「認知障礙症照顧者的需要及社會支援」研究 = Study on the needs and social support of caregivers for people with dementia

香港認知障礙症(dementia)患者個案持續上升，他們大都在接受家庭成員的照顧。本研究旨在了解照顧者面對的困難及在福利服務制度以外獲得甚麼非正規支援(informal support)以協助他們應付有增無減的照顧工作。研究團隊以半結構性訪談(semi-structured interview)的方法，與18位非正規照顧者(informal caregivers)及20位服務提供者(service providers)進行深入訪談。研究發現照顧者面對的困難包括欠缺私人空間、因健康狀況差而難以獨自應付照顧工作、照顧開支帶來沉重的經濟負擔，以及照顧工作造成的心理及人際關係問題。研究結果顯示因應照顧者身處的人際網絡，他們獲得分別來自兄弟姊妹、子女、朋友、鄰里、教友、教會同工或大廈保安員提供不同的非正規支援。他們除了為照顧者提供情感支持外，也分擔了部份的照顧工作，讓照顧者得以「喘息」。部份人士更協助照顧者處理家居問題及應對突發事件，是獨力或年長的照顧者之重要支援者。研究亦發現，除了部份家人能夠分擔患者的起居生活照顧外，其他非正規支援的提供者只能提供周邊工作的支援、情感支持、以及危機應對。主要的起居生活照顧工作，仍由主要的照顧者承擔。研究團隊建議擴大照顧者津貼計劃的對象及提高津貼金額，並加強支援照顧者的服務，包括推行「長者社區保姆」及「家庭托顧」服務、加強宣傳及改善照顧者身心健康的支援服務及、為患者家人提供家庭輔導。此外，研究團隊建議提供培訓給支援人士及團體以增加對認知障礙症患者及其照顧者需要的知識及技巧，透過這些正規服務的承托，寶貴的社會資本可繼續累積及發揮社區互助精神

香港鄉村地區長者居家養老的需要：錦田例案報告 = The needs of ageing in place in rural Hong Kong: The case of Kam Tin

香港面臨人口高齡化，政府統計處（2020）估計65 歲或以上人口會由2019年的120萬增加至2039年252 萬。長者佔總人口比例亦由18.4%上升至33.3%；而老年撫養比率（65 歲及以上人口相對每千名15 至64 歲人口的比率）將由249大幅上升至508。這意味着社會在撫養和照顧長者, 將會面對更大的壓力。另外，老年家庭人口亦不斷增加, 家庭所有成員均為長者的數目從2006年大約18萬上升至2016年超過30萬（增長67.4%）；獨居長者佔長者人口的比例亦由11.6%上升至13.1% （政府統計處，2018）。面對人口老化﹑雙老及獨居家庭等問題，社區需要有更全面的支持配套，才能使長者有良好的生活質素。 香港「社區照顧」（community care）政策源於政府於1977年發佈的《老人服務綠皮書》，強調居家安老為服務原則。該綠皮書（政府社會事務科，1977，頁5）指出，在社會及財政上而言，最可行的辦法就是提供適當的社會服務以幫助老年人能繼續與社會接觸在一起…當一個家庭在照顧老年人方面感到吃力時，政府便提供各種服務作爲對家庭一種的支持和協助。使老年人能繼續在家庭生活。 儘管政府一直強調「居家安老為本，院舍照顧為後援」，但多年來的資源分佈仍是以院舍照顧服務佔較大比例 （香港政策研究所，2017；羅致光，2018）。政府近年開始作出規劃上的調整，安老事務委員會（2017）於2017年發佈《安老服務計劃方案》建議加大社區照顧服務的比例，將社區照顧服務及院舍照顧服務的名額比率 由2016 年的1:1.3 加大至2031年的1:1.1（安老事務委員會，2017；羅致光， 2018）。因此, 加強「居家安老」政策，將會是政府其中一個安老服務規劃方向。 雖然政府及不同的社福機構在「居家安老」方面都有提供長者服務，但服務主要仍集中在城市，居住鄉村的長者因缺乏資源和渠道，較難得到協助。以居於元朗錦田 的長者為例，公營長者日間護理服務單位，全部位於元朗、天水圍或朗屏市區（社會福利署，2021），與他們的住處有一段距離。此外，針對鄉郊長者情況的「居家安老」服務規劃，亦未有在《安老服務計劃方案》中提及。因此, 本研究選取錦田區的長者作為主要訪談對象, 以了解鄉郊長者的「居家安老」情況。 錦田有悠久歷史，為最早來港定居的鄧氏族人居住地，有相當豐富的歷史建築群（陳天權，2016）。錦田面積龐大，近年開始規劃的錦田南和錦田北，佔地約1,400 公頃 （政府新聞公報，2014），佔元朗區14,430 公頃約一成面積，但人口只有 13,489，佔元朗人口約2% （政府統計處，2017；民政事務署，2021）。政府在錦 田規劃大綱中，仍保留不少地帶作「農業」、「自然保育區」或「鄉村式發展」用途（政府新聞公報，2014，2018）。因此，錦田仍然是本港主要的鄉郊地區之一。 本研究希望了解錦田長者的居家養老狀況和需求，為發展鄉郊長者服務的提供參考 資料。研究團隊探討長者於三個範疇的狀況，包括「社交支持」、「居所及社區支援 服務」和「長期護理服務的認識及意見」，並針對這三部分的發現提供相關建議

Secretory Stanniocalcin 1 promotes metastasis of hepatocellular carcinoma through activation of JNK signaling pathway

© 2017 Elsevier B.V. The hypoxic microenvironment is well-characterized in hepatocellular carcinoma (HCC). Delineation of hypoxia-responsive events is an integral part to understand the pathogenesis of HCC. We studied the functional role and clinical relevance of Stanniocalcin 1 (STC1), a hypoxia-induced molecular target, in HCC. In our clinical cohort, STC1 transcript was up-regulated in HCC tumor tissues. Moreover, STC1 protein was detected in the sera of HCC patients. A higher serum STC1 level was correlated with larger tumor size and poorer 5-year disease-free survival. Functionally, recombinant STC1 protein (rhSTC1) promoted cell migration and cell invasion in vitro; and the effect was abolished by co-treatment of anti-STC1 neutralizing antibody. By in vivo mouse model, silencing of STC1 in HCC cells downregulated secretory STC1 level and suppressed lung metastasis. Furthermore, we found that rhSTC1 activated the JNK pathway, as evidenced by altered expression of the key molecular targets pJNK and p-c-Jun. The functional effects conferred by rhSTC1 were abrogated by co-treatment of JNK inhibitor. In summary, secretory STC1 enhances metastatic potential of HCC via JNK signaling. It potentially serves as a prognostic serum biomarker and a therapeutic target for HCC.Link_to_subscribed_fulltex

Intranasal infection by SARS-CoV-2 Omicron variants can induce inflammatory brain damage in newly weaned hamsters

ABSTRACTChildren infected by SARS-CoV-2 Omicron variant may develop neurological complications. To study the pathogenesis in the growing brain, we intranasally challenged newly-weaned or mature hamsters with SARS-CoV-2 Omicron BA.2, BA.5, or Delta variant. Omicron BA.2 and Delta infection produced a significantly lower viral load in the lung tissues of newly-weaned than mature hamsters despite comparable histopathological damages. Newly-weaned hamsters had higher brain viral load, significantly increased cerebrospinal fluid concentration of TNF-α and CXCL10 and inflammatory damages including mild meningitis and parenchymal vascular congestion, despite sparse expression of nucleocapsid antigen in brain cells. Furthermore, 63.6% (28/44) of all SARS-CoV-2 infected newly-weaned hamsters showed microgliosis in olfactory bulb (OB), cerebral cortex, and hippocampus. In infected mature hamsters, microgliosis was observed mainly in OB and olfactory cortex of 35.3% (12/34) of their brains. Neuronal degeneration was found in 75% (33/44) of newly-weaned hamsters affecting multiple regions including OB, olfactory cortex, midbrain cortex, and hippocampus, while such changes were mainly observed in the hippocampus of mature hamsters. Importantly, similar brain histopathology was also observed in Omicron BA.5-infected newly-weaned hamsters. Our study suggested that SARS-CoV-2 may affect the brain at a young age. This kind of brain involvement and histological changes are not virus variant or subvariant specific. Incidentally, a moderate amount of eosinophilic infiltration was observed in the mucosa of nasal turbinate and trachea of newly-weaned hamsters infected by Omicron BA.2 and BA.5 but not Delta variant. This histological finding is consistent with the higher incidence of laryngotracheobronchitis in young children infected by the Omicron variant.Summary Intranasal infection of newly-weaned Syrian hamsters by SARS-CoV-2 Omicron variants can lead to brain inflammation and neuron degeneration with detectable low level of viral load and sparse expression of viral nucleoprotein

Intranasal infection by SARS-CoV-2 Omicron variants can induce inflammatory brain damage in newly-weaned hamsters

Intranasal infection of newly-weaned Syrian hamsters by SARS-CoV-2 Omicron variants can lead to brain inflammation and neuron degeneration with detectable low viral load and sparse expression of viral nucleoprotein. Abstract Children infected by SARS-CoV-2 Omicron variant may develop neurological complications. To study the pathogenesis in the growing brain, we intranasally challenged newly-weaned or mature hamsters with SARS-CoV-2 Omicron BA.2, BA.5 or Delta variant. Omicron BA.2 and Delta infection produced a significantly lower viral load in the lung tissues of newly-weaned than mature hamsters despite comparable histopathological damages. Newly-weaned hamsters had higher brain viral load, significantly increased cerebrospinal fluid concentration of TNF-α and CXCL10 and inflammatory damages including mild meningitis and parenchymal vascular congestion, despite sparse expression of nucleocapsid antigen in brain cells. Furthermore, 63.6% (28/44) of all SARS-CoV-2 infected newly-weaned hamsters showed microgliosis in olfactory bulb, cerebral cortex and hippocampus. In infected mature hamsters, microgliosis were observed mainly in olfactory bulb and olfactory cortex of 35.3% (12/34) of their brains. Neuronal degeneration was found in 75% (33/44) of newly-weaned hamsters affecting multiple regions including olfactory bulb, olfactory cortex, midbrain cortex and hippocampus, while such changes were mainly observed in hippocampus of mature hamsters. Importantly, similar brain histopathology was observed in Omicron BA.5 infected newly-weaned hamsters. Our study suggested that SARS-CoV-2 may affect the brain at young age. This kind of brain involvement and histological changes are not virus variant or subvariant specific. Incidentally, moderate amount of eosinophilic infiltration was observed in the mucosa of nasal turbinate and trachea of newly-weaned hamsters infected by Omicron BA.2 and BA.5 but not Delta variant. This histological finding is consistent with the higher incidence of laryngotracheobronchitis in young children infected by the Omicron variant.</p

Development and validation of risk prediction models for COVID-19 positivity in a hospital setting

ObjectivesTo develop: (1) two validated risk prediction models for coronavirus disease-2019 (COVID-19) positivity using readily available parameters in a general hospital setting; (2) nomograms and probabilities to allow clinical utilisation.MethodsPatients with and without COVID-19 were included from 4 Hong Kong hospitals. The database was randomly split into 2:1: for model development database (n = 895) and validation database (n = 435). Multivariable logistic regression was utilised for model creation and validated with the Hosmer-Lemeshow (H-L) test and calibration plot. Nomograms and probabilities set at 0.1, 0.2, 0.4 and 0.6 were calculated to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).ResultsA total of 1330 patients (mean age 58.2 ± 24.5 years; 50.7% males; 296 COVID-19 positive) were recruited. The first prediction model developed had age, total white blood cell count, chest x-ray appearances and contact history as significant predictors (AUC = 0.911 [CI = 0.880-0.941]). The second model developed has the same variables except contact history (AUC = 0.880 [CI = 0.844-0.916]). Both were externally validated on the H-L test (p = 0.781 and 0.155, respectively) and calibration plot. Models were converted to nomograms. Lower probabilities give higher sensitivity and NPV; higher probabilities give higher specificity and PPV.ConclusionTwo simple-to-use validated nomograms were developed with excellent AUCs based on readily available parameters and can be considered for clinical utilisation

Identification of 38 novel loci for systemic lupus erythematosus and genetic heterogeneity between ancestral groups

The presentation of systemic lupus erythematosus has been known to differ by ancestry, but the underlying genetic factors remain unclear. Here, the authors report ancestry-specific susceptibility loci and better risk prediction when using data from matched ancestral groups

Thromboembolic events and hemorrhagic stroke after mRNA (BNT162b2) and inactivated (CoronaVac) covid-19 vaccination : a self-controlled case series study

Background: This study aims to evaluate the association between thromboembolic events and hemorrhagic stroke following BNT162b2 and CoronaVac vaccination. Methods: Patients with incident thromboembolic events or hemorrhagic stroke within 28 days of covid-19 vaccination or SARS-CoV-2 positive test during 23 February to 30 September 2021 were included. The incidence per 100,000 covid-19 vaccine doses administered and SARS-CoV-2 test positive cases were estimated. A modified self-controlled case series (SCCS) analysis using the data from the Hong Kong territory-wide electronic health and vaccination records. Seasonal effect was adjusted by month. Findings: A total of 5,526,547 doses of BNT162b2 and 3,146,741 doses of CoronaVac were administered. A total of 334 and 402 thromboembolic events, and 57 and 49 hemorrhagic stroke cases occurred within 28 days after BNT162b2 and CoronaVac vaccination, respectively. The crude incidence of thromboembolic events and hemorrhagic stroke per 100,000 doses administered for both covid-19 vaccines were smaller than that per 100,000 SARS-CoV-2 test positive cases. The modified SCCS detected an increased risk of hemorrhagic stroke in BNT162b2 14-27 days after first dose with adjusted IRR of 2.53 (95% CI 1.48-4.34), and 0-13 days after second dose with adjusted IRR 2.69 (95% CI 1.54-4.69). No statistically significant risk was observed for thromboembolic events for both vaccines. Interpretation: We detected a possible safety signal for hemorrhagic stroke following BNT162b2 vaccination. The incidence of thromboembolic event or hemorrhagic stroke following vaccination is lower than that among SARS-CoV-2 test positive cases; therefore, vaccination against covid-19 remains an important public health intervention. Funding: This study was funded by a research grant from the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (reference COVID19F01)