = 0.0058).ConclusionThe transplantation outcomes in elderly recipients are satisfactory, and age per se should not be considered a contraindication to transplantation

Epidemiology and risk factors for carbapenemase-producing Enterobacteriaceae carriage in the hospital: A population-based nested case-control study

ABSTRACT: Objectives: This study aims to study the epidemiology of carbapenemase-producing Enterobacteriaceae (CPE) in Hong Kong. Methods: This is a longitudinal population-based study reporting monthly CPE incidence rate and a nested case-control study for identifying risk factors for CPE carriage. The cases were patients with at least one CPE-positive genotypic test, while the controls were randomly selected from the cohort with negative tests. Up to four controls per case were matched by sex, age group, and admission year-month. The independent risk factors were identified from a conditional logistic regression with potential covariates. Results: From 1 January 2008 to 31 December 2019, 8588 patients received CPE genotyping tests, and 2353 had at least one positive result. Class B carbapenemase was the predominant enzyme in the samples (78.6%). The incidence rate increased from 0.04 in 2015 to 1.62 in 2019 per 10,000 person-year. In the nested case-control study, 1709 cases and 6664 controls were matched. Previous use of any beta-lactam antibiotics (odds ratio:1.37 [1.22–1.53], P < 0.001) was found as an independent risk factor for carriage of CPE. Conclusion: The carriage of CPE was found with an increasing trend in Hong Kong. Previous use of any beta-lactam antibiotics is a risk factor for CPE

Development of a Novel, Genome Subtraction-Derived, SARS-CoV-2-Specific COVID-19-nsp2 Real-Time RT-PCR Assay and Its Evaluation Using Clinical Specimens

The pandemic novel coronavirus infection, Coronavirus Disease 2019 (COVID-19), has affected at least 190 countries or territories, with 465,915 confirmed cases and 21,031 deaths. In a containment-based strategy, rapid, sensitive and specific testing is important in epidemiological control and clinical management. Using 96 SARS-CoV-2 and 104 non-SARS-CoV-2 coronavirus genomes and our in-house program, GolayMetaMiner, four specific regions longer than 50 nucleotides in the SARS-CoV-2 genome were identified. Primers were designed to target the longest and previously untargeted nsp2 region and optimized as a probe-free real-time reverse transcription-polymerase chain reaction (RT-PCR) assay. The new COVID-19-nsp2 assay had a limit of detection (LOD) of 1.8 TCID50/mL and did not amplify other human-pathogenic coronaviruses and respiratory viruses. Assay reproducibility in terms of cycle threshold (Cp) values was satisfactory, with the total imprecision (% CV) values well below 5%. Evaluation of the new assay using 59 clinical specimens from 14 confirmed cases showed 100% concordance with our previously developed COVID-19-RdRp/Hel reference assay. A rapid, sensitive, SARS-CoV-2-specific real-time RT-PCR assay, COVID-19-nsp2, was developed