Prevalence of medical students' burnout and its associated demographics and lifestyle factors in Hong Kong.

BACKGROUND: Burnout causes personal suffering and adverse professional consequences. It is prevalent among medical students, although the relationship between burnout and lifestyle factors are understudied in Chinese medical students. Thus, this study aims to (i) estimate the prevalence of burnout among medical students in Hong Kong (HK) and (ii) delineate the relationship between burnout and various lifestyle factors. METHOD: 1,341 students were invited to complete a questionnaire from September to December 2017. Burnout was measured by the Maslach Burnout Inventory. Lifestyle factors including drinking habit, sleep habit and quality, and exercise level were assessed by validated instruments, including Alcohol Use Disorder Identification Test (AUDIT-C), Pittsburgh Sleep Quality Index (PSQI), and Godin-Shephard Leisure-Time Physical Activity (GSLTPA), respectively. Smoking status and use of self-medications were also inquired into, while demographic data was self-reported. Prevalence of burnout with confidence intervals was calculated. Difference in lifestyle and demographic data in students with or without burnout, were compared by t-test and Chi-square/Fisher's exact test. From this, all associations with significant p-value at p<0.1 were entered into the multiple logistic regression model. RESULTS: 731 students (55.6%) responded to the questionnaire. Prevalence of burnout was 27.9% (95%CI: 24.6%-31.5%). Only 3 students in the whole sample smoked; and 6.6% of students drank weekly but rarely drank more than 2 drinks per week. 6.3% and 2.3% self-medicated themselves with medications to improve their sleep and concentration, respectively. Using a multiple logistic regression model, only sleep quality and exercise level were significantly associated with the presence of burnout. CONCLUSION: Around a quarter of medical students in HK suffered from burnout. Burnout was found to be significantly associated with sleep quality and physical exercise. The study also highlighted that HK medical students lived very different lifestyles from those from other countries. More research is needed to design and establish the effectiveness of lifestyle interventional programs that enhance exercise level and sleep quality.

Virtual reality-based prospective memory training program for people with acquired brain injury.

Acquired brain injuries (ABI) may display cognitive impairments and lead to long-term disabilities including prospective memory (PM) failure. Prospective memory serves to remember to execute an intended action in the future. PM problems would be a challenge to an ABI patient's successful community reintegration. While retrospective memory (RM) has been extensively studied, treatment programs for prospective memory are rarely reported. The development of a treatment program for PM, which is considered timely, can be cost-effective and appropriate to the patient's environment. A 12-session virtual reality (VR)-based cognitive rehabilitation program was developed using everyday PM activities as training content. 37 subjects were recruited to participate in a pretest-posttest control experimental study to evaluate its treatment effectiveness. Results suggest that significantly better changes were seen in both VR-based and real-life PM outcome measures, related cognitive attributes such as frontal lobe functions and semantic fluency. VR-based training may be well accepted by ABI patients as encouraging improvement has been shown. Large-scale studies of a virtual reality-based prospective memory (VRPM) training program are indicated.

Virtual reality (VR)-based community living skills training for people with acquired brain injury: A pilot study.

PRIMARY OBJECTIVE: The purpose of the present study was to test the usability and effectiveness of a newly-developed virtual reality (VR)-based community living skills training program for people with acquired brain injury (ABI). METHOD: A small-sample, pre- and post-quasi experimental design was adopted to initially study the efficacy of the VR-based training program. Its usability was also investigated through interviewing subjects. Outcomes were documented in terms of subjects' skills acquisition, self-efficacy in applying the learnt skills and the transfer ratio of the learnt skills to the real environment. Global cognitive ability and the functional independence level were also assessed. RESULTS: Four subjects with ABI (one traumatic brain injury and three stroke subjects) were successfully recruited and received 10 sessions of VR-based community living skills training. All four subjects showed improvement in skills acquisition and memory performance, while three out of four also showed improvement in self-efficacy and demonstrated transfer of skills to the real environment. Usability was initially supported. CONCLUSIONS: Preliminary results suggested positive changes in ABI subjects. The proposed virtual reality (VR) community living skills training software will be further investigated in a randomized controlled trial.

Comparative transcriptomal analysis of isogenic Plasmodium falciparum clones of distinct antigenic and adhesive phenotypes.

Antigenic variation is a survival mechanism developed by the malaria parasite Plasmodium falciparum in order to allow for the establishment of a chronic infection. Here we have studied clonal differences in the transcriptomes of two isogenic P. falciparum clones (3D7S8.4 and 3D7AH1S2) of distinct adhesive and antigenic phenotypes employing a P. falciparum 70-mer oligonucleotide microarray. Fifteen transcripts were highly differentially expressed (greater than a 5-fold change) with five transcripts upregulated in 3D7AH1S2 compared to 3D7S8.4, and ten downregulated. Identified genes encode apical organellar (Gbph2, GBP-related antigen), cell cycle and DNA/RNA processing (SERA-5, RNA-methylase), cell-rescue, defense/virulence (RESA-2, RIFIN, PfEMP1) and hypothetical proteins (PFB0115w, PFI1445w, MAL13P1.121). A number of short and full-length var transcripts were differentially expressed between the clones but one full-length transcript was dominant in both rings and trophozoites (PFD0630c versus PFF0845c). Distinct members of two other variant gene families (phist-a and rif-like), scattered over the subtelomeric areas of the 14 chromosomes, were also found to be clonally and developmentally expressed. Three sibling-clones of 3D7AH1S2 (3D7AH1S1, -S3, -S4) were further studied for the expression of transcripts upregulated in 3D7AH1S2 compared to 3D7S8.4. Individual var and phist-a genes were found expressed in all of the clones while the expression of a rif-like gene and gbph2 varied in-between the clones. The present data provides evidence for complex transcriptional differences between closely related isogenic P. falciparum of distinct adhesive and antigenic characteristics.

Carrier incidence for spinal muscular atrophy in southern Chinese.

A real time quantitative PCR (QPCR) method using TaqMan technology was used to assess the copy number of the two survival motor neuron genes (SMN1 and SMN2) on chromosome 5q13. This allows the accurate determination of carriers for spinal muscular atrophy (SMA), with one copy of SMN1. Analysis of 569 normal southern Chinese individuals revealed a carrier incidence of 1.6%, similar to that found in the western society. Study of 42 obligatory carriers showed a (2 + 0) genotype in two (4.8 %). In 27 SMA patients with homozygous deletion of the SMN1 gene, the number of SMN2 gene correlated with disease phenotype, with 68% of type II and III patients carrying three or more SMN2 genes, whilst the incidence of three or more SMN2 genes in the normal population was 1.57%.

A new cross-over region for hemogloboin-Lepore-Hollandia.

Hb Lepore-Hollandia, identified in a Thai patient, was found to be due to a new cross-over between IVS1-nt 42 and nt 56 of the delta- and beta-globin genes. This differs from a previous case which crossed-over between codon 22 and IVS1-nt 16. Two independent homologous unequal cross-over events account for these two Lepore-Hollandia genes.

Evaluating the efficacy of tele-cognitive rehabilitation for functional performance in three case studies.

Traumatic brain injury (TBI) is one of the main causes of long-term disability, and its rehabilitation is a challenge to the healthcare team. Tele-rehabilitation, through using advancements in networking and tailor-made software, has been developed and applied to the cognitive rehabilitation of persons with brain injury in the present study. Tele-cognitive rehabilitation uses customized online computer software as a treatment mode. The online treatment software is operated on an interactive tele-communication platform--for example, video conferencing with screen sharing. Through implementing the tele-cognitive rehabilitation activities, therapists can help clients to practise and thus improve their cognitive skills through using the treatment software successfully. Moreover, hypermedia programming techniques allow the therapist to adjust the software to meet the client's treatment needs, so that the treatment is appropriate to his/her functional levels and living environment. Also the software can customize immediate visual, auditory and personalized feedback to motivate the client and training can be set at the right pace for the client's needs. The present study aimed to evaluate the effectiveness and perceived efficacy of the newly developed customized tele-cognitive rehabilitation programme for three subjects with traumatic brain injury through using single-case and qualitative research design. The cognitive factors investigated in this pilot study were, respectively, Chinese word recognition, prospective memory and semantic memory. The subjects had undergone a recruitment process with stipulated screening criteria. A single case experimental design (ABA reversal/withdrawal design) consisted of a no-intervention baseline phase (A), an intervention phase (B) and a no-intervention withdrawal phase (A). There were six sessions in each phase, making a total of 18 sessions. Tele-cognitive rehabilitation software was tailor-made according to each subject's cognitive functional needs. To monitor the change in cognitive functions, variables were tapped by tailor-made assessment and qualitative questionnaires through interviews, and they were then used to explore subjects' opinions of the programme and to test the treatment efficacy of the tele-cognitive rehabilitation programme. Finally, the relationships among the three phases were analysed through visual analysis and trend line analysis by means of the split-middle method. The three persons with brain injury showed improving trends and levels of specific cognitive performance during the treatment phase. Qualitative findings were analysed and confirmed the efficacy of the treatment module. The tele-cognitive rehabilitation approach was well received by subjects. The authors suggest that further replication studies of this kind should be conducted in the future and that more subjects should be recruited to improve the generalizability of the results.

A genetic locus for adolescent idiopathic scoliosis linked to chromosome 19p13.3.

Adolescent idiopathic scoliosis (AIS) is one of the most common orthopedic disorders, affecting up to 4% of schoolchildren worldwide. We studied seven unrelated multiplex families of southern Chinese descent with AIS, consisting of 25 affected members. A genomewide scan with >400 fluorescent microsatellite markers was performed. Multipoint linkage analysis by GENEHUNTER revealed significant linkage of the abnormal phenotype to the distal short arm of chromosome 19, with both a maximum multipoint LOD score and a nonparametric LOD score of 4.93. Two-point linkage analysis by MLINK gave a LOD score of 3.63 (recombination fraction theta[m=f]=0.00) at D19S216. Further high-density mapping and informative recombinations defined the AIS critical region in the vicinity of D19S216, flanked by D19S894 and D19S1034, spanning 5.2 cM on the sex-averaged genetic map on chromosome 19p13.3.