The effectiveness of a psychoeducational intervention on health outcomes of patients undergoing haemodialysis: A randomized controlled trial.

AIM: The aim of this work is to examine the effectiveness of a psychoeducational intervention on self-efficacy (primary outcome), anxiety, depression, treatment adherence, and health-related quality of life (HRQoL) of patients undergoing haemodialysis. METHODS: A two-group randomized controlled trial of 124 patients (65 and 59 patients in the intervention and control groups, respectively) recruited from a tertiary hospital in Singapore was conducted. Data were collected from January 2015 to June 2016. Outcomes were measured at baseline and 1, 3, and 6 months after the intervention. General linear model was used to analyse data. RESULTS: Our findings showed significant group effect on HRQoL (effects of kidney disease on daily life; p = 0.041), time effect on all outcomes (p < 0.05; except for treatment adherence behaviours and HRQoL [burden of kidney disease]), and group * time interaction effect on anxiety (p = 0.040) and depression (p = 0.003), with the intervention group reporting better outcomes. CONCLUSIONS: The positive effects of our intervention on patients' self-efficacy, psychological well-being, treatment adherence attitudes, and HRQoL implied its potential use in dialysis/renal centres to improve patients' self-care and health outcomes.

An evaluation of online Edcraft gamified learning (EGL) to understand motivation and intention of recycling among youth.

Recycling is a process carried out by various organizations and individuals to enhance the environment's long-term sustainability. Some youth think that recycling is a monotonous action as it may seem inconvenient, less aware of the environmental issues and more time-consuming than they think and rather go for video games. Therefore, this study investigates the relationship between motivation and recycling intention in gamified learning among youth. To address the research aim, this study uses gamification as a motivational driver for a game-like learning experience to improve recycling intentions among youth. Self-determination theory (SDT) and the theory of Planned Behavior (TPB) will be this study's main motivational and behavioral theories. (n = 124) high schools and college students were invited to take part in an online gamified recycling activity, Edcraft Gamified Learning (EGL), consisting of two levels of gamified unused plastic-crafting recycling activities. After the activity, the participants will answer a post-event questionnaire and the data collected were analyzed. The result shows that controlled motivation (CM) and autonomous motivation (AM) positively influenced youth attitudes and social norms. Besides, attitude is the only psychosocial determinant that positively influences the recycling intention of the youth. Gamification only moderates positively between attitude and recycling intention. This study has clearly shown the effectiveness of gamified learning activity towards recycling intention directly and as a component that moderates the relationship between attitude and recycling intention, which shows a favorable evaluation towards recycling intention with gamified learning involved. Moreover, the findings showed that not all relationships are positive in a gamified learning environment, and it gives a good view on the weakness and strengths with the guideline of SDT and TPB.

The Important Role of Motivation and Pleasure Deficits on Social Functioning in Patients With Schizophrenia: A Network Analysis.

Negative symptoms, particularly the motivation and pleasure (MAP) deficits, are associated with impaired social functioning in patients with schizophrenia (SCZ). However, previous studies seldom examined the role of the MAP on social functioning while accounting for the complex interplay between other psychopathology. This network analysis study examined the network structure and interrelationship between negative symptoms (at the "symptom-dimension" and "symptom-item" levels), other psychopathology and social functioning in a sample of 269 patients with SCZ. The psychopathological symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Positive and Negative Syndrome Scale (PANSS). Social functioning was evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). Centrality indices and relative importance of each node were estimated. The network structures between male and female participants were compared. Our resultant networks at both the "symptom-dimension" and the "symptom-item" levels suggested that the MAP factor/its individual items were closely related to social functioning in SCZ patients, after controlling for the complex interplay between other nodes. Relative importance analysis showed that MAP factor accounted for the largest proportion of variance of social functioning. This study is among the few which used network analysis and the CAINS to examine the interrelationship between negative symptoms and social functioning. Our findings supported the pivotal role of the MAP factor to determine SCZ patients' social functioning, and as a potential intervention target for improving functional outcomes of SCZ.

Playing Edcraft at Home: Gamified Online Learning for Recycling Intention during Lockdown.

Background: Gamification is an innovative approach to engaging in activities that people believe as less interesting. Recycling has been an issue not taken aware by the people in environmental sustainability. There are substantial studies on recycling intention due to the continual growth of unethical and unsustainable waste disposal. Creative approaches to recycling awareness activities should be made to fulfil youths' increasing interest in and demand for recycling. The main objective of this study is to explore the factors related to youths' recycling intentions after experiencing a gamified online recycling learning activity, Edcraft Gamified Learning (EGL). Gamified recycling education is believed to be a practical and engaging approach for youths. Methods: 100 students participated in EGL, consisting of two levels of plastic crafting and recycling activities. They experienced online EGL at home between May and September in 2020, during the COVID-19 pandemic total lockdown in Malaysia, namely, Movement Control Order (MCO). 29 participants were selected to participate in five focus group discussions (FGDs) with five to eight participants per session to explore their opinions towards gamified learning, motivation and recycling intention. Results: This paper reports the findings of the FGDs. A codebook was developed based on the codes from the FGD feedback. The codes were rated by two raters, followed by an assessment of inter-rater reliability and thematic analysis. The findings emerged and were confirmed with four themes as factors that influence recycling intention. They are gameful experience, social influence, intrinsic motivation, and extrinsic motivation. Conclusion: The dependent variable, recycling intention, was connected to the four themes to verify the conceptual framework. One limitation of the study was the design of the EGL activity, which was only carried out over two days with two levels of gamified recycling education, as students had concurrent academic online classes during that period.

Validation and extension of the Motivation and Pleasure Scale-Self Report (MAP-SR) across the schizophrenia spectrum in the Chinese context.

BACKGROUND: Developed based on the Clinical Assessment Interview for Negative Symptoms (CAINS), the Motivation and Pleasure Scale-Self Report (MAP-SR) was designed to address the conceptual and psychometric limitations of other instruments assessing negative symptoms. We sought to validate and extend the applicability of the MAP-SR in the Chinese context across the schizophrenia spectrum. METHODS: Three samples, including college students, individuals with social anhedonia and patients with schizophrenia, were recruited. Test-retest reliability, internal consistency, factor structure, and convergent/discriminant validity of the MAP-SR were examined. The group differences between the three participant groups were examined. RESULTS: A four-factor structure of the MAP-SR was found consistently in all three groups of participants. The scale showed convergent/discriminant validity in patients with schizophrenia and individuals with social anhedonia, along with good reliability found in schizophrenia patients. The MAP-SR was also able to distinguish individuals with SocAnh and patients with SZ from matched controls. CONCLUSIONS: The MAP-SR is a valid and reliable instrument in assessing negative symptoms in individuals along the schizophrenia spectrum.

Impact of a pharmacist-led education and follow-up service on anticoagulation control and safety outcomes at a tertiary hospital in China: a randomised controlled trial.

OBJECTIVES: This study was designed to evaluate the impact of a pharmacist-led anticoagulation service on international normalised ratio (INR) control and other outcomes among patients receiving warfarin therapy at a tertiary hospital in Zhuhai, China. METHODS: In this randomised controlled trial, adult patients who were newly initiated on warfarin with intended treatment duration of at least 3 months were recruited. Participants were randomly allocated to receive the pharmacist-led education and follow-up service (PEFS) or usual care (UC). Anticoagulation control was calculated as the proportions of time within the target INR range (TTR) and time within the expanded target range (TER). KEY FINDINGS: A total of 152 participants (77 in the PEFS group and 75 in the UC group) were included. Within 180 days after hospital discharge, the PEFS group spent more TER than the UC group (54.4% versus 42.0%; P = 0.024), whereas the difference in TTR did not reach statistical significance (35.9% versus 29.5%; P = 0.203). No major bleeding events were observed, and the cumulative incidences of major thromboembolic events (6.5% versus 9.3%) and mortality (1.3% versus 1.3%) were similar between the two groups (P> 0.05). At 30 days postdischarge, the PEFS group had better warfarin knowledge by answering 57.5% of questions correctly, compared with the UC group (43.0%) (P = 0.003). CONCLUSIONS: The PEFS markedly enhanced anticoagulation control and warfarin knowledge but there was room for improvement. The expansion of pharmacists' clinical role and the development of more effective education and follow-up strategies are warranted to optimise anticoagulation management services in China.

Spiritual Experiences of Women with Breast Cancer in Singapore: a Qualitative Study.

OBJECTIVE: Although there has been increasing emphasis on the importance of spirituality in patients with cancer, few studies have examined the spiritual experiences of an ethnically diverse sample of Asian women with breast cancer. The objective of this study was to examine the spiritual experiences of Singaporean women with breast cancer in the first year of diagnosis. METHODS: A qualitative exploratory study design was used and data were gathered using individual semi-structured interviews. Purposive sampling selected the participants and data saturation sample size was reached after interviews with 28 participants. Data were analyzed using Braun and Clarke's thematic approach. RESULTS: The participants were aged between 28 and 64 years and included women from the three major ethnic groups. The three themes that emerged from the data included transcendental experiences, meaning and purpose, and changing perspectives. CONCLUSIONS: This study informs that while spiritual needs are common, Singaporean women in their first year of the breast cancer diagnosis express spirituality in culturally specific ways. The clinical implications of the study emphasize the importance of addressing women's spiritual concerns, with attention to cultural differences so as to render holistic patient-centered care.

An observational study of temperature and thermal images of surgical wounds for detecting delayed wound healing within four days after surgery.

AIM: To elucidate the infrared thermal patterns and temperature readings of the surfaces of surgical wounds for detecting delayed wound healing within four days after surgery. BACKGROUND: The nursing assessment of surgical wounds within the first four days after surgery is commonly based on visual and physical examination. Surgical wounds with delayed healing may be not detected if they do not exhibit signs such as redness or exudate within four days after surgery. DESIGN: This study was conducted using prospective observational design with reference to the STROBE Statement (see Supporting Information Appendix S1) to examine the temperatures of surgical wounds in their natural settings. METHODS: Based on convenience sampling, 60 participants admitted to the colorectal surgical ward for enterostoma closure from January-November 2013 were recruited. RESULTS: Although both infected and noninfected surgical wounds exhibited a significant increase in wound temperature from Days 1-4, the infected wounds revealed a statistically significantly lower temperature than the noninfected ones. Within the infrared thermal images, the infected wounds presented with partial warming of the skin surrounding and along the incision, suggesting that delayed healing could be identified. CONCLUSION: This study demonstrates that delayed wound healing can be detected within the first four days after surgery for early intervention of prevention and treatment before discharge. RELEVANCE TO CLINICAL PRACTICE: This paper provides evidence-based information for healthcare professionals in assessing surgical wounds for delayed healing within the first four days after surgery. The findings herein enable the early detection of delayed wound healing, based on which early intervention of prevention and treatment may be instituted for affected patients before their discharge.

Clustering-Based Compression for Population DNA Sequences.

Due to the advancement of DNA sequencing techniques, the number of sequenced individual genomes has experienced an exponential growth. Thus, effective compression of this kind of sequences is highly desired. In this work, we present a novel compression algorithm called Reference-based Compression algorithm using the concept of Clustering (RCC). The rationale behind RCC is based on the observation about the existence of substructures within the population sequences. To utilize these substructures, k-means clustering is employed to partition sequences into clusters for better compression. A reference sequence is then constructed for each cluster so that sequences in that cluster can be compressed by referring to this reference sequence. The reference sequence of each cluster is also compressed with reference to a sequence which is derived from all the reference sequences. Experiments show that RCC can further reduce the compressed size by up to 91.0 percent when compared with state-of-the-art compression approaches. There is a compromise between compressed size and processing time. The current implementation in Matlab has time complexity in a factor of thousands higher than the existing algorithms implemented in C/C++. Further investigation is required to improve processing time in future.

Breast cancer screening behavior, attitude, barriers among middle-aged Chinese women in Macao, China.

Background: Breast cancer is the third leading cause of death from cancer among females in Macao, but little is known about local practice of breast cancer screening. The study aims to evaluate breast cancer screening behaviors and to identify the predictors of insufficient knowledge and attitudes towards breast cancer and its screening among female residents. Methods: This was a cross-sectional study conducted from April to June 2016 in Macao. Quota sampling of women completed the modified Chinese Breast Cancer Screening Beliefs questionnaire (CBCSB) to assess their breast cancer-related perceptions, screening attitudes and behaviors. Univariate and multivariate logistic regressions were performed to identify the predictors of poor-screening practices, attitudes, knowledge and perceived barriers to mammography. Result: A total of 417 women (mean age±SD: 50.5±5.7) completed surveys, with 160 (38.4%), 196 (47.0%) and 103 (24.7%) women received breast self-examination, clinical breast examination and mammography as recommended, respectively. Nulliparity (OR=2.56, 95% CI = 1.14-5.73) and low education (OR = 1.72, 95% CI = 1.04-2.84) were significantly associated with negative attitude towards health check-ups. Women did not know anyone with breast cancer (OR = 2.30, 95% CI = 1.50-3.55) were more likely to have insufficient knowledge about breast cancer. Low education (OR = 1.95, 95% CI = 1.25-3.04) and not knowing anyone with breast cancer (OR = 2.02, 95% CI = 1.31-3.13) were identified as predictors for perceived barriers to mammography. Conclusion: Recommendations for breast cancer screening are poorly followed by the residents in Macao, and a culturally tailored educational program is urgently needed to raise the public's awareness of the disease and the screening practices.

Effects of postoperative pain management educational interventions on the outcomes of parents and their children who underwent an inpatient elective surgery: A randomized controlled trial.

AIM: To examine the effects of a postoperative pain management educational intervention on the outcomes of parents and their children who underwent inpatient elective surgery. BACKGROUND: Equipping parents with knowledge and skills to manage their children's postoperative pains is essential. Very limited studies have examined the effects of educational interventions on parents' knowledge, attitudes and use of pharmacological and non-pharmacological pain relief methods. DESIGN: Three-group pre- and post-test randomized controlled trial. METHODS: Parent-child pairs (N = 152) were recruited from September 2013-January 2015 and randomly assigned to either the control group or one of the two intervention groups. Valid and reliable instruments and diary entries were used to collect data at the baseline, 6, 12 and 24 hr and 2 weeks after the surgery. IBM SPSS 23.0 was used to analyse the data. RESULTS: Parents reported moderate levels of knowledge, attitudes, pain relief methods used and children's postoperative pain. Except for parents' knowledge, types and frequencies of non-pharmacological methods used, there were no statistically significant differences among the three groups in parents' attitudes on pain management and pain medication, their uses of pain relief strategies (questionnaire data), satisfaction with postoperative pain management and children's worst postoperative pain in 2 weeks after surgery. CONCLUSION: Education seemed effective in improving parents' knowledge and use of non-pharmacological methods, but not attitudes, satisfaction with pain management and children's postoperative pain. Future studies are needed to develop modern digitalized ways for educating and supporting parents to optimize their children's postoperative pain management. TRIAL REGISTRATION: This study has been registered with BioMed Central Ltd. (Registration No.: ISRCTN24910957).

Underdiagnosis of depression in an economically deprived population in Macao, China.

INTRODUCTION: Previous literature revealed an association between low income and depression. Despite the availability of effective treatments, depression is often underdiagnosed and undertreated. This study was designed to evaluate the prevalence of depressive symptoms and their impact on health-related quality of life (HRQoL) in a low-income population in Macao. METHODS: This cross-sectional study targeted the adult beneficiaries of local food bank program. The program was established to provide food assistance to the residents who had low income but were ineligible for government financial assistance. All data were collected through interview and questionnaires. The Patient Health Questionnaire (PHQ-9) was used for assessing depressive symptoms. Information about depression diagnosis was obtained by the self-report method. HRQoL levels were measured by the 12-item Short-Form Health Survey, Version 2.0. RESULTS: A total of 272 study participants were included for analysis. Based on the PHQ-9 scores, 27.6% of the participants suffered from moderate to severe depressive symptoms. Among them, 76% were not diagnosed with depression. Those with moderate to severe depressive symptoms had significantly lower levels of HRQoL (P < 0.001). Anxiety disorders (OR = 9.71, 95% CI = 2.36-40.06), migraine (OR = 3.88, 95% CI = 1.55-9.73), and poor to fair self-rated health (OR = 6.30, 95% CI = 1.95-20.40) were the independent factors associated with moderate to severe depressive symptoms. DISCUSSION: Underdiagnosis of depression was prevalent in this low-income population. There is a need to raise their awareness of mental disorders and improve their access to mental health services.

Compression of Multiple DNA Sequences Using Intra-Sequence and Inter-Sequence Similarities.

Traditionally, intra-sequence similarity is exploited for compressing a single DNA sequence. Recently, remarkable compression performance of individual DNA sequence from the same population is achieved by encoding its difference with a nearly identical reference sequence. Nevertheless, there is lack of general algorithms that also allow less similar reference sequences. In this work, we extend the intra-sequence to the inter-sequence similarity in that approximate matches of subsequences are found between the DNA sequence and a set of reference sequences. Hence, a set of nearly identical DNA sequences from the same population or a set of partially similar DNA sequences like chromosome sequences and DNA sequences of related species can be compressed together. For practical compressors, the compressed size is usually influenced by the compression order of sequences. Fast search algorithms for the optimal compression order are thus developed for multiple sequences compression. Experimental results on artificial and real datasets demonstrate that our proposed multiple sequences compression methods with fast compression order search are able to achieve good compression performance under different levels of similarity in the multiple DNA sequences.

A randomized controlled trial of the effectiveness of an educational intervention on outcomes of parents and their children undergoing inpatient elective surgery: study protocol.

AIM: To report a study protocol that tests the effectiveness of an educational intervention on outcomes of parents and their children who undergo inpatient elective surgery. BACKGROUND: Inadequate children's postoperative pain management remains a global problem. Parents are required to be involved in their child's pain assessment and management, yet they often lack relevant knowledge and skills. Education is an effective strategy for enhancing a person's knowledge, attitudes and behaviour. However, few studies have examined its effectiveness in parents and their children undergoing inpatient elective surgery. DESIGN: Randomized controlled trial and embedded qualitative process evaluation. METHODS: One hundred and sixty-two pairs of participants (each comprised of one parent and his/her child undergoing inpatient elective surgery) will be recruited (protocol approved in January 2013). Participants will be randomized to either a Control group (routine care), an Intervention group 1 (routine care and an educational intervention with face-to-face teaching), or an Intervention group 2 (routine care and an educational intervention without face-to-face teaching). Outcome measures will include parents' knowledge, attitude and behaviour related to postoperative pain management; their child's postoperative pain; and parents' satisfaction with their child's pain management at baseline and around 6, 12 and 24 hours after the operation. DISCUSSION: A standardized educational intervention protocol and detailed study procedure have been developed in this study to improve parents' knowledge, attitude and behaviour related to postoperative pain management and reduce their child's postoperative pain.

A joint framework for missing values estimation and biclusters detection in gene expression data.

DNA microarray experiment unavoidably generates gene expression data with missing values. This hardens subsequent analysis such as biclusters detection which aims to find a set of co-expressed genes under some experimental conditions. Missing values are thus required to be estimated before biclusters detection. Existing missing values estimation algorithms rely on finding coherence among expression values throughout the data. In view that both missing values estimation and biclusters detection aim at exploiting coherence inside the expression data, we propose to integrate these two steps into a joint framework. The benefits are twofold; the missing values estimation can improve biclusters analysis and the coherence in detected biclusters can be exploited for accurate missing values estimation. Experimental results show that the bicluster information can significantly improve the accuracy in missing values estimation. Also, the joint framework enables the detection of biologically meaningful biclusters.

Regulation of myelopoiesis by CD137L signaling.

CD137 ligand (CD137L) has emerged as a powerful regulator of myelopoiesis that links emergency situations, such as infections, to the generation of additional myeloid cells, and to their activation and maturation. CD137L is expressed on the cell surface of hematopoietic stem and progenitor cells (HSPC) and antigen presenting cells (APC) as a transmembrane protein. The signaling of CD137L into HSPC induces their proliferation and differentiation to monocytes and macrophages, and in monocytes CD137L signaling induces differentiation to potent dendritic cells (DC). CD137L signaling is initiated by CD137 which is expressed by T cells, once they become activated. Some of these activated, CD137-expressing T cells migrate from the site of infection to the bone marrow where they interact with HSPC to induce myelopoiesis, or they induce monocyte to DC differentiation locally at the site of infection. Therapeutically, induction of CD137L signaling can be utilized to reinitiate myeloid differentiation in acute myeloid leukemia cells, and to generate potent DC for immunotherapy.

CD137 ligand signalling induces differentiation of primary acute myeloid leukaemia cells.

CD137 ligand (CD137L), a member of the tumour necrosis factor family, is expressed as a cell surface molecule. Engagement of CD137L on haematopoietic progenitor cells induces monocytic differentiation, and in peripheral monocytes CD137L signalling promotes differentiation to mature dendritic cells. We hypothesized that CD137L signalling would also induce differentiation in transformed myeloid cells. Here we show that recombinant CD137 protein, which crosslinks CD137L and initiates reverse CD137L signalling in myeloid cells, induces morphological changes (adherence, spreading), loss of progenitor markers (CD117), expression of maturation markers (CD11b, CD13) and secretion of cytokines that are indicative of myeloid differentiation. Under the influence of CD137L signalling, acute myeloid leukaemia (AML) cells acquired expression of co-stimulatory molecules (CD80, CD86, CD40), the dendritic cell marker CD83 and dendritic cell activities, enabling them to stimulate T cells. CD137L signalling induced differentiation in 71% (15 of 21) of AML samples, irrespective of French-American-British classification and CD137L expression level. However, the type of response varied with the AML subtype and patient sample. In summary, this study demonstrated that CD137L signalling induced differentiation in malignant cells of AML patients, and suggests that it may be worthwhile to investigate treatment with recombinant CD137 protein as a potential novel therapeutic approach for AML.

Potentially inappropriate prescribing and drug-drug interactions among elderly Chinese nursing home residents in Macao.

BACKGROUND: The ageing of the population has become a concern all over the world, including Macao. In general, older people are more prone to adverse drug events which can result from potentially inappropriate medication (PIM) use and drug-drug interactions (DDIs). OBJECTIVE: This study was designed to evaluate the prevalence of PIM use and DDIs among elderly nursing home residents in Macao, and to find out the factors associated with these drug-related problems. SETTING: This study was conducted in the largest nursing home in Macao, with a bed capacity of 168. METHOD: All data of this cross-sectional study were collected from medical charts and medication administration records. PIM use was determined by the screening tool of older person's prescription (STOPP) criteria and potential DDIs were detected using the preset criteria of two compendia, Drug-Reax and Lexi-Interact. Multivariate logistic regression analysis was performed to identify the independent factors associated with each drug-related problem. MAIN OUTCOME MEASURES: The proportions of elderly nursing home residents who regularly used PIMs and who were exposed to DDIs. RESULTS: A total of 114 elderly residents were eligible for PIM analysis. They consumed an average of 6.9 ± 3.1 different medications. About 46.5 % of them regularly used one or more PIMs. The prevalence of DDIs was 37.8 % among the 111 elderly residents who consumed at least two different medications. An increased number of drugs used was identified as the independent factor associated with PIM use and DDIs (p < 0.05). However, the use of STOPP-related PIMs did not appear to raise the likelihood of DDIs among the study population. CONCLUSION: Both PIM use and DDIs are common among elderly nursing home residents in Macao. Further studies should be conducted to evaluate the clinical outcomes of pharmacist-led interventions for elderly residents in the local nursing home setting.

A randomized, double-blind, controlled trial of a Chinese herbal formula (Er-Xian decoction) for menopausal symptoms in Hong Kong perimenopausal women.

OBJECTIVE: The aim of this study is to investigate the effectiveness and safety of a Chinese herbal formula, Er-Xian decoction (EXD), in the treatment of menopausal symptoms among Hong Kong perimenopausal women. METHODS: A randomized, double-blind, controlled trial was conducted for 12 weeks among 108 Hong Kong perimenopausal women who reported Menopause Rating Scale (MRS) total scores of 28 or higher. Posttreatment follow-up was performed 3 months after the intervention. The primary outcome measure was the frequency and severity of hot flushes. The secondary outcome measures included the MRS, the Menopause-Specific Quality of Life questionnaire, and serum hormone levels. RESULTS: Among 108 participants, 101 participants finished the study. EXD significantly reduced the mean (SD) frequency of hot flushes from 5.8 (5.0) to 2.2 (3.0) in the treatment group and from 5.0 (3.8) to 2.4 (2.5) in the placebo group (P = 0.04). The mean (SD) hot flush score was also reduced from 19.6 (6.6) to 4.9 (7.8) in the treatment group and from 16.6 (5.4) to 7.0 (6.4) in the placebo group (P = 0.02). The superiority of EXD to placebo was also observed with greater improvement in the total scores for the MRS (P = 0.03) and the Menopause-Specific Quality of Life questionnaire (P < 0.01). There were no differences in serum hormone levels between the EXD group and the placebo group. There were no serious adverse events, and the safety indices of whole blood counts, renal function, and liver function were within the normal range before and after treatment. CONCLUSIONS: The Chinese herbal formula EXD is superior to placebo in reducing the frequency and severity of hot flushes and in improving menopausal symptoms in Hong Kong perimenopausal women. It is well tolerated, with no serious adverse events noted during the study period.

A comparison of tenofovir-associated renal function changes in HIV-infected African Americans vs Caucasians.

BACKGROUND: The effects of tenofovir on renal function have been measured in multiple studies. Although African Americans are at a higher risk of developing chronic kidney disease, there are limited data examining the influence of race on tenofovir-related nephrotoxicity. METHODS: This was a retrospective study of human immunodeficiency virus (HIV)-infected patients at a university-affiliated HIV clinic who were prescribed tenofovir between July 1, 2001, and January 31, 2009. The primary outcome was mean change in creatinine clearance. Secondary endpoints assessed the odds of tenofovir discontinuation secondary to nephrotoxicity, and prevalence of grade 2 to 4 serum creatinine elevation and hypophosphatemia during treatment. MAIN FINDINGS: A total of 65 African American and 186 Caucasian patients were included. There were no statistically significant differences in mean change in creatinine clearance, as estimated by the Cockcroft-Gault (-14.2 mL/min vs -15.9 mL/min [P = .525]) and modification of diet in renal disease formulas (-17.2 mL/min/1.73 m2 vs -15.6 mL/min/1.73 m2 [P = .585]) between African Americans and Caucasians. Rates of tenofovir discontinuation secondary to nephrotoxicity were 6.2% and 1.6%, respectively (P = .076). Elevated baseline serum creatinine and female gender may be potential predictors for tenofovir discontinuation. CONCLUSION: There were no statistically significant differences in tenofovir-related renal function changes by race as observed in our HIV patient population.