Cerebral small vessel disease burden is associated with poststroke depressive symptoms: A 15-month prospective study

Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS. Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of _7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent total SVD burden. The association between SVD burden and PDS was assessed with generalized estimating equation models. Results: The study sample had a mean age of 67.0 _ 10.2 years and mild-moderate stroke [National Institutes of Health Stroke Scale score: 3, interquartile, 1–5]. PDS were found in 18.3%, 11.6%, and 12.3% of the sample at 3, 9, and 15 months after stroke, respectively. After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of PDS [odds ratio = 1.30; 95% confidence interval = 1.07–1.58; p = 0.010]. Other significant predictors of PDS were time of assessment, female sex, smoking, number of acute infarcts, functional independence, and social support. Conclusion: SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke

Dramatic reductions in water uptake observed in novel POSS nanocomposites based on anhydride-cured epoxy matrix resins

© 2015.A methylnadic anhydride-cured diglycidylether of bisphenol A, is prepared and characterised and a mono-epoxy POSS reagent added (0.5-4wt-%) to produce a series of nanocomposites. Two reaction mechanisms are observed involving esterification at lower temperatures (60-180°C) and etherification at temperatures above 180°C. Using the Ozawa and Kissinger methods, the activation energy for the first reaction was found to be 87-90kJ/mol and 122-124kJ/mol for the second reaction. Incorporation of POSS into the epoxy-anhydride network increases the Tg and cross-link density, indicating a more rigid network, but the values do not follow a trend based solely on POSS content. The char yield increases with POSS content with very little change in the degradation temperature. Incorporation of POSS (1wt-%) can reduce the moisture uptake in the cured resin by ~25% at 75% relative humidity. This is accompanied by a lower impact on glass transition temperature: the Tg is reduced by 10K at saturation, compared with 31K for the unmodified epoxy

Immunotherapy for Lung Cancers

Lung cancer is the leading cause of cancer-related deaths worldwide. Although treatment methods in surgery, irradiation, and chemotherapy have improved, prognosis remains unsatisfactory and developing new therapeutic strategies is still an urgent demand. Immunotherapy is a novel therapeutic approach wherein activated immune cells can specifically kill tumor cells by recognition of tumor-associated antigens without damage to normal cells. Several lung cancer vaccines have demonstrated prolonged survival time in phase II and phase III trials, and several clinical trials are under investigation. However, many clinical trials involving cancer vaccination with defined tumor antigens work in only a small number of patients. Cancer immunotherapy is not completely effective in eradicating tumor cells because tumor cells escape from host immune scrutiny. Understanding of the mechanism of immune evasion regulated by tumor cells is required for the development of more effective immunotherapeutic approaches against lung cancer. This paper discusses the identification of tumor antigens in lung cancer, tumor immune escape mechanisms, and clinical vaccine trials in lung cancer

Developmental dyscalculia and low numeracy in Chinese children

Children struggle with mathematics for different reasons. Developmental dyscalculia and low numeracy - two kinds of mathematical difficulties - may have their roots, respectively, in poor understanding of exact non-symbolic numerosities and of symbolic numerals. This study was the first to explore whether Chinese children, despite cultural and linguistic factors supporting their mathematical learning, also showed such mathematical difficulties and whether such difficulties have measurable impact on children's early school mathematical performance. First-graders, classified as dyscalculia, low numeracy, or normal achievement, were compared for their performance in various school mathematical tasks requiring a grasp of non-symbolic numerosities (i.e., non-symbolic tasks) or an understanding of symbolic numerals (i.e., symbolic tasks). Children with dyscalculia showed poorer performance than their peers in non-symbolic tasks but not symbolic ones, whereas those with low numeracy showed poorer performance in symbolic tasks but not non-symbolic ones. As hypothesized, these findings suggested that dyscalculia and low numeracy were distinct deficits and caused by deficits in non-symbolic and symbolic processing, respectively. These findings went beyond prior research that only documented generally low mathematical achievements for these two groups of children. Moreover, these deficits appeared to be persistent and could not be remedied simply through day-to-day school mathematical learning. The present findings highlighted the importance of tailoring early learning support for children with these distinct deficits, and pointed to future directions for the screening of such mathematical difficulties among Chinese children. © 2013 Elsevier Ltd.postprin

A Step Toward Workplace Obesity Prevention: Evaluation of Weight Management Program for Hospital-based Health Care Providers

Background: Obesity is a worldwide problem. Healthy workplace and lifestyle are crucial in preventing obesity. A workplace weight management program could create a culture of health and facilitate weight control among health care providers. The present study aims to describe and evaluate the health outcomes of the interaction of professional practice and organizational infrastructure. Method: The hospital-based weight management program was an eight-week pilot randomized controlled study for obese health care providers. The primary outcomes were body weight and body mass index. The secondary outcomes included serum fasting glucose, fasting cholesterol, triglyceride, high- and low-density lipoprotein, body fat percentage, body mass, and quality of life. The RE-AIM framework was used to examine the intervention’s reach, effectiveness, adoption, implementation and maintenance at individual and organizational levels. Results: The program successfully attained the target population. Health care providers demonstrated short-term weight loss and decreased serum fasting cholesterol level after completing the program. The excellent retention rate (95%) of the study suggested that the participants were well-engaged in self-weight management. The program was implemented with adequate resource and support from the health organization. The organization may consider continuing the program in view of its long-term benefits to health care providers. Conclusion: Supportive organizational structure and culture enhanced professional practice and improved the health outcomes of the hospital-based weight management program participants

Evaluation of a village-based digital health kiosks program: A protocol for a cluster randomized clinical trial

Background To address disparities in healthcare quality and access between rural and urban areas in China, reforms emphasize strengthening primary care and digital health utilization. Yet, evidence on digital health approaches in rural areas is lacking. Objective This study will evaluate the effectiveness of Guangdong Second Provincial General Hospital's Digital Health Kiosk program, which uses the Dingbei telemedicine platform to connect rural clinicians to physicians in upper-level health facilities and provide access to artificial intelligence-enabled diagnostic support. We hypothesize that our interventions will increase healthcare utilization and patient satisfaction, decrease out-of-pocket costs, and improve health outcomes. Methods This cluster randomized control trial will enroll clinics according to a partial factorial design. Clinics will be randomized to either a control arm with clinician medical training, a second arm additionally receiving Dingbei telemedicine training, or a third arm with monetary incentives for patient visits conducted through Dingbei plus all prior interventions. Clinics in the second and third arm will then be orthogonally randomized to a social marketing arm that targets villager awareness of the kiosk program. We will use surveys and Dingbei administrative data to evaluate clinic utilization, revenue, and clinician competency, as well as patient satisfaction and expenses. Results We have received ethical approval from Guangdong Second Provincial General Hospital (IRB approval number: GD2H-KY IRB-AF-SC.07-01.1), Peking University (IRB00001052-21007), and the University of North Carolina at Chapel Hill (323385). Study enrollment began April 2022. Conclusions This study has the potential to inform future telemedicine approaches and assess telemedicine as a method to address disparities in healthcare access. Trial registration number: ChiCTR210005387

Promoting resilience for HIV prevention in female sex workers in Hong Kong: a randomised controlled trial

Background: Female sex workers are considered a reservoir of HIV and their psychological health has a role to play in HIV infections. In China, commercial sex workers were reported to account for nearly 50% of heterosexual transmission of HIV. Therefore, HIV prevention targeted at mental health could be an innovative strategy in controlling the infection. We aimed to provide an evidence-based resilience-promoting intervention targeting mental health and ultimately safe sexual practices of female sex workers. Methods: This randomised controlled trial was done at three Hong Kong non-governmental organisations, namely Action for REACH OUT, JJJ Association, and the Society of Rehabilitation and Crime Prevention. Participants in this study were women (aged ≥18 years) who had worked as a sex worker in the previous 6 months. We randomly assigned participants to either intervention or usual care (control) according to a predetermined, computer-generated randomisation list. Both group facilitator and partcipants were unmasked to the group allocation, but an independent researcher who was masked to the treatment allocation administered the questionnaires. About half of the participants were permanent residents of Hong Kong whereas the other half were from mainland China. The six-session resilience-promoting intervention was designed to improve the coping skills, self-esteem, and self-efficacy (i.e. the belief of an individuals’ ability to control their actions to achieve desired goal), as measured by Brief-COPE, the Rosenberg Self-esteem Scale, and the Generalised Self- efficacy Scale of female sex workers. Questionnaires were administered by an independent assessor at baseline, post-treatment, and at 3-months follow-up. Participants in the control group received standard service, which included outreach visits, screening for HIV or sexually transmitted infections, and social activities provided by non-governmental organisations. The primary outcome of this study was the resilience scores measured by Connor-Davidson Resilience Scale. We analysed the differences between the two groups using the intention-to-treat analysis. This study was approved by the University of Hong Kong/Hospital Authority Hong Kong West Cluster Internal Review Board (UW 12-220). Verbal informed consent was obtained from all participants. Findings: 127 female sex workers were randomly assigned: 64 joined the control group and 63 joined intervention group. There were significant differences on the score on resilience, self-esteem, and mental health status between groups at post-intervention and 3- month follow-up. We found that condom use in the intervention group at 3-month follow-up was improved compared with the control group. After controlling for marital status and family size, improved resilience scores were associated with intervention group assignment (odds ratio 2∙95 [95% CI 1∙19–7∙35]; p=0∧021) and self-efficacy (1∧13 [1∧03–1∧24]; p=0∧006). Interpretation: Our findings suggest that resilience-promoting intervention programme was effective in improving the mental health status among Chinese female sex workers. This programme is an innovative approach to HIV prevention by promoting both psychological well-being and safe sex for this high-risk population. Funding: Council for the AIDS Trust Fund and General Research Grant, Research Grants Council, HKSAR

Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial

Background: Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD). Aims: To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive–behavioural therapy-based psychoeducation and usual care. Method: In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels. Results: Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only. Conclusions: These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms

A randomized, controlled clinical trial: the effect of mindfulness-based cognitive therapy on generalized anxiety disorder among Chinese community patients: protocol for a randomized trial

<b>Background</b> Research suggests that an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program may be effective in the treatment of generalized anxiety disorders. Our objective is to compare the clinical effectiveness of the MBCT program with a psycho-education programme and usual care in reducing anxiety symptoms in people suffering from generalized anxiety disorder.<p></p> <b>Methods and Design</b> A three armed randomized, controlled clinical trial including 9-month post-treatment follow-up is proposed. Participants screened positive using the Structure Clinical Interview for DSM-IV (SCID) for general anxiety disorder will be recruited from community-based clinics. 228 participants will be randomly allocated to the MBCT program plus usual care, psycho-education program plus usual care or the usual care group. Validated Chinese version of instruments measuring anxiety and worry symptoms, depression, quality of life and health service utilization will be used. Our primary end point is the change of anxiety and worry score (Beck Anxiety Inventory and Penn State Worry Scale) from baseline to the end of intervention. For primary analyses, treatment outcomes will be assessed by ANCOVA, with change in anxiety score as the baseline variable, while the baseline anxiety score and other baseline characteristics that significantly differ between groups will serve as covariates.<p></p> <b>Discussion</b> This is a first randomized controlled trial that compare the effectiveness of MBCT with an active control, findings will advance current knowledge in the management of GAD and the way that group intervention can be delivered and inform future research

Career and life development intervention for non-engaged youth: Evaluating the Hong Kong Benchmarks (Community) Pilot Program

In our study, aimed at examining the effectiveness and impact of the Hong Kong Benchmarks (Community) Pilot Program, a career and life development (CLD) intervention program targeting non-engaged youth (NEY) in Hong Kong, we employed a pretest–posttest quasi-experimental design to compare changes in career-related competencies between a pilot group (N = 289) and a comparison group (N = 160). We also conducted five focus group interviews with the leaders of nongovernmental organizations, social workers, NEY, parents, and employers to explore the program’s impacts on the CLD service provisions. Our quantitative results indicate that the piloting group showed greater improvement in two career-related competencies—youth career development competency and career and life development hope—than the comparison group. Meanwhile, our qualitative results suggest both the benefits and difficulties experienced by stakeholders in the program. The findings thus provide preliminary evidence of the Hong Kong Benchmarks (Community) Pilot Program’s positive impacts on NEY and other important stakeholders. The implications of expanding the existing program and theorizing the community-based benchmark approach are also discussed