120 research outputs found
Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c
BACKGROUND: although type 2 diabetes increases risk of dementia by 2-fold, whether optimizing glycemic level in late life can reduce risk of dementia remains uncertain. We examined if achieving the glycemic goal recommended by the American Diabetes Association (ADA) within a year was associated with lower risk of dementia in 6Â years. METHODS: in this population-based observational study, we examined 2246 community-living dementia-free Chinese older adults with type 2 diabetes who attended the Elderly Health Centres in Hong Kong at baseline and followed their HbA1c level and cognitive status for 6Â years. In line with the ADA recommendation, we defined the glycemic goal as HbA1câ<â7.5%. The study outcome was incident dementia in 6Â years, diagnosed according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Clinical Dementia Rating of 1-3. RESULTS: those with HbA1cââ„â7.5% at baseline and HbA1câ<â7.5% in 1Â year were associated with higher rather than lower incidence of dementia, independent of severe hypoglycemia, glycemic variability and other health factors. Sensitivity analyses showed that a relative reduction of â„10%, but not 5-10%, in HbA1c within a year was associated with higher incidence of dementia in those with high (â„8%) and moderate (6.5-7.9%) HbA1c at baseline. CONCLUSION: a large reduction in HbA1c could be a potential predictor and possibly a risk factor for dementia in older adults with type 2 diabetes. Our findings suggest that optimizing or intensifying glycemic control in this population requires caution
Risk of incident dementia varies with different onset and courses of depression
Background: This study aims to examine if risk of dementia differs between adult- and late-onset depression.
Methods: 16,608 community-living dementia-free older adults were followed for 6 years to the outcome of
incident dementia. Depression was diagnosed according to international diagnostic guidelines. Depression in
adulthood or late life was categorized using age 65 as cutoff. Hazard ratio for dementia was estimated using Cox
regression analysis.
Results: People with depression in adulthood only did not have higher dementia incidence, suggesting those in
remission from adult-onset depression are not at greater risk of dementia. Conversely, having depression in both
adulthood and late life was associated with higher dementia risk, and improvement in depression in late life was
associated with lower risk, suggesting persistent or recurrent lifetime depression is a risk factor for dementia.
Those with depression in late life only were not associated with higher dementia risk after controlling for the
longitudinal changes in depressive symptoms, consistent with late-onset depression being a prodrome of
dementia.
Limitations: Reverse causation is a potential limitation. This was minimized by careful ascertainment of
depression and dementia cases, exclusion of individuals with suspected dementia at baseline and those who
developed dementia within 3 years after baseline, and controlling for various important confounders.
Conclusions: Risk of incident dementia varies with presence and resolution of depression at different ages. Further
studies are needed to test whether treating adult-onset depression may prevent dementia. Older adults with a
history of depression present for an extended time should be monitored for cognitive decline
Physical health and lifestyle predictors for significant cognitive impairment in community-dwelling Chinese older adults in Hong Kong
published_or_final_versio
Association between vascular risk factors and incident significant cognitive impairment in Chinese older people in Hong Kong in a six-year study
Objective: This study aimed to examine the association
between vascular risk factors, namely hypertension, diabetes
mellitus and hypercholesterolemia, and incident significant
cognitive impairment in community-dwelling Chinese older
people in Hong Kong.
Methods: Community-dwelling Chinese older people
aged 65 years and above who attended Nam Shan Elderly
Health Centre in 2005 with no history of dementia or
stroke constituted the baseline sample. Retrospective
data retrieval for the presence of vascular risk factors at
baseline was conducted. Annual clinical assessment on
cognition was offered in the 6-year study period. Significant
cognitive impairment was defined by presence of dementia
in accordance with DSM-IV-TR, scoring below the cut-off
point on the Cantonese version of the Mini-Mental State
Examination, and / or a global Clinical Dementia Rating
score of 1-3.
Results: A total of 1925 subjects were recruited into our
study; 161 (8.4%) subjects developed significant cognitive
impairment in the 6-year study period. Subjects with incident
significant cognitive impairment was older (75 vs. 73 years;
Mann-Whitney U test, p < 0.001) with lower education
attainment (30.4% vs. 23.9% of illiteracy; Ï2 test, p = 0.06).
However, there was no statistically significant difference
in the point prevalence of pre-existing hypertension (Ï2
test, p = 0.68), diabetes mellitus (Ï2 test, p = 0.21), and
hypercholesterolemia (Ï2 test, p = 0.31) between subjects
who developed significant cognitive impairment and those
who remained cognitively stable. Interestingly, baseline
pulse pressure, but not systolic or diastolic blood pressure,
was found to be higher among subjects with incident
significant cognitive impairment (70 mm Hg vs. 66 mm Hg;
Mann-Whitney U test, p = 0.03).
Conclusions: This study did not have evidence to show that
hypertension, diabetes mellitus, and hypercholesterolemia
were associated with incident significant cognitive
impairment in the Chinese older people in Hong Kong.
Further studies are needed to examine the role of pulse
pressure in contributing to cognitive decline in late life.published_or_final_versio
The Hong Kong mental morbidity survey: background and study design
Mental disorders are highly prevalent conditions with immense disease burden. To inform health
and social services policy formulation, local psychiatric epidemiological data are required. The Hong
Kong Mental Morbidity Survey is a 3-year population-based study in which 5700 community-dwelling
Chinese adults aged between 16 and 75 years were interviewed with the aim of evaluating the prevalence, co-morbidity, functional impairment, physical morbidity, and social determinants of significant mental disorders in the population. This paper describes the background and design of the survey, and is the first territory-wide psychiatric epidemiological study in Hong Kong.
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Measuring and Valuing Health-Related Quality of Life among Children and Adolescents in Mainland China - A Pilot Study
Background: The Child Health Utility 9D (CHU9D), a new generic preference-based health-related quality of life (HRQoL)
instrument, has been validated for use in young people in both the UK and Australia. The main objectives of this study were
to examine the feasibility of using a Chinese version of the CHU9D (CHU9D-CHN) to assess HRQoL and to investigate the
association of physical activity, homework hours and sleep duration with HRQoL in children and adolescents in Mainland
China.
Methods: Data were collected using a multi-stage sampling method from grades 4â12 students in May 2013 in Nanjing,
China. Consenting participants (N = 815) completed a self-administered questionnaire including the CHU9D-CHN instrument
and information on physical activity, homework and sleep duration, self-reported health status, and socio-demographic
characteristics. Descriptive and multivariate linear regression analyses were undertaken. CHU9D-CHN utility scores were
generated by employing two scoring algorithms currently available for the instrument, the first derived from UK adults
utilising the standard gamble (SG) valuation method and the second derived from Australian adolescents utilising the bestworst
scaling (BWS) method.
Results: It was found that CHU9D utility scores discriminated well in relation to self-reported health status and that better
health status was significantly associated with higher utility scores regardless of which scoring algorithm was employed
(both p,0.001). The adjusted mean utilities were significantly higher for physically active than inactive students (0.023 by
SG, 0.029 by BWS scoring methods, p,0.05). An additional hour of doing homework and sleep duration were, separately,
associated with mean utilities of 20.019 and 0.032 based on SG, and 20.021 and 0.040 according to BWS scoring algorithms
(p,0.01).
Conclusion: The CHU9D-CHN shows promise for measuring and valuing the HRQoL of children and adolescents in China.
Levels of self-reported physical activity, homework and sleep time were important influencers of utility scores
Suicide among adults aged 30â49: A psychological autopsy study in Hong Kong
<p>Abstract</p> <p>Background</p> <p>A surge in suicide rates in middle age people in Hong Kong and many Asian countries was recently observed. However, there is a paucity of suicide research on this subgroup of people in Asia.</p> <p>Methods</p> <p>The next-of-kin of 85 suicide cases and 85 community subjects aged 30â49 years were interviewed by a psychological autopsy approach. Information was triangulated by interview notes, coroner's court files, and police investigation reports.</p> <p>Results</p> <p>A multiple logistic regression analysis identified the following risk factors for suicide among the middle age people in Hong Kong: the presence of at least one psychiatric disorder (OR = 37.5, 95% CI 11.5â121.9, p < 0.001), indebtedness (OR = 9.4, 95% CI 2.2â40.8, p < 0.01), unemployment (OR = 4.8, 95% CI 1.3â17.5, p < 0.05), never married (OR = 4.2, 95% CI 1.1â16.3, p < 0.05), and lived alone (OR = 3.9, 95% CI 1.2â13.4, p < 0.05).</p> <p>Conclusion</p> <p>The data show that socio-economical factors had a strong impact on suicide in the target group. Further research is needed to explore any positive qualities that protect the middle-aged from suicide. The prevention of suicide in the middle-aged requires multiple strategies.</p
Systematic Review of Potential Health Risks Posed by Pharmaceutical, Occupational and Consumer Exposures to Metallic and Nanoscale Aluminum, Aluminum Oxides, Aluminum Hydroxide and Its Soluble Salts
Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007).
Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of âtotal Alâassumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold.
The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al+ 3 to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)+ 2 and Al(H2O)6 + 3] that after complexation with O2âąâ, generate Al superoxides [Al(O2âą)](H2O5)]+ 2. Semireduced AlO2âą radicals deplete mitochondrial Fe and promote generation of H2O2, O2 âą â and OHâą. Thus, it is the Al+ 3-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates.
Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer\u27s disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants.
The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances
Comparing recruitment, retention, and safety reporting among geographic regions in multinational Alzheimerâs disease clinical trials
INTRODUCTION: Most Alzheimerâs disease (AD) clinical trials enroll participants multinationally. Yet, few data exist to guide investigators and sponsors regarding the types of patients enrolled in these studies and whether participant characteristics vary by region. METHODS: We used data derived from four multinational phase III trials in mild to moderate AD to examine whether regional differences exist with regard to participant demographics, safety reporting, and baseline scores on the Mini Mental State Examination (MMSE), the 11-item Alzheimerâs Disease Assessment ScaleâCognitive subscale (ADAS-cog11), the Clinical Dementia Rating scale Sum of Boxes (CDR-SB), the Alzheimerâs Disease Cooperative StudyâActivities of Daily Living Inventory (ADCS-ADL), and the Neuropsychiatric Inventory (NPI). We assigned 31 participating nations to 7 geographic regions: North America, South America/Mexico, Western Europe/Israel, Eastern Europe/Russia, Australia/South Africa, Asia, and Japan. RESULTS: North America, Western Europe/Israel, and Australia/South Africa enrolled similar proportions of men, apolipoprotein E Δ4 carriers, and participants with spouse study partners, whereas Asia, Eastern Europe/Russia, and South America/Mexico had lower proportions for these variables. North America and South America/Mexico enrolled older subjects, whereas Asia and South America/Mexico enrolled less-educated participants than the remaining regions. Approved AD therapy use differed among regions (range: 73% to 92%) and was highest in North America, Western Europe/Israel, and Japan. Dual therapy was most frequent in North America (48%). On the MMSE, North America, Western Europe/Israel, Japan, and Australia/South Africa had higher (better) scores, and Asia, South America/Mexico, and Eastern Europe/Russia had lower scores. Eastern Europe/Russia had more impaired ADAS-cog11 scores than all other regions. Eastern Europe/Russia and South America/Mexico had more impaired scores for the ADCS-ADL and the CDR-SB. Mean scores for the CDR-SB in Asia were milder than all regions except Japan. NPI scores were lower in Asia and Japan than in all other regions. Participants in North America and Western Europe/Israel reported more adverse events than those in Eastern Europe/Russia and Japan. CONCLUSIONS: These findings suggest that trial populations differ across geographic regions on most baseline characteristics and that multinational enrollment is associated with sample heterogeneity. The data provide initial guidance with regard to the regional differences that contribute to this heterogeneity and are important to consider when planning global trials
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