1
|
Parada-Kusz M, Clatworthy AE, Goering ER, Blackwood SM, Salm EJ, Choi C, Combs S, Lee JSW, Rodriguez-Osorio C, Tomita S, Hung DT. A tryptophan metabolite modulates the host response to bacterial infection via kainate receptors. bioRxiv 2023:2023.08.16.553532. [PMID: 37645903 PMCID: PMC10462041 DOI: 10.1101/2023.08.16.553532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Bacterial infection involves a complex interaction between the pathogen and host where the outcome of infection is not solely determined by pathogen eradication. To identify small molecules that promote host survival by altering the host-pathogen dynamic, we conducted an in vivo chemical screen using zebrafish embryos and found that treatment with 3-hydroxy-kynurenine protects from lethal gram-negative bacterial infection. 3-hydroxy-kynurenine, a metabolite produced through host tryptophan metabolism, has no direct antibacterial activity but enhances host survival by restricting bacterial expansion in macrophages by targeting kainate-sensitive glutamate receptors. These findings reveal new mechanisms by which tryptophan metabolism and kainate-sensitive glutamate receptors function and interact to modulate immunity, with significant implications for the coordination between the immune and nervous systems in pathological conditions.
Collapse
Affiliation(s)
- Margarita Parada-Kusz
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Anne E. Clatworthy
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Emily R. Goering
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Stephanie M. Blackwood
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Elizabeth J. Salm
- Department of Cellular and Molecular Physiology and Neuroscience, Yale School of Medicine; New Haven, Connecticut, USA
| | - Catherine Choi
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Senya Combs
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Jenny S. W. Lee
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Carlos Rodriguez-Osorio
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| | - Susumu Tomita
- Department of Cellular and Molecular Physiology and Neuroscience, Yale School of Medicine; New Haven, Connecticut, USA
| | - Deborah T. Hung
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital; Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School; Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard; Cambridge, Massachusetts, USA
| |
Collapse
|
2
|
Auyeung TW, Leung JCS, Lu ZH, Tsang C, Lee JSW, Kwok TCY, Woo J. Comparison of the Physical Function Trajectories in Three Birth Cohorts of Chinese Older Adults: A 14-Year Longitudinal Study. J Nutr Health Aging 2023; 27:1056-1062. [PMID: 37997728 DOI: 10.1007/s12603-023-2026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES It remains uncertain whether the favorable trend of reduction in physical disabilities has become reversed in the recent-born cohorts of older adults. This study aimed to compare the rate of decline with time in self-reported Instrumental Activity of Daily Living (IADL) difficulties, objective measurement of gait speed and grip strength, in three birth cohorts of Chinese older adults. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Four thousand Chinese older adults aged 65 years or above in three birth cohorts (1934-1938, 1929-1933, 1905-1928) were recruited from the community in Hong Kong. MEASUREMENTS Grip strength, gait speed and IADL difficulties were measured between 2001 to 2017. Joint models were used to examine the trajectories of grip strength, gait speed and IADL difficulties over time, and the interaction effect of age-by-cohort (or also age2-by-cohort) was also examined. RESULTS The recently born cohort (1934 - 1938) had worse grip strength and more IADL difficulties at the same age than the earlier two cohorts (1929 - 1933; 1905 - 1928). Furthermore, the most recently born cohort also followed a more rapid decline longitudinally with a greater decline observed in gait speed, grip strength and IADL difficulties for women whereas a greater decline in grip strength and IADL difficulties for men. CONCLUSIONS The continuous improvement of physical limitations in old age may have halted and there appears to be a reversal of this favourable trend in the recent born cohort of older adults living in Hong Kong.
Collapse
Affiliation(s)
- T W Auyeung
- Zhi-Hui Lu, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China, Tel: (852) 2252 8895
| | | | | | | | | | | | | |
Collapse
|
3
|
Yeung SSY, Lee JSW, Kwok T. A Nutritionally Complete Oral Nutritional Supplement Powder Improved Nutritional Outcomes in Free-Living Adults at Risk of Malnutrition: A Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:11354. [PMID: 36141627 PMCID: PMC9517313 DOI: 10.3390/ijerph191811354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This randomized controlled trial investigated the effectiveness of an oral nutritional supplement (ONS) on nutrition-related outcomes over 12 weeks in Chinese adults with or at risk of malnutrition. METHODS 88 Chinese adults ≥18 years living independently in Hong Kong with Mini Nutritional Assessment-Short Form (MNA-SF) score ≤11 were randomly assigned to (1) 2 servings/day of nutritionally complete ONS powder made with water (Fresubin® Powder (Fresubin Kabi Deutschland GmbH, Bad Homburg, Germany), 600 kcal, 22.4 g protein) for 12 weeks (intervention group) or (2) no treatment (control group). The primary outcome was increase in body weight (BW) over 12 weeks. Secondary outcomes included improvement in body mass index (BMI), mid-arm circumference (MAC), calf circumference, MNA-SF score, quality of life, self-rated health, frailty, and diet quality. RESULTS The intervention group showed a significantly higher mean increase in BW compared with the control group (1.381 kg, intervention vs control, p < 0.001). The intervention group also showed significantly higher mean increases in BMI, MAC, calf circumference, intake of energy, protein, vitamin D, and calcium compared with the control group. No group differences in the changes of other outcomes were observed. CONCLUSIONS For Chinese free-living adults at risk of malnutrition, daily consumption of a nutritionally complete ONS powder improved nutritional outcomes compared with the control group.
Collapse
Affiliation(s)
- Suey S. Y. Yeung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
- Department of Medicine and Geriatrics, To Po Hospital, Hong Kong, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
4
|
Lam LCW, Chan WC, Kwok TCY, Lee JSW, Yu BML, Lee S, Lee ATC, Ma SL, Cheng ST. Combined physical exercise-working memory training on slowing down cognitive decline in elders with mild clinical Alzheimer disease: a randomised controlled study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:28-30. [PMID: 35701227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - J S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - B M L Yu
- Social Welfare Department, Hong Kong SAR Government
| | - S Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - A T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S T Cheng
- Department of Health and Physical Education, The Education University of Hong Kong
| |
Collapse
|
5
|
Cheng ST, Chen PP, Chow YF, Law ACB, Lee JSW, Leung EMF, Sim TC, Tam CWC, Cheng JOS. An exercise cum cognitive-behavioral intervention for older adults with chronic pain: A cluster-randomized controlled trial. J Consult Clin Psychol 2022; 90:221-233. [PMID: 35099206 DOI: 10.1037/ccp0000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the medium-term effects of a group intervention combining exercise and cognitive-behavioral strategies (EC) on older adults with chronic pain. METHOD One hundred and fifty-two Hong Kong Chinese older adults with chronic pain affecting bones, muscles, and joints were randomized by clinic/social center to receive 10 weekly sessions of EC or pain education (control). The primary (pain intensity) and secondary outcomes (pain disability, pain self-efficacy, pain catastrophizing, pain coping, depressive symptoms, health-related quality of life, and hip and knee strength) were collected at baseline (T1), postintervention (T2), and 3- (T3) and 6-month follow-ups (T4). The trajectories of intervention effects were modeled by EC × time and EC × time2 interaction terms in mixed-effects regression. RESULTS Significant EC × time and/or EC × time2 interactions were found for pain intensity, pain disability, self-efficacy, and catastrophizing, such that the treatment effect leveled off (pain disability) or diminished (pain intensity and catastrophizing) over time, or continued to increase in a linear fashion (self-efficacy). There was also a treatment main effect on hip/knee muscle strength. Group differences in favor of EC were observed up to 3-month follow-up for pain intensity (d = -0.51) and hip/knee muscle strength (d = 0.38), and up to 6-month follow-up for pain disability (d = -0.60) and self-efficacy (d = 0.52). No group difference was found for catastrophizing at any time point. No treatment effects were found for the other outcomes. CONCLUSION Older people suffering from chronic pain can benefit from a program incorporating both cognitive-behavioral techniques and physical exercise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Yu Fat Chow
- Department of Anaesthesiology & Operating Theatre Services
| | | | | | | | | | | | | |
Collapse
|
6
|
Cheng ST, Chan KL, Lau RWL, Mok MHT, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. Correction to: A multicomponent intervention for the management of chronic pain in older adults: study protocol for a randomized controlled trial. Trials 2021; 22:842. [PMID: 34823551 PMCID: PMC8613921 DOI: 10.1186/s13063-021-05780-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK.
| | - Ka Long Chan
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Rosanna W L Lau
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
| | - Monique H T Mok
- Department of Rehabilitation and Extended Care, Kowloon Hospital, 147A Argyle Street, Kowloon, Hong Kong
| | - Phoon Ping Chen
- Department of Anesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Yu Fat Chow
- Department of Anesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong
| |
Collapse
|
7
|
Fung E, Lui LT, Huang L, Cheng KF, Lau GHW, Chung YT, Ahmadabadi BN, Xie S, Lee JSW, Hui E, So WY, Sung JJY, King I, Goggins WB, Chan Q, Järvelin MR, Ma RCW, Chow E, Kwok T. Characterising frailty, metrics of continuous glucose monitoring, and mortality hazards in older adults with type 2 diabetes on insulin therapy (HARE): a prospective, observational cohort study. The Lancet Healthy Longevity 2021; 2:e724-e735. [DOI: 10.1016/s2666-7568(21)00251-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022]
|
8
|
Cheng ST, Chen PP, Mok MHT, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. Typology of pain coping and associations with physical health, mental health, and pain profiles in Hong Kong Chinese older adults. Aging Ment Health 2021; 25:2169-2177. [PMID: 33016774 DOI: 10.1080/13607863.2020.1821171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify typology of pain coping in older adults and to see whether the coping types or patterns were associated with pain, physical health, and mental health outcomes. METHODS Six hundred and fifty six Chinese older adults were recruited on a convenience basis from social centers in Hong Kong. A 14-item Brief Pain Coping Scale (BPCS) was constructed on the basis of the Chronic Pain Coping Inventory. Outcome measures included pain intensity, pain disability, pain-related cognitions, depressive symptoms, health-related quality of life, and health and physical functioning (in terms of chronic illnesses, basic and instrumental activities of daily living, and self-rated health). Coping typology was identified using latent class analysis. RESULTS A 3-class solution based on BPCS provided the best fit to data. Class 1 used almost all coping strategies on a daily basis, Class 2 used the strategies less frequently, whereas Class 3 adopted few strategies. Yet, Class 3 was basically indistinguishable from Class 1 across the outcome variables, even though the participants had more chronic illnesses and poorer instrumental activities of daily living than those in Class 1. Class 2, however, had the poorest outcome profiles, reporting more pain, disability, depression, and health-related quality of life than the other two classes. The differences in coping could not be explained by the differential effectiveness of coping strategies across groups. CONCLUSION The way coping was used, and the way it was related to pain, mood, health and functioning outcomes, varied substantially across individuals. Implications for coping skills interventions are discussed.
Collapse
Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Phoon Ping Chen
- Department of Anaesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | | | - Yu Fat Chow
- Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong
| |
Collapse
|
9
|
Cheng ST, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. Corrigendum to: Developing a Short Multidimensional Measure of Pain Self-efficacy: The Chronic Pain Self-efficacy Scale-Short Form. Gerontologist 2021; 61:481. [PMID: 32738039 DOI: 10.1093/geront/gnaa085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Phoon Ping Chen
- Department of Anaesthesiology & Operating Services, Alice HoMiu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Yu Fat Chow
- Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kowloon, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong
| |
Collapse
|
10
|
Cheng ST, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. Developing a Short Multidimensional Measure of Pain Self-efficacy: The Chronic Pain Self-efficacy Scale-Short Form. Gerontologist 2020; 60:e127-e136. [PMID: 31112597 DOI: 10.1093/geront/gnz041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The 22-item Chronic Pain Self-efficacy Scale (CPSS) measures three domains of pain self-efficacy: pain management, physical functioning, and coping with symptoms. This study aims to develop a short form (CPSS-SF) that retains the multidimensional structure of the instrument. RESEARCH DESIGN AND METHODS Six hundred sixty-four community-dwelling Chinese older adults aged 60-95 years with chronic pain completed a survey. Confirmatory factor analysis (CFA) was conducted on the 22-item CPSS. Regression analyses were performed to examine the items' correlations with criterion variables. After CPSS-SF items were selected, the performance of CPSS-SF subscales in terms of accounting for pain-related outcomes was compared with the full version. RESULTS CFA supported a modified 3-factor model of the CPSS. On the basis of factor loadings on the 3 dimensions and the items' correlations with pain intensity and pain disability, 11 items were selected for the CPSS-SF, which correlated at .97 with the full version. Regression analyses showed that the associations of the CPSS-SF subscales with pain intensity, pain disability, depressive symptoms, instrumental activities of daily living, and physical and mental health-related quality of life, were indistinguishable from their full-version counterparts. DISCUSSION AND IMPLICATIONS The CPSS-SF is a valid instrument that can be used in lieu of the full scale. Its availability will facilitate the assessment of pain self-efficacy in research and clinical settings due to its brevity but strong psychometric properties. However, the current evidence is limited to Chinese older adults; more research is needed to ascertain its validity in other age and cultural groups.
Collapse
Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Phoon Ping Chen
- Department of Anaesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Yu Fat Chow
- Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kowloon, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong
| |
Collapse
|
11
|
Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020; 21:300-307.e2. [PMID: 32033882 DOI: 10.1016/j.jamda.2019.12.012] [Citation(s) in RCA: 2422] [Impact Index Per Article: 605.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
Abstract
Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
Collapse
Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Prasert Assantachai
- Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tung-Wai Auyeung
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, China
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jenny S W Lee
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ken Sugimoto
- Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Tanaka
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Teimei Zhang
- Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Health, Beijing, China
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| |
Collapse
|
12
|
Abstract
OBJECTIVES Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance. DESIGN Observational study. SETTING We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative. PARTICIPANTS Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre. MEASUREMENTS Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml. RESULTS Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD. CONCLUSIONS Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.
Collapse
Affiliation(s)
- X Yang
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Sng G, Lim DYZ, Sia CH, Lee JSW, Shen XY, Lee ECY, Dalakoti M, Wang KJ, Kwan CKW, Chow WE, Tan RS, Lam CSP, Chua T, Yeo TJ, Chong DTT. P1925Machine learning versus classic electrocardiographic criteria for left ventricular hypertrophy in a young pre-participation cohort: results from the SAFE protocol study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Classic electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) have been well studied in Western populations, particularly in hypertensive patients. However, their utility in Asian populations is not well studied, and their applicability to young pre-participation cohorts is unclear. We sought to evaluate the performance of classical criteria against that of machine learning models.
Aims
We sought to evaluate the performance of classical criteria against the performance of novel machine learning models in the identification of LVH.
Methodology
Between November 2009 and December 2014, pre-participation screening ECG and subsequent echocardiographic data was collected from 13,954 males aged 16 to 22, who reported for medical screening prior to military conscription.
Final diagnosis of LVH was made on echocardiography, with LVH defined as a left ventricular mass index >115g/m2. The continuous and binary forms of classical criteria were compared against machine learning models using receiver-operating characteristics (ROC) curve analysis. An 80:20 split was used to divide the data into training and test sets for the machine learning models, and three fold cross validation was used in training the models. We also compared the important variables identified by machine learning models with the input variables of classical criteria.
Results
Prevalence of echocardiographic LVH in this population was 0.91% (127 cases). Classical ECG criteria had poor performance in predicting LVH, with the best predictions achieved by the continuous Sokolow-Lyon (AUC = 0.63, 95% CI = 0.58–0.68) and the continuous Modified Cornell (AUC = 0.63, 95% CI = 0.58–0.68). Machine learning methods achieved superior performance – Random Forest (AUC = 0.74, 95% CI = 0.66–0.82), Gradient Boosting Machines (AUC = 0.70, 95% CI = 0.61–0.79), GLMNet (AUC = 0.78, 95% CI = 0.70–0.86). Novel and less recognized ECG parameters identified by the machine learning models as being predictive of LVH included mean QT interval, mean QRS interval, R in V4, and R in I.
ROC curves of models studies
Conclusion
The prevalence of LVH in our population is lower than that previously reported in other similar populations. Classical ECG criteria perform poorly in this context. Machine learning methods show superior predictive performance and demonstrate non-traditional predictors of LVH from ECG data. Further research is required to improve the predictive ability of machine learning models, and to understand the underlying pathology of the novel ECG predictors identified.
Collapse
Affiliation(s)
- G Sng
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - D Y Z Lim
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - J S W Lee
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - X Y Shen
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - E C Y Lee
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - K J Wang
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C K W Kwan
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - W E Chow
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - R S Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - C S P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - T Chua
- National Heart Centre Singapore, Singapore, Singapore
| | - T J Yeo
- National University Heart Centre, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Singapore, Singapore
| |
Collapse
|
14
|
Lee JSW, Lim DYZ, Sng G, Shen XY, Wang KJ, Tan BYQ, Sia CH, Dalakoti M, Kwan CKW, Chow WE, Chua TSJ, Yeo TJ, Chong DTT. P308Utility of a prominent R wave in lead V1 of a resting electrocardiogram for detecting significant cardiac pathology in an unselected population of young males. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pre-participation electrocardiogram (ECG) screening is proposed as a means to detect cardiac pathology in asymptomatic individuals, and to select individuals for further cardiac investigation. Isolated ECG finding of Right Ventricular Hypertrophy (RVH) does not require further investigation based on the recent 2017 International Criteria. However, a prominent R wave in V1 has been described in cardiac abnormalities such as Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, cardiomyopathy in Duchenne muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy (ARVC), atrial septal defect and pulmonary hypertension.
Purpose
We sought to examine the utility of a prominent R wave in V1 as a screening criterion in an asymptomatic young male population of predominantly non-athletes, to detect significant structural cardiac pathology.
Methods
As part of the Singapore Armed Forces Electrocardiographic and Echocardiographic (SAFE) Protocol Study, pre-military enlistment screening ECG data was collected from 144,346 males between the ages of 16 to 22 from November 2009 to December 2014. Patients with ECGs with a prominent R wave, defined as an R wave ≥0.5mV in lead V1 with an R/S ratio of ≥1, were sent to a tertiary medical facility for a detailed transthoracic echocardiogram and subsequent cardiologist review. Any cardiac pathology identified was deemed significant if it led to the patient being excluded from participation in vigorous physical activity.
Results
1,144 patients with an isolated prominent R wave in V1 were studied. The mean age was 18.2±1.09 years and 81% were of Chinese ethnicity. None of the patients had echocardiographic evidence of RVH, 5 patients had a dilated right ventricle and 3 individuals had an elevated pulmonary artery systolic pressure. 11 patients (0.96%) had significant structural heart disease known to be associated with a prominent R wave in V1 that excluded them from participation in physical activity. These included large atrial septal defects (n=8), pulmonary stenosis (n=1), total anomalous pulmonary venous return (n=1) and hypertrophic cardiomyopathy (n=1). The test has a sensitivity of 21.6%, specificity of 93.4%, positive predictive value of 0.96% and negative predictive value of 99.8%,
Performance As Screening Criteria Number of Patients With Cardiac Pathology In Those Tested Positive Number of Patients With Cardiac Pathology In Those Tested Negative Positive Predictive Value (%) Negative Predictive Value (%) Sensitivity (%) Specificity (%) 11 40 0.96 99.8 21.6 93.4
Significant Cardiac Pathology Identified
Conclusion
A prominent R in V1 is not associated with echocardiographic RVH, or ARVC even in a large predominantly non-athletic male population. However, 0.96% of such patients would have other significant cardiac pathologies such as a large atrial septal defect.
Collapse
Affiliation(s)
- J S W Lee
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - D Y Z Lim
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - G Sng
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - X Y Shen
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - K J Wang
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - B Y Q Tan
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C K W Kwan
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - W E Chow
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - T S J Chua
- National Heart Centre Singapore, Singapore, Singapore
| | - T J Yeo
- National University Hospital, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Singapore, Singapore
| |
Collapse
|
15
|
Styrkarsdottir U, Stefansson OA, Gunnarsdottir K, Thorleifsson G, Lund SH, Stefansdottir L, Juliusson K, Agustsdottir AB, Zink F, Halldorsson GH, Ivarsdottir EV, Benonisdottir S, Jonsson H, Gylfason A, Norland K, Trajanoska K, Boer CG, Southam L, Leung JCS, Tang NLS, Kwok TCY, Lee JSW, Ho SC, Byrjalsen I, Center JR, Lee SH, Koh JM, Lohmander LS, Ho-Pham LT, Nguyen TV, Eisman JA, Woo J, Leung PC, Loughlin J, Zeggini E, Christiansen C, Rivadeneira F, van Meurs J, Uitterlinden AG, Mogensen B, Jonsson H, Ingvarsson T, Sigurdsson G, Benediktsson R, Sulem P, Jonsdottir I, Masson G, Holm H, Norddahl GL, Thorsteinsdottir U, Gudbjartsson DF, Stefansson K. GWAS of bone size yields twelve loci that also affect height, BMD, osteoarthritis or fractures. Nat Commun 2019; 10:2054. [PMID: 31053729 PMCID: PMC6499783 DOI: 10.1038/s41467-019-09860-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 04/03/2019] [Indexed: 12/12/2022] Open
Abstract
Bone area is one measure of bone size that is easily derived from dual-energy X-ray absorptiometry (DXA) scans. In a GWA study of DXA bone area of the hip and lumbar spine (N ≥ 28,954), we find thirteen independent association signals at twelve loci that replicate in samples of European and East Asian descent (N = 13,608 - 21,277). Eight DXA area loci associate with osteoarthritis, including rs143384 in GDF5 and a missense variant in COL11A1 (rs3753841). The strongest DXA area association is with rs11614913[T] in the microRNA MIR196A2 gene that associates with lumbar spine area (P = 2.3 × 10-42, β = -0.090) and confers risk of hip fracture (P = 1.0 × 10-8, OR = 1.11). We demonstrate that the risk allele is less efficient in repressing miR-196a-5p target genes. We also show that the DXA area measure contributes to the risk of hip fracture independent of bone density.
Collapse
Affiliation(s)
| | | | | | | | - Sigrun H Lund
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | | | | | | | - Florian Zink
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
| | | | | | | | | | | | | | - Katerina Trajanoska
- Department of Epidemiology, ErasmusMC, 3015 GD, Rotterdam, The Netherlands
- Department of Internal Medicine, ErasmusMC, 3015 GD, Rotterdam, the Netherlands
| | - Cindy G Boer
- Department of Internal Medicine, ErasmusMC, 3015 GD, Rotterdam, the Netherlands
| | - Lorraine Southam
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Nelson L S Tang
- Faculty of Medicine, Department of Chemical Pathology and Laboratory for Genetics of Disease Susceptibility, Li Ka Shing Institute of Health Sciences,, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Shenzhen Research Institute, Shenzhen, 518000, China
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Jenny S W Lee
- Faculty of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Hong Kong, China
| | - Suzanne C Ho
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jacqueline R Center
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, 2010, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, 2010, Australia
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - L Stefan Lohmander
- Orthopaedics, Department of Clinical Sciences Lund, Lund University, SE-22 100, Lund, Sweden
| | - Lan T Ho-Pham
- Bone and Muscle Research Lab, Ton Duc Thang University, Ho Chi Minh City, 700000, Vietnam
| | - Tuan V Nguyen
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, 2010, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - John A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, 2010, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, 2010, Australia
- Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
| | - Jean Woo
- Faculty of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping-C Leung
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - John Loughlin
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, NE1 7RU, UK
| | - Eleftheria Zeggini
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, UK
- Institute of Translational Genomics, Helmholtz Zentrum München, 85764, München, Germany
| | | | - Fernando Rivadeneira
- Department of Epidemiology, ErasmusMC, 3015 GD, Rotterdam, The Netherlands
- Department of Internal Medicine, ErasmusMC, 3015 GD, Rotterdam, the Netherlands
| | - Joyce van Meurs
- Department of Internal Medicine, ErasmusMC, 3015 GD, Rotterdam, the Netherlands
| | | | - Brynjolfur Mogensen
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
- Department of Emergengy Medicine, Landspitali, The National University Hospital of Iceland, 101, Reykjavik, Iceland
- Research Institute in Emergency Medicine, Landspitali, The National University Hospital of Iceland, and University of Iceland, 101, Reykjavik, Iceland
| | - Helgi Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
- Department of Medicine, Landspitali-The National University Hospital of Iceland, 101, Reykjavik, Iceland
| | - Thorvaldur Ingvarsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
- Department of Orthopedic Surgery, Akureyri Hospital, 600, Akureyri, Iceland
- Institution of Health Science, University of Akureyri, 600, Akureyri, Iceland
| | - Gunnar Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
- Research Service Center, Reykjavik, 201, Iceland
- Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, 101, Reykjavik, Iceland
| | - Rafn Benediktsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
- Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, 101, Reykjavik, Iceland
| | | | - Ingileif Jonsdottir
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
- Department of Immunology, Landspitali-The National University Hospital of Iceland, 101, Reykjavik, Iceland
| | - Gisli Masson
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
| | - Hilma Holm
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
| | | | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, 107, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen Inc., Reykjavik, 101, Iceland.
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.
| |
Collapse
|
16
|
Woo J, Yang X, Tin Lui L, Li Q, Fai Cheng K, Fan Y, Yau F, Lee APW, Lee JSW, Fung E. Utility of the FRAIL Questionnaire in Detecting Heart Failure with Preserved Ejection Fraction. J Nutr Health Aging 2019; 23:373-377. [PMID: 30932136 DOI: 10.1007/s12603-019-1158-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To test the utility of the FRAIL questionnaire as a screening tool for heart failure. DESIGN Cross sectional study. SETTING Chinese older people in Hong Kong. PARTICIPANTS Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. MEASUREMENTS Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). RESULTS The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. CONCLUSION Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.
Collapse
Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Chan RSM, Yu BWM, Leung J, Lee JSW, Auyeung TW, Kwok T, Woo J. How Dietary Patterns are Related to Inflammaging and Mortality in Community-Dwelling Older Chinese Adults in Hong Kong - A Prospective Analysis. J Nutr Health Aging 2019; 23:181-194. [PMID: 30697629 DOI: 10.1007/s12603-018-1143-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Studies examining dietary patterns and inflammageing in relation to mortality are limited. OBJECTIVE We examined the influence of various dietary patterns on all-cause and cardiovascular disease (CVD) mortality, taking into account demographics, lifestyle factors, and serum inflammatory markers. METHODS We conducted multivariate Cox regression analyses using data from a cohort of community-dwelling older Chinese adults (1,406 men, 1,396 women) in Hong Kong. Baseline interviewer administered questionnaires covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, cognitive function and depressive symptoms. Serum high-sensitivity C-reactive protein (hsCRP) and 25-hydroxyvitamin D (25OHD) were measured. All-cause and CVD mortality data at 14-year follow up were retrieved from an official database. RESULTS In men, higher hsCRP level was associated with lower Diet Quality Index-International (DQI-I) score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score, Okinawan diet score, "vegetables-fruits" pattern score and "snacks-drinks-milk" pattern score. Higher serum 25OHD level was associated with higher Mediterranean Diet Score (MDS) but lower "snacks-drinks-milk" pattern score. None of the dietary pattern scores was associated with all-cause or CVD mortality after adjusting for all covariates. In women, hsCRP level and serum 25OHD level were not associated with any dietary patterns. Higher DQI-I score (HR=0.77 (95% CIs: 0.59, 0.99) highest vs. lowest tertile, p-trend=0.038) and Okinawan diet score (HR=0.78 (95% CIs: 0.61, 1.00) highest vs lowest tertile, p-trend=0.046) was associated with a lower risk of all-cause mortality, whereas higher MIND score (HR=0.63 (95% CI: 0.36, 1.09) highest vs. lowest tertile, p-trend=0.045) was associated with a reduced risk of CVD morality in the multivariate adjusted model. CONCLUSION Higher DQI-I score and Okinawan diet score were associated with a lower risk of all-cause mortality, and higher adherence to the MIND diet was related to a reduced risk of CVD mortality in community-dwelling Chinese older women.
Collapse
Affiliation(s)
- R S M Chan
- Dr Ruth Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Tel: 852-3505-2190, Fax: 852-2637-9215,
| | | | | | | | | | | | | |
Collapse
|
18
|
Cheng ST, Leung CMC, Chan KL, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. The relationship of self-efficacy to catastrophizing and depressive symptoms in community-dwelling older adults with chronic pain: A moderated mediation model. PLoS One 2018; 13:e0203964. [PMID: 30226892 PMCID: PMC6143242 DOI: 10.1371/journal.pone.0203964] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/30/2018] [Indexed: 11/18/2022] Open
Abstract
Self-efficacy has been consistently found to be a protective factor against psychological distress and disorders in the literature. However, little research is done on the moderating effect of self-efficacy on depressive symptoms in the context of chronic pain. This cross-sectional study aimed to examine if pain self-efficacy attenuated the direct relationship between pain intensity and depressive symptoms, as well as their indirect relationship through reducing the extent of catastrophizing when feeling pain (moderated mediation). 664 community-dwelling Chinese older adults aged 60-95 years who reported chronic pain for at least three months were recruited from social centers. They completed a battery of questionnaires on chronic pain, pain self-efficacy, catastrophizing, and depressive symptoms in individual face-to-face interviews. Controlling for age, gender, education, self-rated health, number of chronic diseases, pain disability, and pain self-efficacy, pain catastrophizing was found to partially mediate the connection between pain intensity and depressive symptoms. Furthermore, the relationship between pain intensity and depressive symptoms was moderated by pain self-efficacy. Self-efficacy was also found to moderate the relationship between pain intensity and catastrophizing and the moderated mediation effect was confirmed using bootstrap analysis. The results suggested that with increasing levels of self-efficacy, pain intensity's direct effect on depressive symptoms and its indirect effect on depressive symptoms via catastrophizing were both reduced in a dose-dependent manner. Our findings suggest that pain self-efficacy is a significant protective factor that contributes to psychological resilience in chronic pain patients by attenuating the relationship of pain intensity to both catastrophizing and depressive symptoms.
Collapse
Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, United Kingdom
- * E-mail:
| | - Candi M. C. Leung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ka Long Chan
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoon Ping Chen
- Department of Anaesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Yu Fat Chow
- Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Joanne W. Y. Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Alexander C. B. Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Jenny S. W. Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Edward M. F. Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Cindy W. C. Tam
- Department of Psychiatry, North District Hospital, Hong Kong SAR, China
| |
Collapse
|
19
|
Shen X, Lee JSW, Tan BYQ, Dalakoti M, Sia CH, Yeo TJ, Wang L, Tan BY, Lim PCY, Chua KCM, Ho KL, Lim ETS, Ching CK, Teo WS, Chong DTT. 4286Population based prevalence of Brugada syndrome in a young male population in southeast asia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Shen
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - J S W Lee
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - B Y Q Tan
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - T J Yeo
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - L Wang
- Singapore Armed Forces Medical Corps, HQ Medical Corps, Singapore, Singapore
| | - B Y Tan
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - P C Y Lim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K C M Chua
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K L Ho
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - E T S Lim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - C K Ching
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - W S Teo
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | | |
Collapse
|
20
|
Fung E, Hui E, Yang X, Lui LT, Cheng KF, Li Q, Fan Y, Sahota DS, Ma BHM, Lee JSW, Lee APW, Woo J. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us. Front Physiol 2018; 9:347. [PMID: 29740330 PMCID: PMC5928128 DOI: 10.3389/fphys.2018.00347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.
Collapse
Affiliation(s)
- Erik Fung
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- Faculty of Medicine, Gerald Choa Cardiac Research Centre, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Elsie Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Xiaobo Yang
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leong T. Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - King F. Cheng
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Qi Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiting Fan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daljit S. Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Bosco H. M. Ma
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Tai Po, Hong Kong
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- CUHK Jockey Club Institute of Ageing, Chinese University of Hong Kong, Sha Tin, Hong Kong
| |
Collapse
|
21
|
AuYeung TW, Leung J, Yu R, Lee JSW, Kwok T, Woo J. Decline and Peripheral Redistribution of Fat Mass in Old Age - A Four-Year Prospective Study in 3018 Older Community-Living Adults. J Nutr Health Aging 2018; 22:847-853. [PMID: 30080230 DOI: 10.1007/s12603-018-1026-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is widely recognized that fat will accumulate with ageing and is more prominent centrally. However, there were studies reported that fat might not gain either centrally or generally with ageing. METHODS The baseline, 2-year and 4-year total body fat mas, trunk fat mass and percentage fat mass, were measured by DXA in 3018 community-living Chinese older than 65 years. The respective 4-year trajectories of adiposity were analyzed by repeated measure ANOVA p-for-trend test. RESULTS There was a trend of increase in total body fat mass in men and a decreasing trend in women but neither reached statistical significance. However, there was a significant increase in percent fat mass in both genders. Fat mass was relatively stable in the 2 young-old groups but it declined in the oldest group, aged 75 years or above. (men, p=0.017; women, p<0.001). On the contrary, a corresponding rise of percent fat mass was observed, which was steeper in the 2 younger age groups but did not change in the oldest group. For trunk fat mass, there was a statistically significant decreasing trend in women (p < 0.001) but it remained static in men (p = 0.092). The fat mass in upper limbs of both genders did not change but for the lower limbs, there was a statistically significant increase in both men (p < 0.001) and women (p < 0.02). CONCLUSION Absolute total body fat mass does not accumulate in old age and in the contrary, in the oldest old group (75 years or above), it declined instead. With ageing, fat will redistribute from the central region to the lower limbs.
Collapse
Affiliation(s)
- T W AuYeung
- TW AuYeung, Chinese University of Hong Kong, Hong Kong,
| | | | | | | | | | | |
Collapse
|
22
|
Cheng ST, Chan KL, Lam RWL, Mok MHT, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. A multicomponent intervention for the management of chronic pain in older adults: study protocol for a randomized controlled trial. Trials 2017; 18:528. [PMID: 29121961 PMCID: PMC5680817 DOI: 10.1186/s13063-017-2270-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that physical interventions and psychological methods based on the cognitive behavioral approach are efficacious in alleviating pain and that combining both tends to yield more benefits than either intervention alone. In view of the aging population with chronic pain and the lack of evidence-based pain management programs locally, we developed a multicomponent intervention incorporating physical exercise and cognitive behavioral techniques and examined its long-term effects against treatment as usual (i.e., pain education) in older adults with chronic musculoskeletal pain in Hong Kong. METHODS/DESIGN We are conducting a double-blind, cluster-randomized controlled trial. A sample of 160 participants aged ≥ 60 years will be recruited from social centers or outpatient clinics and will be randomized on the basis of center/clinic to either the multicomponent intervention or the pain education program. Both interventions consist of ten weekly sessions of 90 minutes each. The primary outcome is pain intensity, and the secondary outcomes include pain interference, pain persistence, pain self-efficacy, pain coping, pain catastrophizing cognitions, health-related quality of life, depressive symptoms, and hip and knee muscle strength. All outcome measures will be collected at baseline, postintervention, and at 3 and 6 months follow-up. Intention-to-treat analysis will be performed using mixed-effects regression to see whether the multicomponent intervention alleviates pain intensity and associated outcomes over and above the effects of pain education (i.e., a treatment × time intervention effect). DISCUSSION Because the activities included in the multicomponent intervention were carefully selected for ready implementation by allied health professionals in general, the results of this study, if positive, will make available an efficacious, nonpharmacological pain management program that can be widely adopted in clinical and social service settings and will hence improve older people's access to pain management services. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IIR-16008387. Registered on 28 April 2016.
Collapse
Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK.
| | - Ka Long Chan
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Rosanna W L Lam
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
| | - Monique H T Mok
- Department of Rehabilitation and Extended Care, Kowloon Hospital, 147A Argyle Street, Kowloon, Hong Kong
| | - Phoon Ping Chen
- Department of Anesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Yu Fat Chow
- Department of Anesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong
| |
Collapse
|
23
|
Hui E, Ma HM, Tang WH, Lai WS, Au KM, Leung MT, Ng JSW, Ng WWL, Lee JSW, Li PKT, Woo J. A new model for end-of-life care in nursing homes. J Am Med Dir Assoc 2014; 15:287-9. [PMID: 24508325 DOI: 10.1016/j.jamda.2013.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/15/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to promote quality end-of-life (EOL) care for nursing home residents, through the establishment of advance care plan (ACP) and introduction of a new care pathway. This pathway bypassed the emergency room (ER) and acute medical wards by facilitating direct clinical admission to an extended-care facility. DESIGN An audit on a new clinical initiative that entailed the Community Geriatrics Outreach Service, ER, acute medical wards, and an extended-care facility during winter months in Hong Kong. METHODS The participants were older nursing home residents enrolled in an EOL program. We monitored the ratio of clinical to emergency admissions, ACP compliance rate, average length of stay (ALOS) in both acute hospital and an extended-care facility, and mortality rates. RESULTS A total of 76 patients were hospitalized from January to March 2013. Of them, 30 (39%) were directly admitted to the extended-care facility, either through the liaison of Community Geriatrics Outreach Service (group A, 19/76, 25%) or transferred from the ER (group B, 11/76, 14%). The remaining 46 patients (group C, 61%) were admitted via the ER to acute medical wards following the usual pathway, followed by transfer to an extended-care facility if indicated. The ACP compliance rate was nearly 100%. In the extended-care unit, groups A and C had similar ALOS of 11.8 and 11.1 days, respectively, whereas group B had a shorter stay of 7.6 days. The ALOS of group C in acute medical wards was 3.5 days. The in-hospital mortality rates were comparable in groups A and C of 26% and 28%, respectively, whereas group B had a lower mortality rate of 18%. CONCLUSIONS Nearly 40% of EOL patients could be managed entirely in an extended-care setting without compromising the quality of care and survival. A greater number of patients may benefit from the EOL program by improving the collaboration between community outreach services and ER; and extending hours for direct clinical admission to an extended-care facility.
Collapse
Affiliation(s)
- Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China; Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China
| | - Hon Ming Ma
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China; Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China.
| | - Wing Han Tang
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China; Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wai Sze Lai
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China
| | - Ka Ming Au
- Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mei Tak Leung
- Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China
| | - Joey S W Ng
- Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China
| | - Winnie W L Ng
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China
| | - Jenny S W Lee
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China
| | - Philip K T Li
- Department of Community Geriatrics Assessment Team, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jean Woo
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong SAR, China
| |
Collapse
|
24
|
Auyeung TW, Lee JSW, Leung J, Kwok T, Woo J. The selection of a screening test for frailty identification in community-dwelling older adults. J Nutr Health Aging 2014; 18:199-203. [PMID: 24522474 DOI: 10.1007/s12603-013-0365-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frailty in older Chinese has been less often studied and the selection of one screening test feasible in primary care and population survey is needed. We attempted to examine the sensitivity and specificity of each of the five Fried's criteria as a single screening test in the identification of frailty. METHODS We recruited 4000 community-dwelling Chinese adults 65 years or older stratified by 3 age-stratum and identified frailty as having 3 or more of Fried's criteria: underweight(BMI<18.5), handgrip strength( RESULTS The proportion of frailty in the 3 age groups (65-69 years, 70-74 years, 75 years and above) were 2.3%, 3.4% and 11.9% respectively in men and 1.4%, 2.6% and 11.6% in women. Among the 5 criteria, walking speed, grip strength and physical activity (PASE score) divided at their respective lowest quintile values, achieved similar Area Under Curve in the Receiver Operating Characteristics analysis. For walking speed, the sensitivity and specificity were 82.7% and 83.1% in men and 91.9% and 84.5% in women respectively. For grip strength, the corresponding values were 89.5% and 80.6% in men; and 84.5% and 81.9% in women. For physical activity, they were 83.7% and 83.5% in men; and 82.8% and 84.7% in women. CONCLUSION Either walking speed or grip strength measurement may be suitable for frailty screening in primary care or population health survey. A cut-off value of 0.9 m/s in walking speed and 28 kg in grip strength for older men; and a corresponding value of 0.8 m/s and 18 kg for older women is recommended for the screening of frailty in community-dwelling older Chinese adults.
Collapse
Affiliation(s)
- T W Auyeung
- Tung Wai Auyeung, The S. H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Department of Medicine and Geriatrics, Pok Oi Hospital, Au Tau, NT, Hong Kong, Email : , Telephone: 852 24868985, Fax: 852 24868976
| | | | | | | | | |
Collapse
|
25
|
Lee JSW, Auyeung TW, Leung J, Kwok T, Leung PC, Woo J. Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass. J Nutr Health Aging 2011; 15:857-62. [PMID: 22159773 DOI: 10.1007/s12603-011-0134-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Metabolic and atherosclerotic diseases are known risk factors for disability in old age, and can result in sarcopenia as well as cognitive impairment, which are both components of frailty syndrome. As muscle loss increases with ageing, it is unclear whether muscle loss per se, or the diseases themselves, are the underlying cause of physical frailty in those suffering from these diseases. We tested the hypothesis that metabolic and atherosclerotic diseases and cognitive impairment are associated with physical frailty independent of muscle loss in old age, and further examined their impact on the relationship between physical frailty and mortality. DESIGN Prospective. SETTING Community. PARTICIPANTS 4000 community dwelling Chinese elderly ≥65 years. MEASUREMENTS Diabetes, hypertension, stroke, heart disease, cognitive impairment, smoking, physical activity, waist hip ratio (WHR) and ankle-brachial index (ABI)) were recorded. Physical frailty measurements (grip-strength, chair-stands, stride length and 6-metre walks) were summarized into a composite frailty score (0-20), 0 being the most frail) according to quartiles of performance. Appendicular muscle mass (ASM) was measured using dual X-ray absorptiometry. Relationships between the score and covariates were analyzed. Cox regression was used to study the impact of metabolic and atnerosclerotic risk factors on the relationship between physical frailty and 6-year mortality. RESULTS After adjustment for ASM, all metabolic diseases and indexes, and cognitive impairment were significantly associated with the composite physical frailty score in univariate analysis. In multivariate analysis, cognitive impairment, high WHR, diabetes, stroke and heart disease were all independently associated with higher physical frailty with adjustment for age, physical activity level and ASM. Hypertension was associated with physical frailty in men but not in women. In Cox regression, increased physical frailty was associated with higher 6-year mortality. The impact of metabolic and atherosclerotic risk factors was however only modest after adjustment for age and cognitive function. CONCLUSION Metabolic and atherosclerotic diseases and high WHR, was associated with physical frailty, independent of their adverse effect on cognitive function and muscle mass.
Collapse
Affiliation(s)
- J S W Lee
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | | | | | | | | | | |
Collapse
|
26
|
Auyeung TW, Lee JSW, Kwok T, Woo J. Physical frailty predicts future cognitive decline - a four-year prospective study in 2737 cognitively normal older adults. J Nutr Health Aging 2011; 15:690-4. [PMID: 21968866 DOI: 10.1007/s12603-011-0110-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the association between baseline frailty measurements and cognitive function 4 years later. DESIGN Prospective observational study. SETTING Community. PARTICIPANTS Two thousand seven hundred and thirty seven cognitively normal older adults. MEASUREMENT The appendicular muscle mass (ASM), hand grip strength, timed chair-stand test, walking speed and step length were measured at baseline. The Mini-mental state examination (MMSE) was administered at baseline and 4 years later. RESULTS In men, all baseline frailty measurements, namely, being underweight, lower ASM, weaker grip strength, slower chair-stand test, shorter step length, slower timed walk were significantly associated with a lower MMSE score 4 years afterwards. After adjustment for age, years of education and baseline MMSE score, ASM and timed walk became insignificant. In women, all frailty measurements except underweight and low ASM were significantly associated with MMSE score 4 years later. Moreover, only weaker grip strength persisted to be significant after adjustment for age, years of education and baseline MMSE score. CONCLUSION Physical frailty, as represented by being underweight, weaker grip strength, slower chair-stand test, shorter step-length in men and weaker grip strength in women, was associated with cognitive decline over a four year period.
Collapse
Affiliation(s)
- T W Auyeung
- S.H. Ho Centre for Gerontology and Geriatric, The Chinese University of Hong Kong and Pok Oi Hospital, Hong Kong, China.
| | | | | | | |
Collapse
|
27
|
Lee JSW, Wang K, Cheung TCY, Kwok TCY, Ahuja AT. An uncommon cause of recurrent falls in an elderly man. Hong Kong Med J 2011; 17:328-331. [PMID: 21813904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Falls are common among the elderly population. Examinations for the cause of falls are usually mundane, but may be challenging, leading to surprising diagnoses. We report on a previously healthy elderly man who presented with repeated falls and rapidly progressive limitations in mobility, in addition to a stutter. Neuroimaging was particularly helpful for making the diagnosis in this patient.
Collapse
Affiliation(s)
- J S W Lee
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong.
| | | | | | | | | |
Collapse
|
28
|
Abstract
AIMS Diabetes mellitus may be associated with excessive lean mass loss. Other diabetes-related conditions may also play a role. We assessed body composition changes associated with diabetes in older adults with adjustment for diabetes-related co-morbidities. METHODS Three thousand, one hundred and fifty-three community-living adults aged ≥ 65 years were examined for lifestyle factors, diabetes-related medical conditions and body composition by dual energy X-ray absorptiometry at baseline and 4 years later. Body composition changes were compared between participants with diabetes and those without diabetes. Multivariate linear regression was used to examine the relationship between appendicular lean mass loss and confounders. RESULTS Appendicular lean mass loss in men with diabetes was two times that of men without diabetes (-1.5% in 'no diabetes' vs. -3.0% in 'diabetes') and in women with diabetes was 1.8 times that of those without diabetes (-1.9% in 'no diabetes' vs. -3.4% in 'diabetes') over 4 years. Men with diabetes also had higher total body mass loss and higher total body fat loss than men without diabetes. Women with diabetes had higher total body mass loss but total body fat loss was similar. After adjusting for age, body mass index, diabetes-related conditions, lifestyle factors and total body mass loss, diabetes remained an independent predictor of appendicular lean mass loss in both men and women. CONCLUSION Diabetes was associated with higher body mass loss and higher appendicular lean mass loss in older adults. In men, diabetes was also associated with total body fat loss.
Collapse
Affiliation(s)
- J S W Lee
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
29
|
Lam LCW, Lee JSW, Chung JCC, Lau A, Woo J, Kwok TCY. A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong. Int J Geriatr Psychiatry 2010; 25:395-402. [PMID: 19606455 DOI: 10.1002/gps.2352] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used. METHOD Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months. RESULT CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05). CONCLUSION Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.
Collapse
Affiliation(s)
- Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | | | | | |
Collapse
|
30
|
Auyeung TW, Lee JSW, Kwok T, Leung J, Leung PC, Woo J. Estimation of stature by measuring fibula and ulna bone length in 2443 older adults. J Nutr Health Aging 2009; 13:931-6. [PMID: 19924356 DOI: 10.1007/s12603-009-0254-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 12/10/2008] [Indexed: 10/19/2022]
Abstract
UNLABELLED Estimation of Stature by Measuring Fibula and Ulna Bone Length in 2443 Older Adults. OBJECTIVES Knee height has been commonly used to estimate stature but may not always be possible in the frail older adults with compromised posture. Measurement of fibula and ulna bone length could be an alternative method. We attempted to develop and validate regression models to predict measured and reported height using age, fibula length, ulna length, hip circumferences and body weight. DESIGN A cross-sectional survey. SETTING The study was conducted in the Jockey Club Centre for Osteoporosis Care and Control, School of Public Health, The Chinese University of Hong Kong. PARTICIPANTS Two thousand four hundred and forty three community-dwelling older Chinese aged from 65 to 98 years were recruited. MEASUREMENTS The standing height, fibula length, ulna length, hip circumference and body weight were measured and the reported height was recorded. Three separate multiple linear regression models were developed to predict measured-height and reported-height respectively. RESULTS In predicting measured-height by the bone-length model, the mean errors were +0.52 cm (over-estimation) in men and +0.45 cm (over-estimation) in women and the SDs were +/- 3.5 cm in both genders. The 95% limits of agreement were: -6.65 to +7.70 cm for men and -6.59 to +7.49 cm for women. CONCLUSION The accuracy and precision of stature estimation by fibula and ulna bone length is comparable to that by knee height. This may be an acceptable alternative method when knee height measurement is difficult or when the knee height caliper is not available.
Collapse
Affiliation(s)
- T W Auyeung
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
| | | | | | | | | | | |
Collapse
|
31
|
Lee JSW, Kwok T, Chui PY, Ko FWS, Lo WK, Kam WC, Mok HLF, Lo R, Woo J. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr 2009; 29:453-8. [PMID: 19910085 DOI: 10.1016/j.clnu.2009.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Continuous pump feeding is often used to reduce aspiration risk in older patients on tube feeding, but its effectiveness in preventing aspiration pneumonia is unproven. A randomized controlled trial was therefore performed to examine the effectiveness of continuous pump feeding in decreasing the incidence of pneumonia in tube-fed older hospital patients. METHODS One hundred and seventy eight elderly patients from three convalescence hospitals and one infirmary, on nasogastric tube feeding, were randomly assigned to have intermittent bolus (bolus) or continuous pump (pump) feeding for 4weeks. The primary outcome was the incidence of pneumonia. The secondary outcome was mortality. RESULTS Eighty five subjects were randomized into the pump group and 93 in the bolus group. The groups were comparable in age, nutritional and functional status, co-morbidities and history of pneumonia, except that there were more women in the pump group. Within 4weeks, 15 subjects (17.6%) in the pump group and 18 (19.4%) in the bolus group developed pneumonia. Seven subjects (8.2%) in pump group and 13 subjects (14.0%) in bolus group died. There was no significant difference in either pneumonia or death rates between the two groups. CONCLUSION Continuous pump feeding did not significantly affect the rates of pneumonia or mortality in tube-fed older hospital patients when compared with intermittent bolus feeding.
Collapse
Affiliation(s)
- J S W Lee
- Department of Medicine & Geriatrics, Shatin Hospital, Hong Kong SAR, China
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Auyeung TW, Lee JSW, Leung J, Kwok T, Leung PC, Woo J. Survival in older men may benefit from being slightly overweight and centrally obese--a 5-year follow-up study in 4,000 older adults using DXA. J Gerontol A Biol Sci Med Sci 2009; 65:99-104. [PMID: 19628635 DOI: 10.1093/gerona/glp099] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether overweight in old age is hazardous remains controversial. Body mass index (BMI) overestimates adiposity and fails to measure central adiposity. We used dual-energy x-ray absorptiometry (DXA) to measure adiposity and hypothesized that overall adiposity, distribution of adiposity, and muscle mass might individually affect survival. METHODS We recruited 2000 men and 2000 women aged 65 years or older. Baseline BMI, waist-hip ratio (WHR), body fat index (BFI = total body fat/height square), relative truncal fat (RTF = trunk fat/total body fat), and body muscle mass index (BMMI = total body muscle mass/height square) were measured. Mortality was ascertained by death registry after 63.3 (median) months. RESULTS Two hundred and forty-two men and 78 women died. In men, mortality hazard ratio (HR) decreased consistently by 0.85 (p < .005), 0.86 (p < .005), and 0.86 (p < .005) per every quintile increase in BMI, BFI, and BMMI, respectively. A J-shaped relationship was observed in central adiposity (RTF and WHR) quintiles; the minimum values were at the 3rd WHR quintile (0.92-0.94) and 4th RTF quintile (mean WHR, 0.94). When RTF was tested with BFI, both high and low central adiposity were unfavorable while general adiposity became marginally insignificant (p = 0.062). When BFI and BMMI were tested together, increasing adiposity rather than muscle mass favored survival (BFI quintile, HR 0.97, p .015; BMMI quintile, HR 1.00, p .997). CONCLUSIONS Older men were resistive to hazards of overweight and adiposity; and mild-grade overweight, obesity, and even central obesity might be protective. This may bear significant implication on the recommended cutoff values for BMI and WHR in the older population.
Collapse
Affiliation(s)
- Tung Wai Auyeung
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
33
|
Lee JSW, Chau PPH, Hui E, Chan F, Woo J. Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self-Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales. Eur J Public Health 2009; 19:308-12. [PMID: 19221020 DOI: 10.1093/eurpub/ckp006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With the intention to aid planning for elderly focused public health and residential care needs in rapidly aging societies, a simple model using only age, gender and three Minimum Data Set (MDS) subscales (MDS-ADL Self-Performance Hierarchy, MDS-Cognitive Performance and the MDS-Changes in Health, End-stage disease and Symptoms and Signs scales) was used to estimate long-term survival of older people moving into nursing homes. METHODS A total of 1820 nursing home residents were assessed by the MDS 2.0 and their mortality status 5 years later was used to develop a survival prediction model. RESULT In December 2006, 54.2% of subjects were dead. Older age at nursing home admission (HR = 1.036 per 1-year increment, 95% CI 1.028-1.045), men (HR = 1.895, 95% CI 1.651-2.175), higher impairment level according to the MDS-ADL (HR = 1.135 per 1-unit increment, 95% CI 1.099-1.173) and MDS-CPS (HR = 1.077 per 1-unit increment, 95% CI 1.033-1.123), and more frail on the MDS-CHESS (HR = 1.150 per 1-unit increment, 95% CI 1.042-1.268), were all independent predictors of shorter survival after nursing home admission in multivariate analysis. Survival function was derived from the fitted Cox regression model. Survival time of nursing home residents with different combinations of risk factors were estimated through the survival function. CONCLUSION The MDS-ADL, MDS-CPS and MDS-CHESS scales, in addition to age and gender, provide prognostic information in terms of survival time after institutionalization. The model may be useful for health care and residential care planning in an ageing community.
Collapse
Affiliation(s)
- Jenny S W Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR.
| | | | | | | | | |
Collapse
|
34
|
Abstract
The study is to determine the optimal MRI bowel preparation regime for visualization of the stomach anatomy. Eight healthy volunteers were asked to take water, 75% barium and blueberry juice. The image quality and tolerance of different stomach distension regime were evaluated. Blueberry juice gave the best distension, but the signal intensity was not very homogeneous. Taking into account the image quality, tolerability and adverse effects, it is concluded that water is the most desirable oral contrast for MR stomach imaging.
Collapse
Affiliation(s)
- W W M Lam
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
| | | | | |
Collapse
|
35
|
Lee JSW, Auyeung TW, Kwok T, Lau EMC, Leung PC, Woo J. Associated Factors and Health Impact of Sarcopenia in Older Chinese Men and Women: A Cross-Sectional Study. Gerontology 2007; 53:404-10. [PMID: 17700027 DOI: 10.1159/000107355] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 06/05/2007] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sarcopenia is increasingly being recognized as a feature of frailty in old age and is associated with unfavorable health outcomes in Western populations. Little is known about sarcopenia among Asian elderly populations. OBJECTIVES The study was undertaken to study the association between sarcopenia and common chronic illnesses, lifestyle factors, psychosocial well-being and physical performance. METHODS 4,000 community-dwelling Chinese elderly >/=65 years were recruited. Medical illnesses, cigarette smoking, alcohol consumption, physical activity level and psychosocial well-being scores were recorded. Physical performance measured included grip strength, timed chair-stands, stride length and a timed 6-meter walk. Muscle mass was measured using dual-energy X-ray absorptiometry. Relationships between appendicular skeletal muscle mass (ASM/ht(2)) and multiple variables were analyzed using uni- and multivariate analyses. RESULTS Mean ASM/ht(2) was 7.19 and 6.05 kg/m(2) in men and women respectively. Older age, cigarette smoking, chronic lung disease, atherosclerosis, underweight, and physical inactivity were associated with low adjusted ASM, which was in turn associated with poorer physical well-being in men. After adjustment to age, lower appendicular muscle mass was associated with weaker grip strength in both sexes. In men, lower limb tests (chair-stands, walking speed and step length) were not related to ASM, while in women, lower muscle mass was not associated with poorer lower limb muscle performance. CONCLUSIONS Sarcopenia in community-dwelling older Chinese men and women was associated with cigarette smoking, chronic illnesses, underweight, physical inactivity, poorer well-being and upper limb physical performance.
Collapse
Affiliation(s)
- Jenny S W Lee
- Department of Medicine and Therapeutics, School of Medicine, Hong Kong, SAR, China.
| | | | | | | | | | | |
Collapse
|
36
|
Lee JSW, Kwok T, Leung PC, Woo J. Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age Ageing 2006; 35:246-51. [PMID: 16497683 DOI: 10.1093/ageing/afj056] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have confirmed the contribution of various medications towards falls in the older population. Recently questions were raised as to whether the chronic illnesses or drug use was more important. OBJECTIVE We attempt to test the hypothesis that underlying medical illnesses are the cause of falls rather than medications. DESIGN Cross-sectional. SETTING Urban community in Hong Kong. SUBJECTS 4,000 Ambulatory community-dwelling men and women aged 65 years or over. METHODS Demographic data, fall history in the previous 12 months, medical diagnoses, current medications and self-rated health were recorded. Body measurements and neuromuscular function tests were performed. Medical diagnoses and their corresponding medications were tested simultaneously in a multivariate model. RESULTS 789 (19.7%) Subjects reported at least one fall and 235 (5.9%) experienced two or more falls. After adjustment for age and sex, medications associated with any falls were aspirin, diabetic drugs, nitrates, NSAIDs, and paracetamol, and those associated with recurrent falls were calcium channel blockers, diabetic drugs, nitrates, NSAIDs, aspirin and statins. Only anti-diabetics and nitrate showed moderate and borderline significance in multivariate analyses for recurrent and any falls respectively (OR 2.9, P = 0.01; OR 1.5, P = 0.027). Other medications failed to show significant relationship with falls, while eye diseases, heart diseases and musculoskeletal pain showed variable associations. CONCLUSION The apparent association between many medications and falls was mediated through the underlying medical diagnoses and neuromuscular impairment. Anti-diabetics agents were associated with falls.
Collapse
Affiliation(s)
- Jenny S W Lee
- Department of Medicine and Therapeutics, School of Medicine, The Chinese University of Hong Kong, 9/F Clinical Science Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.
| | | | | | | |
Collapse
|
37
|
Chan JCM, Lee JSW, Dai DLK, Woo J. Unusual cases of human myiasis due to Old World screwworm fly acquired indoors in Hong Kong. Trans R Soc Trop Med Hyg 2005; 99:914-8. [PMID: 16154168 DOI: 10.1016/j.trstmh.2005.06.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 06/20/2005] [Accepted: 06/23/2005] [Indexed: 11/24/2022] Open
Abstract
Myiasis is the infestation of tissue by the larvae of flies. We report eight cases of human myiasis in Hong Kong. All patients were nursing home residents with an average age of 81.8 years. Seven patients were bedridden with advanced dementia. Four patients had pre-existing wounds. Five had poor oral hygiene and four of those were on tube feeding. All of the five patients with poor oral hygiene suffered from oral myiasis. Two patients had vaginal infestations and one had wound myiasis in his diabetic foot ulcer. Seven cases were infested by Chrysomya bezziana, an obligatory parasite that requires living mammalian tissue for its larval development. Larvae of the Calliphoridae family were responsible for the remaining case. Patients were managed with manual removal of larvae and irrigation of the site of infestation with saline. All infestations were nosocomial, being acquired in nursing homes. Carers of the old and debilitated should be made aware of the need for better oral care, especially for those on tube feeding. The use of window screens in nursing homes should be encouraged to reduce the chance of flies entering the vicinity of these patients. Electrocuters could also be mounted indoors to kill flies that do enter.
Collapse
Affiliation(s)
- J C M Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong SAR, China
| | | | | | | |
Collapse
|
38
|
|