An Outcome Study on the Naloxone Education/Dispensing Program for Departure Patients at Cermak Health Services of Cook County.

The objective of this study was to evaluate the utilization of the naloxone nasal spray kit provided to patients after discharge from Cermak Health Services of Cook County (CHS). During May and June 2018, the records of currently incarcerated CHS patients were reviewed to identify patients who (1) received the naloxone education and nasal spray kit upon previous discharge from CHS and (2) were then readmitted to the facility. Of the 76 potential participants, 60 interviews were conducted. This study has shown that 38.3% of patients utilized the nasal sprays provided to them upon discharge. Of those who reported using the nasal spray, 95.7% achieved positive outcomes. This study showed the positive impact the Naloxone Education/Dispensing Program had on patients discharged from CHS. In addition to identifying success in the number of lives saved, the study recognizes the long-term effect on patient safety that emerges from the program.

An Outcome Study on the Naloxone Education/Dispensing Program for Departure Patients at Cermak Health Services of Cook County.

The objective of this study was to evaluate the utilization of the naloxone nasal spray kit provided to patients after discharge from Cermak Health Services of Cook County (CHS). During May and June 2018, the records of currently incarcerated CHS patients were reviewed to identify patients who (1) received the naloxone education and nasal spray kit upon previous discharge from CHS and (2) were then readmitted to the facility. Of the 76 potential participants, 60 interviews were conducted. This study has shown that 38.3% of patients utilized the nasal sprays provided to them upon discharge. Of those who reported using the nasal spray, 95.7% achieved positive outcomes. This study showed the positive impact the Naloxone Education/Dispensing Program had on patients discharged from CHS. In addition to identifying success in the number of lives saved, the study recognizes the long-term effect on patient safety that emerges from the program.

Development and validation of a new cognitive screening test: The Hong Kong Brief Cognitive Test (HKBC).

OBJECTIVES: To develop and examine the validity of a new brief cognitive test with less educational bias for screening cognitive impairment. METHODS: A new cognitive test, Hong Kong Brief Cognitive Test (HKBC), was developed based on review of the literature, as well as the views of an expert panel. Three groups of subjects aged 65 or above were recruited after written consent: normal older people recruited in elderly centres, people with mild NCD (neurocognitive disorder), and people with major NCD. The brief cognitive test, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA), were administered to the subjects. The performance of HKBC in differentiating subjects with major NCD, mild NCD, and normal older people were compared with the clinical diagnosis, as well as the MMSE and MoCA scores. RESULTS: In total, 359 subjects were recruited, with 99 normal controls, 132 subjects with major NCD, and 128 with mild NCD. The mean MMSE, MoCA, and HKBC scores showed significant differences among the 3 groups of subjects. In the receiving operating characteristic curve analysis of the HKBC in differentiating normal subjects from those with cognitive impairment (mild NCD + major NCD), the area under the curve was 0.955 with an optimal cut-off score of 21/22. The performances of MMSE and MoCA in differentiating normal from cognitively impaired subjects are slightly inferior to the HKBC. CONCLUSIONS: The HKBC is a brief instrument useful for screening cognitive impairment in older adults and is also useful in populations with low educational level.

Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial.

BACKGROUND: Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI). METHOD AND FINDINGS: This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses). CONCLUSIONS: Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline. TRIAL REGISTRATION: ClinicalTrials.gov ChiCTR-TRC-11001359.

Psychometric properties of the Hong Kong Chinese (Cantonese) TEMPS-A in medical students.

BACKGROUND: The self-rated auto-questionnaire, the Temperament Scale of Memphis, Pisa, Paris and San Diego (TEMPS-A) is the latest development in the study of temperamental attributes. It has been used and validated in different cultures and countries. The current study aims at validating the Chinese (Cantonese) version of the TEMPS-A and comparing the psychometric properties of the long and short forms of the translated scale. METHODS: The Chinese (Cantonese) version of TEMPS-A was prepared with the standard translation and back-translation method, and approved by the original authors (HSA & KKA). It was administered to medical students of the two local universities, and results were analyzed. RESULTS: 613 valid questionnaires were returned. The Cronbach-Alpha coefficients for the depressive, cyclothymic, hyperthymic, irritable and anxious temperament subscales were 0.63, 0.82, 0.78, 0.80, and 0.84, respectively. The strongest correlation was observed between the cyclothymic and irritable temperaments (R=0.600). Factor analysis yielded one large composite (depressive and anxious) and four homogenous factors, cyclothymic, anxious, hyperthymic and irritable. A newly reconstituted 43-item short form, based on methods suggested by the original authors yielded similar factor structure. LIMITATIONS: The narrow age range of subjects somewhat limits generalization of the results. However, external and concurrent validations against other validated scales have been demonstrated for the original English versions as well as against the most commonly used languages of the world; furthermore, such validation has also been demonstrated for Chinese (Mandarin). CONCLUSIONS: The Chinese (Cantonese) version of TEMPS-A and the reconstituted 43-item short form were found to have good internal consistency and factor structures comparable to those of other languages from diverse cultures across the planet. We propose that the Cantonese TEMPS-A is a useful tool for local use.

A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline.

OBJECTIVES: To compare the effectiveness of Chinese-style mind-body exercise (24 forms simplified Tai Chi) versus stretching and toning exercise in the maintenance of cognitive abilities in Chinese elders at risk of cognitive decline. DESIGN: A 1-year single-blind cluster randomized controlled trial. SETTINGS: Community centers and residential homes for elders in Hong Kong. PARTICIPANTS: A total of 389 subjects at risk of cognitive decline (Clinical Dementia Rating, CDR 0.5 or amnestic-MCI) participated in an exercise intervention program. INTERVENTION: A total of 171 subjects were trained with Tai Chi (Intervention [I]) and 218 were trained with stretching and toning exercise (Control [C]). METHODS: Cognitive and functional performance were assessed at the baseline, and at 5, 9, and 12 months. Data were analyzed using multilevel mixed models. Primary outcomes included progression to clinical dementia as diagnosed by DSM-IV criteria, and change of cognitive and functional scores. Secondary outcomes included postural balance measured by the Berg Balance Scale neuropsychiatric and mood symptoms measured by the Neuropsychiatric Inventory, and Cornell Scale for Depression in Dementia. RESULTS: At 1 year, 92 (54%) and 169 (78%) participants of the I and C groups completed the intervention. Multilevel logistic regression with completers-only analyses controlled for baseline differences in education revealed that the I group had a trend for lower risk of developing dementia at 1 year (odds ratio 0.21, 95% CI 0.05-0.92, P = .04). The I group had better preservation of CDR sum of boxes scores than the C group in both intention-to-treat (P = .04) and completers-only analyses (P = .004). In completers-only analyses, the I group had greater improvement in delay recall (P = .05) and Cornell Scale for Depression in Dementia scores (P = .02). CONCLUSION: Regular exercise, especially mind-body exercise with integrated cognitive and motor coordination, may help with preservation of global ability in elders at risk of cognitive decline; however, logistics to promote long-term practice and optimize adherence needs to be revisited.

The prevalence of sleep problems and their socio-demographic and clinical correlates in young Chinese rural residents.

This study aimed to determine the prevalence of basic forms of sleep disturbance (DIS: difficulty initiating sleep; DMS: difficulty maintaining sleep; and EMA: early morning awakening) as well as insomnia (defined as sleep disturbance accompanied by distress or daily functioning impairment), their socio-demographic and clinical correlates, and the treatment patterns in young Chinese rural people. A sample of 1642 subjects was recruited in Mianyang and interviewed using standardized instruments. Basic socio-demographic and clinical data were collected. The prevalence of at least one type of reported sleep disturbance was 8.0%, while the prevalence of at least one type of insomnia was 2.7%. In multivariate analyses, age between 30 and 34 years, having psychiatric disorders, poorer physical domain of quality of life (QOL), better social QOL domain, depressive symptoms and lower social support were independently associated with more frequent sleep disturbance. At the same time, age between 30 and 34 years, female sex, poorer physical QOL domain, better social QOL domain, depressive symptoms, lower life satisfaction, lower social support and more life events were independently associated with more frequent insomnia. Self-reported sleep disturbances are common among young Chinese residents. The low percentage of treated community residents might suggest a need to promote accessible and easily implemented interventions.

Identifying same-cell contours in image stacks: a key step in making 3D reconstructions.

Identification of contours belonging to the same cell is a crucial step in the analysis of confocal stacks and other image sets in which cell outlines are visible, and it is central to the making of 3D cell reconstructions. When the cells are close packed, the contour grouping problem is more complex than that found in medical imaging, for example, because there are multiple regions of interest, the regions are not separable from each other by an identifiable background and regions cannot be distinguished by intensity differences. Here, we present an algorithm that uses three primary metrics-overlap of contour areas in adjacent images, co-linearity of the centroids of these areas across three images in a stack, and cell taper-to assign cells to groups. Decreasing thresholds are used to successively assign contours whose membership is less obvious. In a final step, remaining contours are assigned to existing groups by setting all thresholds to zero and groups having strong hour-glass shapes are partitioned. When applied to synthetic data from isotropic model aggregates, a curved model epithelium in which the long axes of the cells lie at all possible angles to the transection plane, and a confocal image stack, algorithm assignments were between 97 and 100% accurate in sets having at least four contours per cell. The algorithm is not particularly sensitive to the thresholds used, and a single set of parameters was used for all of the tests. The algorithm, which could be extended to time-lapse data, solves a key problem in the translation of image data into cell information.

Screening of mild cognitive impairment in Chinese older adults--a multistage validation of the Chinese abbreviated mild cognitive impairment test.

OBJECTIVE: To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. METHODS: The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months' follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. RESULTS: The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (chi(2) test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. CONCLUSION: The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored.

Chinese version of the Assessment of Interpersonal Problem Solving Skills.

The study consisted of three phases. In the first phase, we translated the Assessment of Interpersonal Problem Solving Skills (AIPSS) from English to Chinese (CAIPSS), studied the Chinese version's cultural relevance and re-edited the film. A qualified translator translated the package from English to Chinese. Another independent qualified translator backward-translated the materials. An expert panel with 14 experienced clinicians was formed to assess the cultural relevancy of the package. All of them stated that the Chinese version was more culturally relevant. Given the preceding, a culturally relevant CAIPSS was finally developed for use by Hong Kong clinicians. The second phase was to evaluate the reliability of the CAIPSS. Some 30 participants (16 males, 14 females) with schizophrenia were recruited for this study. Internal consistency, test-retest reliability and inter-rater reliability were studied. Results indicated good to excellent internal consistency, excellent inter-rater reliability, and good test-retest reliability. The third phase was the study of convergent validity with another group of 30 participants (13 males, 17 females) with schizophrenia. Results show that CAIPSS had good convergent validity with scales measuring similar constructs. To conclude, this assessment package is user-friendly with good psychometric properties. Local clinicians should feel comfortable using it as an integral part of their daily practice to examine their client's social skills.

Association between cognitive function, behavioral syndromes and two-year clinical outcome in Chinese subjects with late-onset Alzheimer's disease.

OBJECTIVE: To examine associations between behavioral and psychological symptoms of dementia (BPSD), cognitive function and clinical deterioration over 2 years. METHODS: One hundred and four Chinese subjects with late-onset Alzheimer's Disease (AD) who presented to psychogeriatric clinics were followed for an average of 22.5 months. BPSD subgroups were categorized by latent class analysis using the Neuropsychiatric Inventory. Comprehensive cognitive profiles were performed with the Mattis Dementia Scale, the Hong Kong List Learning Test (HKLLT) and the Category Verbal Fluency Test. Interactions between cognitive function and behavioral syndromes were evaluated. Potential predictors for clinical deterioration were computed with logistic regression analysis. RESULTS: Three latent classes of subjects with similar behavioral syndromes were identified: Low BPSD (44%), Affective (32%) and Psychosis (24%) groups. Association between cognitive functions and BPSD was not significant. At follow-up, a higher proportion of subjects in the Affective (70%) and Low BPSD (49%) groups remained stable at the same Clinical Dementia Rating. Baseline scores in the "recognition" test of the HKLLT and age were significant predictors for "deceased" status at 2-year follow-up. CONCLUSION: The lack of association between behavioral syndromes and cognitive function suggests that these relatively independent dimensions of dementia should be examined individually for different prognostic significance.

Presynaptic regulation of quantal size by the vesicular glutamate transporter VGLUT1.

A fundamental question in synaptic physiology is whether the unitary strength of a synapse can be regulated by presynaptic characteristics and, if so, what those characteristics might be. Here, we characterize a newly proposed mechanism for altering the strength of glutamatergic synapses based on the recently identified vesicular glutamate transporter VGLUT1. We provide direct evidence that filling in isolated synaptic vesicles is subject to a dynamic equilibrium that is determined by both the concentration of available glutamate and the number of vesicular transporters participating in loading. We observe that changing the number of vesicular transporters expressed at hippocampal excitatory synapses results in enhanced evoked and miniature responses and verify biophysically that these changes correspond to an increase in the amount of glutamate released per vesicle into the synaptic cleft. In addition, we find that this modulation of synaptic strength by vesicular transporter expression is endogenously regulated, both across development to coincide with a maturational increase in vesicle cycling and quantal amplitude and by excitatory and inhibitory receptor activation in mature neurons to provide an activity-dependent scaling of quantal size via a presynaptic mechanism. Together, these findings underscore that vesicular transporter expression is used endogenously to directly regulate the extent of glutamate release, providing a concise presynaptic mechanism for controlling the quantal efficacy of excitatory transmission during synaptic refinement and plasticity.

Schizophrenia with prominent catatonic features ('catatonic schizophrenia'): I. Demographic and clinical correlates in the chronic phase.

This study set out to determine the frequency of catatonic syndrome in chronic schizophrenia and its association with sociodemographic, clinical, and treatment variables. A cross-sectional assessment of a randomly selected cohort of patients (n=225; mean age=42+/-7 years; mean length of illness=20.4+/-7.5 years) with DSM-IV schizophrenia was employed using standard rating instruments for catatonia, drug-induced extrapyramidal symptoms (EPS), and psychotic, depressive, and obsessive-compulsive symptoms. Using a rather narrow definition of catatonia [the presence of four or more signs/symptoms with at least one having a score '2' or above on the Bush-Francis Catatonia Rating Scale (BFCRS)], 72 subjects (32%) met the criteria for the catatonia group (mean number of catatonic signs/symptoms=5.9+/-2.0; mean sum score of 8.7+/-3.4 on the BFCRS). The frequency distribution of catatonic signs/symptoms in the catatonic group and in the whole sample was very similar, with mannerisms, grimacing, stereotypes, posturing, and mutism being the most frequent. In the logistic regression analysis, catatonic subjects had a significantly earlier age of onset, more negative symptoms, and were more likely to receive benzodiazepines than their noncatatonic counterparts. In multiple regression analysis, the severity of catatonia as indicated by the sum score of BFCRS was predicted only by earlier age of onset and negative symptoms. Using relatively narrow criteria, this study confirmed that, if methodically assessed, catatonic signs and symptoms are prevalent in patients with chronic schizophrenia. Catatonia can be differentiated from EPS. Catatonic features indicate a generally poor prognosis in the chronic phase of schizophrenia.

Ethnoepidemiology of postnatal depression. Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong.

BACKGROUND: Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare. AIMS: To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods. METHOD: A total of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months postpartum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum. RESULTS: Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue - a Chinese post-partum custom of mandated family support - was associated with better social support and a slightly lower risk of postnatal depression. CONCLUSIONS: Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.

Tardive dyskinesia in Chinese inpatients with chronic schizophrenia.

The objective of the study was to determine the point prevalence of tardive dyskinesia (TD) in Chinese inpatients with chronic schizophrenia and its association with sociodemographic, clinical and treatment variables and other movement disorders. A cross-sectional assessment of a randomly selected cohort of inpatients (n=225; mean age=42+/-7 years) with DSM-IV schizophrenia was employed using standard rating instruments for TD and other drug-induced movement disorders, in addition to catatonia, and psychotic, negative, depressive and obsessive-compulsive symptoms. Using Schooler and Kane's criteria, 15 subjects (6.7%) had TD. Patients with TD were significantly older and significantly fewer of them were taking antiparkinsonian medication than subjects without TD. There was no significant difference between the TD and non-TD groups with respect to other demographic, clinical and treatment variables including sex, age of onset, length of contact with psychiatric services, current antipsychotic dosage, negative symptoms, catatonia and parkinsonism. The results confirmed the low prevalence of TD in patients with chronic schizophrenia compared to those found in Caucasian patients. The study has also replicated the association of TD in Chinese schizophrenia patients with older age but failed to demonstrate any association between TD and other demographic or clinical characteristics including catatonia.

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.

The prevalence of narcolepsy among Chinese in Hong Kong.

Narcolepsy is a lifelong, crippling sleep disorder. Although the discovery of the hypocretin system has been a breakthough in genetics, the epidemiological aspects of narcolepsy remain elusive. Ethnic predisposition was suggested to partially account for the 2,500-fold difference in the reported prevalence rates of narcolepsy between Japanese (0.59%) and Israeli Jews (0.00023%). We carried out a general population study, conducting a random telephone survey with a structured questionnaire, which included a validated screening instrument (a Chinese version of the Ullanlinna Narcolepsy Scale). It was followed by clinical-polysomnographic-HLA confirmation of the subjects determined to be positive for narcolepsy based on the questionnaire. Of 9,851 subjects interviewed, 28 subjects (0.28%, 58% female) were screened positive. Ninety percent had a second detailed interview, 64% had HLA typing, and over half of them had a sleep assessment. Only three subjects were found to have genuine narcolepsy. The most common nonnarcolepsy diagnoses were sleep apnea syndrome and sleep-wake schedule disorder. The prevalence rate of narcolepsy in Southern (Hong Kong) Chinese was found to be 0.034% (95% confidence interval = 0.010-0.117%). All available narcoleptic subjects were HLA DRB1-1501 positive and 50% were DQB1-0602 positive. The prevalence rate of narcolepsy among Chinese is comparable to the rates for other populations in studies with stringent epidemiological designs, suggesting that major cross-ethnic differences in the prevalence rates of narcolepsy previously reported likely resulted from methodological limitations.