A community study on burden and depressive symptoms among carers of demented relatives

Background: Most mild to moderate demented patients are cared at home. Studies have shown that carers face increased stress and are prone to depression. In order to understand their needs, a collaboration study between District Board, Community Rehabilitation Network and local hospitals was done. Objective: (1) To understand care needs of demented patients and their carers in the family. (2) To assess difficulties faced by carers and evaluate their stress. (3) To find out which factors may aggravate or relieve carer stress. Method: The study was performed by interviewing 100 carers by questionnaire. Three main themes were studied: (1) presence of depression by Center for Epidemiological Studies Depression Scale (CES-D), (2) caregiver burden by Zarit Burden Interview (ZBI), patients’ memory and behavioural problems by Revised Memory and Behaviour Problems Checklist (RMBPC), patient ADL performance, and (3) carer coping abilities by Brief COPE and perceived social support by Multidimensional Scale of Perceived Social Support (MSPSS). Results: 49% of patients are in moderate to severe stage, with moderate to high ADL dependency level (mean ADL score: 62.4, with 40% of patients scoring 60 or below). On average carers spent 13.8 hours per day on their relative. 24% of carers have rated self-perceived health status as poor or very poor. 36% have little or no knowledge about the dementia illness. Regarding carer depression, 49% had CES-D score in the moderately and severely depressed range. Caregiver burden was high with ZBI score of 38.2 (>24 being highly associated with depression). Memory and behavioural symptoms were common with mean RMBPC 38.2. Carer coping abilities as measured by Brief COPE was 24.6. Perceived social support as measured by MSPSS was 56.2. Carer depression was found to be correlated with cognitive and behaviour problems as well as carer burden; whereas it was negatively correlated with social support. After multiple linear regression analysis, caregiver burden was the most significant factor contributing to caregiver depression (β=0.55, T=5.43, p<0.001). Conclusions: This cohort of carers, having spent long hours caring for their demented relatives had limited knowledge, poor perceived health and emotional problems. They had high burden and showed signs of depression. Caregiver depression was found to be associated with a higher level of burden.published_or_final_versio

Severe acute respiratory syndrome: Report of treatment and outcome after a major outbreak

Background: The outcome is reported of a prospective uncontrolled study based on a stepwise treatment protocol during an outbreak of severe acute respiratory syndrome (SARS) in Hong Kong. Method: One hundred and thirty eight patients were treated with broad spectrum antibiotics, a combination of ribavirin and low dose corticosteroid, and then intravenous high dose methylprednisolone according to responses. Sustained response to treatment was defined as (1) defervescence for ≥4 consecutive days, (2) resolution of lung consolidation by >25%, and (3) oxygen independence by the fourth day without fever. Patients with defervescence who achieved either criterion 2 or 3 were classified as partial responders. Patients who fell short of criteria 2 and 3 were non-responders. Results: Laboratory confirmation of SARS coronavirus infection was established in 132 (95.7%). None responded to antibiotics but 25 (18.1%) responded to ribavirin + low dose corticosteroid. Methylprednisolone was used in 107 patients, of whom 95 (88.8%) responded favourably. Evidence of haemolytic anaemia was observed in 49 (36%). A high level of C-reactive protein at presentation was the only independent predictor for use of methylprednisolone (odds ratio 2.18 per 10 mg/dl increase, 95% confidence interval 1.12 to 4.25, p = 0.02). Thirty seven patients (26.8%) required admission to the intensive care unit and 21 (15.2%) required invasive mechanical ventilation. There were 15 deaths (mortality rate 10.9%), most with significant co-morbidities, whereas 122 (88.4%) had been discharged home 4 months after the outbreak onset. Conclusion: The use of high dose pulse methylprednisolone during the clinical course of a SARS outbreak was associated with clinical improvement, but randomised controlled trials are needed to ascertain its efficacy in this condition.published_or_final_versio

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study

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Enhanced IL-6/IL-6R Signaling Promotes Growth and Malignant Properties in EBV-Infected Premalignant and Cancerous Nasopharyngeal Epithelial Cells

Nasopharyngeal carcinoma (NPC) is etiologically associated with Epstein-Barr virus (EBV) infection. However, the exact role of EBV in NPC pathogenesis remains elusive. Activation of signal transducer and activator of transcription 3 (STAT3) is common in human cancers including NPC and plays an important role in the pathogenesis and progression of human cancers. Interleukin-6 (IL-6), a major inflammatory cytokine, is a potent activator of STAT3. In this study, we report that EBV-infected immortalized nasopharyngeal epithelial (NPE) cells often acquire an enhanced response to IL-6-induced STAT3 activation to promote their growth and invasive properties. Interestingly, this enhanced IL-6/STAT3 response was mediated by overexpression of IL-6 receptor (IL-6R). Furthermore, IL-6R overexpression enhanced IL-6-induced STAT3 activation in uninfected immortalized NPE cells in vitro, and promoted growth and tumorigenicity of EBV-positive NPC cell line (C666-1) in vivo. Moreover, it is shown for the first time that IL-6R was overexpressed in clinical specimens of NPC. IL-6 expression could also be strongly detected in the stromal cells of NPC and a higher circulating level of IL-6 was found in the sera of advance-staged NPC patients compared to the control subjects. Therefore, IL-6R overexpression, coupled with enhanced IL-6/STAT3 signaling may facilitate the malignant transformation of EBV-infected premalignant NPE cells into cancer cells, and enhance malignant properties of NPC cells. © 2013 Zhang et al.published_or_final_versio

Expanding genotype/phenotype of neuromuscular diseases by comprehensive target capture/NGS

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Plasma high sensitivity troponin T levels in adult survivors of childhood leukaemias: determinants and associations with cardiac function

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Story Ending Generation Using Commonsense Casual Reasoning and Graph Convolutional Networks

Story Ending Generation is a task of generating a coherent and sensible ending for a given story The key challenges of this task are i how to obtain a good understanding of context ii how to capture hidden information between lines and iii how to obtain causal progression However recent machine learning models can only partially address these challenges due to the lack of causal entailment and consistency The key novelty in our proposed approach is to capture the hidden story by generating transitional commonsense sentences between each adjacent context sentence which substantially enriches causal and consistent story flow Specifically we adopt a soft causal relation using people s everyday commonsense knowledge to mimic the cognitive understanding process of readers We then enrich the story with causal reasoning and utilize dependency parsing to capture long range text relations Finally we apply multi level Graph Convolutional Networks to deliver enriched contextual information across different layers Both automatic and human evaluation results show that our proposed model can significantly improve the quality of generated story endings 2023 The Author

Diagnostic and mechanistic implications of serum free light chains, albumin and alpha-fetoprotein in hepatocellular carcinoma

Background: Mass spectroscopy analysis suggested low serum albumin and high immunoglobulin free light chain (sFLC) levels may have diagnostic value in hepatocellular carcinoma (HCC). Our aims were to apply quantitative assays to confirm these observations, determine their diagnostic utility, and investigate the mechanisms involved. Methods: Albumin, sFLC, routine liver and renal function tests were measured in patients with chronic liver disease with (n=102) and without (n=113) HCC. The discriminant performance was compared with the current standard serological test alpha-fetoprotein (AFP) using receiver operating characteristic (ROC) and area under the curve (AUC) analyses. Results: sFLC and serum albumin were each confirmed to have discriminatory utility in HCC with AUC values of 0.7 and 0.8, respectively. sFLC were strongly correlated with gammaglobulin levels and both these were inversely related to serum albumin levels. The discriminatory utility of sFLC was retained after adjusting for renal and liver function. Conclusions: Serum levels of sFLC and albumin were strongly associated with HCC as predicted by mass spectroscopy. Discrimination of HCC by AFP was improved by the addition of either albumin or sFLC. Larger prospective studies are required to determine how AFP, sFLC and albumin might be combined in a useful diagnostic approach for HCC

Global sea-surface iodide observations, 1967-2018

The marine iodine cycle has significant impacts on air quality and atmospheric chemistry. Specifically, the reaction of iodide with ozone in the top few micrometres of the surface ocean is an important sink for tropospheric ozone (a pollutant gas) and the dominant source of reactive iodine to the atmosphere. Sea surface iodide parameterisations are now being implemented in air quality models, but these are currently a major source of uncertainty. Relatively little observational data is available to estimate the global surface iodide concentrations, and this data has not hitherto been openly available in a collated, digital form. Here we present all available sea surface (<20 m depth) iodide observations. The dataset includes values digitised from published manuscripts, published and unpublished data supplied directly by the originators, and data obtained from repositories. It contains 1342 data points, and spans latitudes from 70°S to 68°N, representing all major basins. The data may be used to model sea surface iodide concentrations or as a reference for future observations

Changes in Staff Expectations, Competence, and Confidence in Providing EOL Care after Launching a 2-year End-of-life Care Pilot Project in Care and Attention Home

Conference Theme: Clinical, Legal and Administrative ChallengesFree Paper Presentation Ipublished_or_final_versio