From Early Detection Service to Shared Care Model: the Hong Kong Experience

Poster Abstract - Models of care: no. P014The benefits of early intervention and care in dementia are receiving increasing attention. Even in higher-income areas such as Hong Kong, however, a number of barriers need to be overcame to realize this vision. These include a high under-diagnosis rate at 89% in the community and long waiting time to access specialist diagnostic consultation services, and lack of awareness in the general public to detect early symptoms and signs to initiate timely help-seeking. A recent study in Hong Kong has demonstrated the potentials of an Early Detection Service by trained social workers and occupational therapists that collaborates with general practitioners and medical specialists in the community. A shared care model is being developed and piloted by the Hong Kong Alzheimer’s Disease Association (HKADA) in an age-friendly district. The aims are to build up care capacity in the district, to develop a district-based community shared-care model for future replication in other districts, and to strengthen medico-social and public-private interfacing through the shared-care model. A 3-year project designed with multiple interdependent components is being evaluated. The components include public education and awareness, early detection and diagnosis, and early interventions including advance care planning and coordination, drug treatment, and non-drug interventions provided at a specialized dementia day centre in the district. A total of 120 families with dementia are enrolled into a 2-year follow-up study to investigate the quality of life and intention of ageing in place among participants in the project as compared with those receiving traditional forms of services in Hong Kong. Assessments will be done at baseline, 6-month, 12-month, and 24-month follow-up. Cost of care is measured in a subsample of 30 families to estimate the direct and indirect costs associated with the shared-care model compared with traditional services among community-dwelling families with dementia in Hong Kong. Focus groups, interviews and questionnaire survey with stakeholders (families with dementia, general practitioners, dementia care planner, NGO staff) as formative evaluation to generate ideas for continual improvement and roll-out in other districts. Data collection has started in November 2015. This paper presents the preliminary findings from focus groups and questionnaire survey with stakeholders, as well as baseline and 6-month data available from the 2-year follow-up study

Angiogenic efficacy of simplified 2-herb formula (NF3) in zebrafish embryos in vivo and rat aortic ring in vitro

Ethnopharmacological relevance: Diabetic foot ulceration results in high risk of lower extremity amputation, and represents a significant health care expenditure worldwide. Radix Astragali (RA) and Radix Rehmanniae (RR) are widely used Chinese medicinal herbs in treating diabetes, and have shown positive effects in enhancing wound healing in diabetic foot ulcer animal model. Materials and methods: The angiogenic efficacy of NF3, a simplified 2-herb formula consisting of RA and RR in 2:1 ratio, was investigated. Median lethal concentration (LC50) and median effective concentration (EC50) were determined by treating zebrafish embryos with different concentrations of NF3 from 20 hpf to 72 hpf. The angiogenic activity of NF3 was examined in zebrafish embryos in vivo and by rat aortic ring assay in vitro. Cell cycle analysis of endothelial cells induced by NF3 was analyzed by flow cytometry using transgenic zebrafish Tg(fli1:EGFP). Real-time PCR was used to analyze mRNA expression profiles of selected genes involved in VEGF, FGF and MAPK pathways. Results: NF3 enhanced blood vessel formation as indicated by extra growth of intersegmental vessels in zebrafish embryos, and increased microvessels formation in rat aortic ring. NF3 also enhanced endothelial cells proliferation as shown by increased percentage of cells accumulating in S phase and G2/M phase of the cell cycle. NF3 exposure significantly induced up-regulation of VEGF-A, Flk-1, fgf1 and bRaf expression in zebrafish embryos. Conclusions: Our results demonstrated that NF3 was effective in promoting angiogenesis in zebrafish embryos and by rat aortic ring assay, which provided scientific basis to support the use of NF3 as potential therapeutics in treating diabetic foot ulceration. © 2011 Elsevier Ireland Ltd.link_to_subscribed_fulltex

A cascade of irx1a and irx2a controls shh expression during retinogenesis

In animal retina, hedgehog expression drives waves of neurogenesis, but genetic programs that control its expression during retinal neurogenesis are poorly elucidated. We have previously reported that irx1a is required for propagation of the sonic hedgehog (shh) expression waves in developing zebrafish retina. Here, we found that irx2a is expressed in the developing retina and that knockdown of irx2a results in a retinal phenotype strikingly similar to that of irx1a morphants. The expression of irx2a in retina ganglion cells was shown to be irx1a- and ath5-dependent suggesting that irx1a and ath5 are transcriptional regulators of irx2a. Furthermore, irx2a expression could rescue impaired propagation of shh waves in irx1a morphants. Together, these observations suggest that Irx2 functions downstream of irx1a to control shh expression in the retina. We proposed a novel transcriptional cascade of ath5-irx1a-irx2a in the regulation of hedgehog waves during vertebrate retinal development. © 2010 Wiley-Liss, Inc.link_to_OA_fulltex