Lipid production in Nannochloropsis gaditana is doubled by decreasing expression of a single transcriptional regulator.

Lipid production in the industrial microalga Nannochloropsis gaditana exceeds that of model algal species and can be maximized by nutrient starvation in batch culture. However, starvation halts growth, thereby decreasing productivity. Efforts to engineer N. gaditana strains that can accumulate biomass and overproduce lipids have previously met with little success. We identified 20 transcription factors as putative negative regulators of lipid production by using RNA-seq analysis of N. gaditana during nitrogen deprivation. Application of a CRISPR-Cas9 reverse-genetics pipeline enabled insertional mutagenesis of 18 of these 20 transcription factors. Knocking out a homolog of fungal Zn(II)2Cys6-encoding genes improved partitioning of total carbon to lipids from 20% (wild type) to 40-55% (mutant) in nutrient-replete conditions. Knockout mutants grew poorly, but attenuation of Zn(II)2Cys6 expression yielded strains producing twice as much lipid (∼5.0 g m-2 d-1) as that in the wild type (∼2.5 g m-2 d-1) under semicontinuous growth conditions and had little effect on growth.

A community-based study of the relationship between somatic and psychological distress in Hong Kong.

Although the predominantly somatic presentation of distress has been used to explain low rates of emotional illnesses and health service use in Chinese communities, this concept of somatization has not been examined by concurrently studying the profile of somatically and psychologically distressed Chinese individuals. A random population-based sample of 3014 adults underwent a structured telephone interview that examined their sociodemographic characteristics, somatic distress (Patient Health Questionnaire-15, PHQ-15), non-specific psychological distress (Kessler Scale-6, K6), health service use, and functional impairment. Four groups of individuals identified by PHQ-15 and K6 cut-off scores were compared. Results showed that PHQ-15 and K6 scores were positively correlated. The large majority of respondents (85.9%) reported both somatic and psychological distress. The proportions of Low Distress Group, Somatically Distressed Group, Psychologically Distressed Group, and Mixed Distress Group were 69.2%, 5.0%, 15.8%, and 10.0%, respectively. Specific age range, male gender, greater family income, higher education level, and retirement were associated with decreased odds of somatic and/or psychological distress. Although psychological distress best predicted impairment, somatic distress best predicted health service use. Mixed distress predicted most impairment and health service use. Thus, psychological distress and somatic distress commonly coexist across Chinese sociodemographic groups. This speaks against the conventional notion of somatization and is consistent with recent findings of a higher prevalence of emotional illnesses in Chinese people. That psychologically distressed individuals are more impaired but less inclined to seek help than somatically distressed individuals may partly explain low levels of help-seeking for mental disorders found in epidemiological studies.

A community-based epidemiological study of health anxiety and generalized anxiety disorder.

This community-based study examined the frequency of worry about personal health in respondents with and without generalized anxiety disorder (GAD), and the impact of health anxiety on the disorder. A random community-based telephone survey of 5118 Chinese respondents aged 18-64 was conducted. A fully structured questionnaire covered the DSM-IV-TR criteria of GAD, major depressive episode (MDE), eight domains of worry, the seven-item Whiteley Index (WI-7), health service use, and socio-demographic information. Worry about personal health ranked fifth (75.6%) among eight domains of worries examined. GAD respondents with high level of health anxiety were significantly older, less educated, and had lower family income. High health anxiety significantly increased the occurrence of one-year MDE, previous persistent worry, previous persistent low mood, number of domains of worries, number of non-core DSM-IV-TR GAD symptoms, health service use, and mistrust of doctors. Health anxiety is common in GAD and may signify greater severity of the disorder.

Gastrointestinal dysfunction in Chinese patients with fat-phobic and nonfat-phobic anorexia nervosa.

Although gastrointestinal and other somatic symptoms are common in patients with anorexia nervosa (AN), and a growing cross-national literature indicates that not all anorexic patients exhibit the core diagnostic symptom of fat phobia, the relationship between somatic symptoms and anorexic illness remains unclear. Our objective was to evaluate gastrointestinal dysfunction (GD) in Chinese patients with fat phobic (FP) and nonfat phobic (NFP) anorexia nervosa. A total of 113 FP- and 28 NFP-AN outpatients underwent standardized clinical assessment and completed a new 8-item GD scale and other psychopathological measures. A majority (79.4%) of AN patients reported at least some gastrointestinal complaints on the GD scale (Cronbach's alpha = 0.78). FP-AN patients scored significantly higher than NFP-AN patients. The FP-AN with high GD group reported a higher level of specific and general psychopathology than the FP- and NFP-AN with low GD groups. Contrary to expectations, gastrointestinal symptoms were more common in FP-AN than NFP-AN patients. FP-AN with high GD was more severe than FP- and NFP-AN with low GD. The current fat phobic conceptualization of the anorexic illness may overlook its phenomenologic heterogeneity and reify a dichotomy that is inconsistent with patients' varied experience of food restriction.

Prognostic significance of plasma osteopontin in patients with locoregionally advanced head and neck squamous cell carcinoma treated on TROG 02.02 phase III trial.

PURPOSE: High plasma osteopontin (OPN) levels have been reported to be an adverse prognostic factor in head and neck squamous cell carcinomas (HNSCC), correlate with tumor hypoxia, and be predictive of benefit from hypoxia-targeted therapy. We sought to confirm the prognostic and predictive significance of OPN in patients treated on a large international trial. EXPERIMENTAL DESIGN: Patients with stage III/IV HNSCC were randomized to receive definitive radiotherapy concurrently with cisplatin or cisplatin plus the hypoxic cell cytotoxin, tirapazamine (TPZ). Eligibility criteria for this prospective substudy included plasma sample availability for OPN assay by ELISA and absence of major radiation therapy deviations (N = 578). OPN concentrations were analyzed for overall survival (OS) and time to locoregional failure (TTLRF), adjusting for known prognostic factors. Additional analysis was carried out in patients with available tumor p16(INK4A) staining status. RESULTS: The median OPN level was 544 ng/mL (range: 7-2,640). High OPN levels were not associated with worse OS (relative HR, 1.03 for highest tertile) or TTLRF (relative HR 0.91 for highest tertile). There was no interaction between OPN and treatment arm for OS or TTLRF (P = 0.93 for OS; P = 0.87 for TTLRF). For the highest tertile the 2-year OS was 66% on control arm and 67% on TPZ arm (HR = 1.11, P = 0.67). Similarly for p16(INK4A) negative patients in the highest tertile, the 2-year OS was 61% on control arm and 63% on TPZ arm (HR = 1.05, P = 0.86). CONCLUSIONS: We found no evidence that high plasma OPN levels were associated with an adverse prognosis in HNSCC, or were predictive of benefit with hypoxia targeting therapy.

Performance of the 6-item Kessler scale for measuring serious mental illness in Hong Kong.

BACKGROUND: The 6-item Kessler scale (K6) promises to be a valuable epidemiological tool for assessing serious mental illness (SMI) in communities with limited resources for psychiatric research and treatment. Its performance in Chinese community has not been studied with reference to clinically assessed SMI. METHOD: From a representative telephone-based population survey (n = 3014) that administered the K6, 153 participants were readministered the K6 and, on the same day, interviewed face-to-face by clinicians using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Axis I Disorder. Predictive indicators such as McNemar χ(2), area under receiver operating characteristic curve and stratum-specific likelihood ratios were used to investigate the concordance between the K6 and clinical status of SMI, individual-level predicted probabilities of having SMI, and the weighted prevalence of SMI in the community. RESULT: The K6 exhibited high internal consistency and test-retest reliability. Factor analysis revealed 2 correlating components composed of depression and anxiety. Matching of K6 caseness and SMI status showed that at the cutoff of 12/13, the area under receiver operating characteristic curve was moderate (0.69). The K6 had high specificity and was a stronger screen-out than screen-in tool for SMI. The weighted prevalence estimate of SMI in Hong Kong was 6.5%. A person scoring 13 or above on the K6 has a probability of at least 22.2% of having SMI. CONCLUSION: The Chinese K6 is reliable and generates the likelihood of SMI with substantial concordance with face-to-face clinical interviews in Hong Kong. It is a valuable tool for screening SMI, behavioral risk factor surveillance, and community epidemiological surveys.

A general population study of the Chinese Whiteley-7 index in Hong Kong.

OBJECTIVE: To examine the psychometric properties of the Chinese seven-item Whiteley Index (WI-7) in the general population of Hong Kong. METHODS: A random community-based telephone survey of 3014 respondents aged 15-65 was conducted using a fully structured questionnaire that included the WI-7, 15-item Patient Health Questionnaire (PHQ-15), Sheehan Disability Scale (SDS), and items about the frequency of health service use, perceived helpfulness of doctors, level of satisfaction with doctors, and sociodemographic variables. A sub-sample of 199 respondents was re-interviewed to assess test-retest reliability. RESULTS: The WI-7 exhibited satisfactory internal consistency (Cronbach's α=0.73) and stable one-month test-retest reliability. The most commonly endorsed item was "worrying a lot about one's health" (55.7%), followed by "worrying about getting the disease oneself if it is brought to his/her attention" (48.7%) and "bothered by many different pains and aches" (33.9%). Age, gender, and monthly family income significantly predicted WI-7 score. Confirmatory factor analysis revealed that a 2-factor structure was superior to a 1-factor structure in fitting the data. WI-7 total score was positively associated with PHQ-15 somatic distress, SDS impairment, number of healthcare visits, lower levels of perceived helpfulness of doctors and of satisfaction with doctors. CONCLUSION: The Chinese WI-7 exhibits satisfactory reliability and internal validity in a general population. It is a promising tool for the empirical examination of health anxiety which is a common experience with a mostly typical epidemiological profile among Chinese people in Hong Kong.

Evidence for the 2008 economic crisis exacerbating depression in Hong Kong.

BACKGROUND: There is a lack of population-level research on the relationship between economic contraction and specific mental disorders and how individual-level variables may mediate such a relationship. METHODS: Two cross-sectional surveys using identical random sampling and diagnostic methods were conducted among Hong Kong adults in 2007 (January-February) and 2009 (April-May). 3016 and 2011 Chinese speaking adults completed structured interviews based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV). RESULTS: The twelve-month prevalence of DSM-IV major depressive episode (MDE) was significantly higher in 2009 (12.5%) than 2007 (8.5%). A significant increase of prevalence was found in both male and female respondents, those in the highest (55-65 years) age group, having secondary education level, were married/cohabited, divorced/widowed, employed, home-making, and in the lowest and high-middle income groups. Those with large investment loss had a significantly higher prevalence of MDE (20.3%) than those with less or no-investment loss (9.2-13.7%). The symptom pattern and severity of depression in 2007 and 2009 were similar. CONCLUSION: Economic contraction triggered by a global financial crisis was associated with a significant increase in the risk of depression in the Hong Kong population. This increase was not explained primarily by unemployment and had a significant contribution from employed, home-making, high-middle income, and having married people. A holistic perspective that encompasses both ecological and individual levels of analysis is essential for studying the net impact of economic contraction on depression across communities and sociodemographic groups and for health policy planning.

The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong (1987-2007).

OBJECTIVE: To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007. METHOD: Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987-1997 (n = 67) and 1998-2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared. RESULTS: Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients. DISCUSSION: The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries.

Generalized anxiety disorder with and without excessive worry in Hong Kong.

BACKGROUND: Two previous U.S. studies found that although generalized anxiety disorder (GAD) without self-perceived excessive worry was milder than GAD with excessive worry, its persistence, impairment, and risk for subsequent onset of other mental disorders were still substantial. This study examined the implications of relaxing the "excessiveness" criterion on the prevalence and socio-demographic profile of GAD in a Chinese population sample by considering both self and others' perception of excessive worry. METHOD: 2,005 respondents aged 15-65 years participated in a structured telephone interview that covered socio-demographic profile, 12-month DSM-IV diagnosis of GAD, core depressive symptoms, longest duration of worry episode, number of domains of worry, impairment measured by the Sheehan Disability Scale, and treatment-seeking. Excessive worry was assessed from the perception of both respondents and others as reported by respondents. RESULT: The 12-month prevalence of GAD increased from 3.4 to 4% when the excessiveness requirement was relaxed. Excessive GAD and nonexcessive GAD had similar socio-demographic, symptom, chronicity, impairment, depressive symptom, and treatment-seeking profiles. CONCLUSION: GAD without excessive worry was less common than GAD with excessive worry but was likely to be a valid nosological entity. Future iterations of the DSM-IV should clarify whether excessive worry should be retained and, if so, how individuals who only reported excessive worries perceived by others should be optimally assessed.

Prevalence and correlates of social fears in Hong Kong.

This study examined the 12-month prevalence of social fears and their correlates in Hong Kong. A random telephone survey of 3006 Chinese individuals aged 15-45 years was conducted using a questionnaire that covered sociodemographic information, 14 social fears, age of onset, duration of fear, DSM-IV diagnostic features of social anxiety disorder and other psychosocial features. The prevalence of any social fear was 28.7%. The most common fear was talking to a person of higher status. Respondents with social fears were more likely to be younger and female than those without. A two-step cluster analysis revealed three subgroups with 1-3 (34.0%), 4-7 (43.9%) and 8-13 (22.0%) fears, respectively. As the number of social fears increased across these subgroups, respondents exhibited younger age of onset, more physical symptoms, avoidance behavior, impairment, and suicidality. The prevalence and profile of social fears among Chinese people resembled those of their Western counterparts.

A community epidemiological survey of generalized anxiety disorder in Hong Kong.

Generalized anxiety disorder (GAD) is understudied in Asian communities. There were 3,304 Chinese subjects (aged 15-60 years) randomly drawn from the general population of Hong Kong and successfully interviewed. The participation rate was 65.8%. The six-month prevalence of DSM-IV GAD was 4.1%. Over half of the GAD subjects reported palpitations and bowel symptoms. Comorbid depressive mood (65%) and substance use (35%) were common. Forty-one percent of GAD subjects sought help, usually from general practitioners who prescribed tranquilizers after negative physical investigations. Telephone-based surveys have limitations but provide an affordable and destigmatizing alternative to face-to-face surveys for communities with limited mental health resources.

Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong.

BACKGROUND: The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago. The lifetime prevalence rates of DSM-III major depressive disorder (females 2.44% and males 1.29%) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong. METHODS: Each of 5004 adults randomly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode (MDE), sociodemography, help-seeking, and other epidemiological data. RESULTS: Twelve-month prevalence of MDE was 8.4%. The female-to-male ratio was low but typical of surveys in Chinese communities. Female sex and unemployment were associated with increased risk. 32.5% of respondents with MDE reported frequent thoughts of suicide. Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low. LIMITATIONS: Response rate was low though cooperation rate was moderately high. Detailed demography, comorbidity, and clinical reappraisal interviews were not covered. CONCLUSIONS: Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people. Although longitudinal studies are needed to confirm a genuine increase in prevalence, depression is likely to be more common in Hong Kong than previously suggested. High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment.

A community-based telephone survey of social anxiety disorder in Hong Kong.

BACKGROUND: Research on the prevalence and characteristics of social anxiety disorder (SAD) is lacking in Chinese communities. METHODS: A random telephone survey of 3006 individuals aged 15-45 years in Hong Kong was conducted using a questionnaire that generated DSM-IV diagnosis and other clinical characteristics of SAD. RESULTS: 3.2% of the participants surveyed met criteria for SAD in the previous year. Their demographic and clinical characteristics are typical. Only 8.7% of sufferers sought medical treatment. LIMITATIONS: No clinical reappraisal was conducted. Severity and comorbidity of SAD were not examined. CONCLUSIONS: SAD is a cross-culturally real illness. The prevalence, chronicity, and under-treatment of SAD in Chinese people calls for further research and efforts to reduce its treatment gap.

A community-based telephone survey of panic disorder in Hong Kong.

Panic disorder (PD) is prevalent, impairing, under-recognized, and often mistreated. Previous surveys in Chinese communities indicate very low prevalence estimates and provide limited information about its clinical characteristics. A random telephone survey of the general population (age range, 15-60 years) in Hong Kong was conducted using a questionnaire that generated the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-based diagnosis of PD, its symptom profile, help-seeking behavior, and health visit expenditure. Of 3,004 interviews successfully completed, 3.89% of participants (n=117) met criteria of PD in the previous 6 months. Their demographic and clinical profile resembled that of their Western counterparts. Excessive physical investigations and under-treatment were common. Participants with subthreshold PD (14.9%; n=449) exhibited a similar but attenuated clinical profile. We conclude that PD may be more common in Chinese people than what previous epidemiological surveys suggest. The present study is limited by the lack of clinical reappraisal, examination of comorbidity, and a low overall response rate. Nonetheless, it suggests that telephone interviews may provide a cost-effective alternative to large-scale epidemiological surveys for communities with limited resources for mental health research and high unmet needs for treatment.

The experience of SARS-related stigma at Amoy Gardens.

Severe Acute Respiratory Syndrome (SARS) possesses characteristics that render it particularly prone to stigmatization. SARS-related stigma, despite its salience for public health and stigma research, has had little examination. This study combines survey and case study methods to examine subjective stigma among residents of Amoy Gardens (AG), the first officially recognized site of community outbreak of SARS in Hong Kong. A total of 903 residents of AG completed a self-report questionnaire derived from two focus groups conducted toward the end of the 3-month outbreak. Case studies of two residents who lived in Block E, the heart of the SARS epidemic at AG, complement the survey data. Findings show that stigma affected most residents and took various forms of being shunned, insulted, marginalized, and rejected in the domains of work, interpersonal relationships, use of services and schooling. Stigma was also associated with psychosomatic distress. Residents' strategies for diminishing stigma varied with gender, age, education, occupation, and proximity to perceived risk factors for SARS such as residential location, previous SARS infection and the presence of ex-SARS household members. Residents attributed stigma to government mismanagement, contagiousness of the mysterious SARS virus, and alarmist media reporting. Stigma clearly decreased, but never completely disappeared, after the outbreak. The findings confirm and add to existing knowledge on the varied origins, correlates, and impacts of stigma. They also highlight the synergistic roles of inconsistent health policy responses and risk miscommunication by the media in rapidly amplifying stigma toward an unfamiliar illness. While recognizing the intrinsically stigmatizing nature of public health measures to control SARS, we recommend that a consistent inter-sectoral approach is needed to minimize stigma and to make an effective health response to future outbreaks.

Relationship between control and the intermediate term outcome of anorexia nervosa in Hong Kong.

OBJECTIVE: To examine the relationship between control and the intermediate term outcome of Chinese patients with anorexia nervosa. METHOD: 88 patients who fulfilled the DSM-III-R criteria for typical (fat phobic, n=63) and atypical (non-fat phobic, n=25) anorexia nervosa were contacted 9 years after the onset of illness. They completed the Morgan-Russell Outcome Assessment Schedule, Shapiro Control Inventory, and Eating Disorder Inventory-I. RESULTS: 62.2%, 32.4% and 5.4% of patients had good, intermediate, and poor outcome. Outcome was positively correlated with the overall general and specific sense of control, positive sense of control, and negatively with negative sense of control. Patients with good outcome exhibited the least negative modes of control and had the least desire for control. Typical and atypical patients showed similar but not identical control profiles. CONCLUSION: Healthier control was associated with better outcome of anorexia nervosa but their causal relationship was far from clear because of the cross-sectional nature of the present study. The Shapiro Control Inventory is a potentially useful instrument for studying control in eating disorders.

Screening Chinese patients with eating disorders using the Eating Attitudes Test in Hong Kong.

OBJECTIVE: To evaluate the Chinese Eating Attitudes Test (EAT-26) in screening patients with anorexia nervosa (AN) and bulimia nervosa (BN) in Hong Kong. METHOD: A consecutive series of Chinese patients with BN (N = 67) and typical (fat phobic; N = 65) and atypical (nonfat phobic; N = 44) AN underwent clinical assessment and completed the EAT-26. Results were compared with those of Chinese female undergraduates (N = 646). RESULTS: The mean EAT scores for bulimic and typical AN patients were significantly higher than those of undergraduates, but the scores of atypical AN patients were anomalously low. The dieting and bulimia factor, scores and body mass indices entered the classification tree. When compared with using the conventional EAT-26 cutoff, the misclassification rate for typical AN, atypical AN, and BN changed from 41.4% to 52.3%, 88.6% to 43.2%, and 23.9% to 29.9%, respectively. DISCUSSION: Using the EAT-26 in the conventional manner would lead to an underestimate of atypical AN in community surveys. Complementary use of a classification tree improved the prediction of atypical AN, but the EAT-26 remains a suboptimal screening instrument for the community epidemiological study of AN.