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The heterogeneity of chronic post-COVID neuropsychiatric symptoms (PCNPS), especially after infection by the Omicron strain, has not been adequately explored.
Aims
To explore the clustering pattern of chronic PCNPS in a cohort of patients having their first COVID infection during the ‘Omicron wave’ and discover phenotypes of patients based on their symptoms’ patterns using a pre-registered protocol.
Method
We assessed 1205 eligible subjects in Hong Kong using app-based questionnaires and cognitive tasks.
Results
Partial network analysis of chronic PCNPS in this cohort produced two major symptom clusters (cognitive complaint–fatigue and anxiety–depression) and a minor headache–dizziness cluster, like our pre-Omicron cohort. Participants with high numbers of symptoms could be further grouped into two distinct phenotypes: a cognitive complaint–fatigue predominant phenotype and another with symptoms across multiple clusters. Multiple logistic regression showed that both phenotypes were predicted by the level of pre-infection deprivation (adjusted P-values of 0.025 and 0.0054, respectively). The severity of acute COVID (adjusted P = 0.023) and the number of pre-existing medical conditions predicted only the cognitive complaint–fatigue predominant phenotype (adjusted P = 0.003), and past suicidal ideas predicted only the symptoms across multiple clusters phenotype (adjusted P < 0.001). Pre-infection vaccination status did not predict either phenotype.
Conclusions
Our findings suggest that we should pursue a phenotype-driven approach with holistic biopsychosocial perspectives in disentangling the heterogeneity under the umbrella of chronic PCNPS. Management of patients complaining of chronic PCNPS should be stratified according to their phenotypes. Clinicians should recognise that depression and anxiety cannot explain all chronic post-COVID cognitive symptoms.
As many as 1 in 12 people in residential care are likely to have a pressure injury at any time(1). Our pragmatic intervention, consented by both patients and their Enduring Power of Attorney, provided 20g whey protein concentrate (WPC) in 200ml whole milk to be consumed by the resident in the morning with breakfast or morning tea, to compensate for the likely lowest protein meal of the day(2), and increase total protein intake. WPC has a number of beneficial substances that support wound healing, such as arginine, and glutamine(3), plus the branch chain amino acids(4). The intervention was uncomplicated, well tolerated and resulted in wound healing, as evidenced by the pictures of the three initial cases. We need further trials to show that this is better than usual interventions. However, we believe this is a useful protocol to address a recognised problem of poor protein intake for those who need extra to heal wounds
This is a proof-of-concept study to compare the effects of a 2-week program of “Remind-to-move” (RTM) treatment using closed-loop and open-loop wearables for hemiparetic upper extremity in patients with chronic stroke in the community. The RTM open-loop wearable device has been proven in our previous studies to be useful to address the learned nonuse phenomenon of the hemiparetic upper extremity. A closed-loop RTM wearable device, which emits reminding cues according to actual arm use, was developed in this study. A convenience sample of 16 participants with chronic unilateral stroke recruited in the community was engaged in repetitive upper extremity task-specific practice for 2 weeks while wearing either a closed-loop or an open-loop ambulatory RTM wearable device on their affected hand for 3 hrs a day. Evaluations were conducted at pre-/post-intervention and follow-up after 4 weeks using upper extremity motor performance behavioral measures, actual arm use questionnaire, and the kinematic data obtained from the device. Results showed that both open-loop and closed-loop training groups achieved significant gains in all measures at posttest and follow-up evaluations. The closed-loop group showed a more significant improvement in movement frequency, hand functions, and actual arm use than did the open-loop group. Our findings supported the use of closed-loop wearables, which showed greater effects in terms of promoting the hand use of the hemiparetic upper extremity than open-loop wearables among patients with chronic stroke.
Background: Self-injurious behaviours (SIB) are repetitive, non-accidental movements that result in physical damage inflicted upon oneself, without suicidal intent. SIB are prevalent among children with autism spectrum disorder and can lead to permanent disability or death. Neuromodulation at a locus of neural circuitry implicated in SIB, the nucleus accumbens (NAc), may directly influence these behaviours. Methods: We completed a phase I, open-label clinical trial of deep brain stimulation (DBS) of the NAc in children with severe, treatment-refractory SIB (ClinicalTrials.gov NCT03982888). Participants were monitored for 12 months following NAc-DBS to assess the primary outcomes of safety and feasibility. Secondary outcomes included serial assessments of SIB, ambulatory actigraphy, and changes in brain glucose metabolism induced by DBS. Results: Six children underwent NAc-DBS without any serious adverse events. NAc-DBS resulted in significant reductions in SIB and SIB-associated behaviours across multiple standardized scales, concurrent with clinically meaningful improvements in quality-of-life. Ambulatory actigraphy showed reductions in high-amplitude limb movements and positron emission tomography revealed treatment-induced reductions in metabolic activity within the thalamus, striatum, and temporoinsular cortex. Conclusions: This first-in-children phase 1 clinical trial demonstrates the safety and feasibility of NAc-DBS in children with severe, refractory SIB at high risk of physical injury and death and supports further investigations.
The presence of an intraluminal thrombus in acutely symptomatic carotid stenosis is thought to represent a high-risk lesion for short-term stroke reccurrence though evidence on natural history and treatment is lacking, leading to equipoise and much variation in practice. The objective of this study was to map these variations in practice (medical management and timing of revascularization), determine the considerations that influence clinician decision-making in this condition and gather opinions that inform the development and design of future trials in the area.
Methods:
This was a mixed-methods study using both quantitative survey methods and qualitative interview-based methods. International perspectives were gathered by distributing a case-based survey via the “Practice Current” section of Neurology: Clinical Practice and interviewing international experts using established qualitative research methods.
Results:
The presence of an intraluminal thrombus significantly increased the likelihood of using a regimen containing anticoagulation agents (p < 0.001) in acutely symptomatic carotid stenosis in the case-based survey. Themes that emerged from qualitative interview analysis were therapeutic uncertainty regarding anticoagulation, decision to reimage, revascularization choices and future trial design and anticipated challenges.
Conclusion:
Results of this study demonstrate a preference for anticoagulation and delayed revascularization after reimaging to examine for clot resolution, though much equipoise remains. While there is interest from international experts in future trials, further study is needed to understand the natural history of this condition in order to inform trial design.
We present the Pilot Survey Phase 2 data release for the Wide-field ASKAP L-band Legacy All-sky Blind surveY (WALLABY), carried-out using the Australian SKA Pathfinder (ASKAP). We present 1760 H i detections (with a default spatial resolution of 30′′) from three pilot fields including the NGC 5044 and NGC 4808 groups as well as the Vela field, covering a total of $\sim 180$ deg$^2$ of the sky and spanning a redshift up to $z \simeq 0.09$. This release also includes kinematic models for over 126 spatially resolved galaxies. The observed median rms noise in the image cubes is 1.7 mJy per 30′′ beam and 18.5 kHz channel. This corresponds to a 5$\sigma$ H i column density sensitivity of $\sim 9.1\times10^{19}(1 + z)^4$ cm$^{-2}$ per 30′′ beam and $\sim 20$ km s$^{-1}$ channel and a 5$\sigma$ H i mass sensitivity of $\sim 5.5\times10^8 (D/100$ Mpc)$^{2}$ M$_{\odot}$ for point sources. Furthermore, we also present for the first time 12′′ high-resolution images (“cut-outs”) and catalogues for a sub-sample of 80 sources from the Pilot Survey Phase 2 fields. While we are able to recover sources with lower signal-to-noise ratio compared to sources in the Public Data Release 1, we do note that some data quality issues still persist, notably, flux discrepancies that are linked to the impact of side lobes associated with the dirty beams due to inadequate deconvolution. However, in spite of these limitations, the WALLABY Pilot Survey Phase 2 has already produced roughly a third of the number of HIPASS sources, making this the largest spatially resolved H i sample from a single survey to date.
Gaming disorder has become a global concern and it could have a variety of health and social consequences. The trauma model has been applied to the understanding of different types of addictions as behavioral addictions can sometimes be conceptualized as self-soothing strategies to avoid trauma-related stressors or triggers. However, much less is known about the relationship between trauma exposure and gaming disorder.
Objectives
To inform prevention and intervention strategies and to facilitate further research, we conducted the first scoping review to explore and summarize the literature on the relationship between trauma and gaming disorder.
Methods
A systematic search was conducted on the Web of Science, Scopus and ProQuest. We looked for original studies published in English that included a measure of trauma exposure and a measure of gaming disorder symptoms, as well as quantitative data regarding the relationship between trauma exposure and gaming disorder.
Results
The initial search generated 412 articles, of which 15 met the inclusion criteria. All of them were cross-sectional studies, recruiting participants from both clinical and non-clinical populations. Twelve of them (80%) reported significant correlations between trauma exposure and the severity of gaming disorder symptoms (r = 0.18 to 0.46, p < 0.010). Several potential mediators, including depressive symptoms and dissociative experiences, have been identified. One study found that parental monitoring moderated the relationship between trauma and gaming disorder symptoms. No studies reported the prevalence of trauma or trauma-related symptoms among people with gaming disorder.
Conclusions
There is some evidence supporting the association between trauma and gaming disorder, at small to medium effect sizes. Future studies should investigate the mediators and moderators underlying the relationship between trauma and gaming disorder. The longitudinal relationship between trauma exposure and the development of gaming disorder should be clarified. A trauma-informed approach may be a helpful strategy to alleviate gaming disorder symptoms.
Adolescents with depression have distinct affective reactions to daily events, but current research is controversial. The emotional context insensitivity theory suggests blunted reactivity in depression, whereas the hypotheses of negative potentiation and mood brightening effect suggest otherwise. While nonlinear associations between depression severity and affective reactivity have been observed, studies with a separate subclinical group remain rare. Subthreshold depression (SD), defined by two to four symptoms lasting for two weeks or more, provides a dimensional view to the underpinnings of affective reactivity. In this study, we compared positive affect (PA) and negative affect (NA) reactivity to positive and negative daily events (uplifts and stress) among adolescents with Major Depressive Disorder (MDD), SD and healthy controls (HC) using experience sampling methods (ESM).
Objectives
We hypothesized a stepped difference in affective reactivity along the depression spectrum: the MDD group will have the strongest reactivity of PA and NA to uplifts and stress, followed by SD and HC.
Methods
Three groups (MDD, SD, and HC) of adolescents were recruited from an epidemiologic sample entitled ‘Hong Kong Child and Adolescent Psychiatric Epidemiologic Survey: Age 6 to 17’. Group status was determined by the Diagnostic Interview Schedule for Children Version 5. They completed an experience sampling diary on smartphone for 14 consecutive days, with 5-10 entries per day. Momentary levels of PA (happy, relaxed, contented), NA (irritated, low, nervous), uplifts and stress experienced before the entry were measured on a 1-7 Likert scale.
Results
The sample consisted of 19 adolescents with MDD, 30 with SD, and 59 HC. The M:F ratio was 17:19. The age range was 12-18 with a mean of 14.8. The overall ESM completion rate was 46%. The MDD group had the highest levels of stress and NA, and the lowest levels of uplifts and PA, followed by the SD and HC groups respectively (p<0.01). Across groups, levels of PA were positively associated with uplifts and negatively associated with stress, whereas levels of NA were positively associated with stress and negatively associated with uplifts. The Group x Uplift interaction effect on PA was significant, with greater PA reactivity in SD (p<0.01) and MDD (p=0.07) when compared with HC. The Group x Uplift interaction effect on NA was significant, with greater NA reactivity in SD than HC (p<0.01). The Group x Stress interaction effect on PA was significant, with greater PA reactivity in SD than HC (p<0.01) and MDD (p<0.01). The Group x Stress interaction effect with NA is non-significant.
Conclusions
Contrary to our hypothesis, adolescents with SD experienced strongest PA and NA reactivity in uplifts and PA reactivity in stress. It provides evidence towards a nonlinear relationship between severity of depression and affective reactivity.
New prevalence and time trend data from various Asian countries show that Eating Disorders (ED) are increasingly common in Asia. (Youl-Ri Kim. Int J Eat Disord. Dec 2020). A recent study estimating the prevalence of ED in Singapore found an alarming 6.2% screened positive for a clinical ED diagnosis, 19.5% were screened to be at high risk, and estimated the point prevalence of Anorexia Nervosa (AN) to be 0.9%. (Chua SN et al. Int J Eat Disord. Jan 2021).
The ED unit in Singapore General Hospital (SGH) was set up in 2003 as a National Treatment Programme for patients with ED.
Two local studies have been published to date on the demographics and clinical profile of patients with AN. The first study examined 126 patients from 1994 – 2002 (HY Lee et al. Singapore Med J 2005; 46(6): 275-281). The second study reported on 271 cases from our SGH ED unit from 2003-2010 (Kuek et al. SIngapore Med J 2015; 56(6): 324-328). There have been no further studies in the last decade.
Objectives
1. Study the demographics and clinical profile of patients who presented with AN to our ED unit from 2011-2022
2. Compare our data with the 2 previous studies and examine for any changes and trends in the past 30 years.
Methods
We conducted a review of the ED unit new case registry at SGH from 2011-2022. A total of 910 patients were diagnosed with AN at presentation. The data was analysed with approval from the hospital instituitional review board.
Results
A total of 910 cases presented with AN over 12 years. Comparing with the 2 previous studies, the number of new cases each year has continued to increase from <15 in the 1990s to hit a peak of 109 per year in 2022. 94% were females, with a mean presenting age of 19. 79.2% were Chinese, 5.2% were Indians and 2.9% were of Malay ethnicity. The Malay population continue to be under-represented whereas other ethnic groups continue to be over-represented, increasing from 3.2% to 7% in the previous studies to 11.1%. Referrals were mainly from tertiary healthcare intuitions accounting for 41.4% of cases. Self-referrals have decreased over the last decade whereas referrals from primary care has increased. The mean presenting body mass index (BMI) was 15.9. Compared to a previous study, there was a significant increase in presenting BMI (15.9+/- 0.78 vs 14.4 +/- 1.77, p value 0.0074).
Conclusions
The number of new cases of AN has seen an almost 10-fold increase in the last 30years. The Malay ethnicity continues to be under-represented – more research is needed if they are somehow culturally protected or if they are not coming forth for treatment. Majority of referrals are from tertiary healthcare institutions but referrals from primary care have increased, reflecting a possible increase in awareness amongst primary care doctors. The mean presenting BMI has increased – hopefully reflecting an increase in ED awareness such that patients are coming forward earlier for treatment.
Like a great work of literary art, which indeed it is, Alexis de Tocqueville's extraordinary analysis of American society grows more impressive with each exposure to it. Everything has changed and nothing has changed since Democracy in America was published in the 1830’s. Its author grasped with remarkable perception both the mutable and the immutable qualities of man. There could be nothing more salutary for us today than to assimilate his fine sense of what was permanent in a world which, like ours, was undergoing deep convulsions. Committed to the classical economics of Adam Smith, Tocqueville did not share Smith's illusions about the eternal nature of the market. On the contrary, as Albert Salomon has emphasized, his point of view was Heraclitean, the specter of continual change and ceaseless transformation dominating his thought. Surely such a perspective, which antedates both Darwin and Marx, is more appropriate for sociologists in a revolutionary age than elegantly constructed theories of social equilibrium which treat change as a special problem or a deus ex machina.
Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic.
Methods
By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions.
Results
A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.
Conclusions
Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.
Persons newly diagnosed with dementia and their family member is imperative often experience uncertainty and inadequate support. This study aims to evaluate a post-diagnostic support programme guided by the 5 Pillars Model proposed by Alzheimer Scotland on the self-efficacy among persons with early dementia and their family members.
Methods:
A prospective cohort study design was conducted between 2019 and 2022. Subject recruitment was conducted in four non-government organizations. A multi-domain empowerment programme, covering various aspects about dementia knowledge, management skills, peer support, future decision-making and community resources, was developed. The programme was provided to people newly diagnosed of early dementia in small group format over 2 months and to family members individually through an eLearning platform over 9 months. Self efficacy in dementia management of people with dementia and their family members were measured using Chronic Disease Self-efficacy Scale and Caregiver Self-efficacy Scale (CSES), respectively, whereas caregiving burden was measured using Zarit Burden Interview (ZBI). Study outcomes were measured at baseline, immediate and 6-month post-intervention. Paired t-tests were performed to detect within-subject changes over time.
Results:
A total of 151 persons with early dementia and 294 family caregivers completed assessment at baseline and follow up. Self-efficacy in dementia management reported by persons with dementia at 6-month post-intervention was significantly higher than that reported at baseline (p = .021) and immediate post-intervention (i.e. 2-month follow up) (p = .006). Family members reported a significantly higher CSES score (p < .001) and subscale scores in thoughts (p = .001) and disruptive behaviour management (p = .001) at 9-month follow up, but significant reduction in caregiving burden (p < .001) was only noted among those who perceived higher burden than the local norms at baseline (ZBI score ≥ 25, n = 110).
Discussion:
This study provides empirical evidence that post-diagnostic support would empower persons with early dementia and their family members on adapting the impacts brought by dementia. Further study on examining the longer term effects on care outcomes and health service utilisation would be valuable.
People with dementia are more prone to premature nursing home placement after hospitalization due to physical and mental deconditioning which makes care-at- home more difficult. This study aimed to evaluate the effect of a post hospital discharge transitional care program on reduction of nursing home placement in people with dementia.
Methods:
A matched case-control study was conducted between 2018 and 2021. A transitional care program using case management approach was developed. Participants enrolled the program by self-enrolment or referral from hospitals or NGOs. Community-dwelling people with dementia discharged from hospitals received a four- week residential care at a dementia care centre with intensive nursing care, physiotherapy and group activities promoting social engagement, followed by eight- week day care rehabilitation activities to improve their mobility and cognitive functioning. They were matched on a 1:5 ratio by age and sex to people with dementia discharged from a convalescent hospital who did not participate in this program for comparison. The study outcome was nursing home admission, measured three months (i.e. post-intervention), six months, and nine months after hospital discharge. Multinomial logistic regression was conducted to investigate factors associated with nursing home placement at each measurement time-point.
Results:
361 hospital admission episodes (n=67 interevntion, n=294 control) were examined. The regression results showed that participants in the intervention group were significantly less likely to be admitted to nursing home three months (OR = 0.023, 95% CI: 0.003-0.201, p = .001) and six months (OR = 0.094, 95% CI: 0.025-0.353, p = .001) than the controls after hospital discharge, but the intervention effect did not sustain nine months after hospital discharge. Longer hospital length of stay, and hospital admission due to dementia, mental disturbances such as delirium, or mental disorders IPA_Abstract_PDP_20230119_clean 2 such as schizophrenia significantly predicted nursing home admission three months and six months after hospital discharge.
Conclusion:
The transitional care program could help reduce nursing home placement in people with dementia after hospital discharge. To sustain the intervention effect, more continual support after the intervention as well as family caregiver training would be required.
During the COVID-19 pandemic, ad hoc direct relief payments were used extensively as a means of economic stimulation and individual compensation. Current studies are focusing on the economic impact of these policies, but they seldom consider how these payments affect individual beliefs and attitudes. This study used a survey with quasi-experimental elements to examine how these payments affected tertiary students in Hong Kong by focusing primarily on a cohort including both eligible and noneligible students. Whereas satisfaction with the economy and government and support for democracy were not affected, nonrecipients assigned greater importance to meritocratic factors in improving life outcomes. The findings of this study shed light on how governments inadvertently may be affecting the outlook of young adults with transfers during the COVID-19 pandemic.
We present observations of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes spanning $l = 250^{\circ}$ ($-110^{\circ}$) to $l = 355^{\circ}$ ($-5^{\circ}$), with a latitudinal coverage of at least $|b|<1^\circ$, totalling an area of $>$210 deg$^{2}$. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s$^{-1}$ spectral resolution, providing an unprecedented view of the molecular gas clouds of the Southern Galactic Plane in the 109–115 GHz $J = 1-0$ transitions of $^{12}$CO, $^{13}$CO, C$^{18}$O, and C$^{17}$O.
Excessive and persistent fear of clusters of holes, also known as trypophobia, has been suggested to reflect cortical hyperexcitability and may be associated with mental health risks. No study, however, has yet examined these associations in representative epidemiological samples.
Aims
To examine the prevalence of trypophobia in a population-representative youth sample, its association with mental health and functioning, and its interaction with external stress.
Method
A total of 2065 young people were consecutively recruited from a household-based epidemiological youth mental health study in Hong Kong. Trypophobia, symptoms of anxiety, depression and stress, and exposure to personal stressors were assessed. Logistic regression was used to assess the relationships between trypophobia and mental health. Potential additive and interaction effects of trypophobia and high stress exposure on mental health were also tested.
Results
The prevalence of trypophobia was 17.6%. Trypophobia was significantly associated with severe symptoms of anxiety (odds ratio (OR) = 1.83, 95% CI = 1.32–2.53), depression (OR = 1.78, 95% CI = 1.24–2.56) and stress (OR = 1.68, 95% CI = 1.11–2.53), even when accounting for sociodemographic factors, personal and family psychiatric history, resilience and stress exposure. Dose–response relationships were observed, and trypophobia significantly potentiated the effects of stress exposure on symptom outcomes, particularly for depressive symptoms. Those with trypophobia also showed significantly poorer functioning across domains and poorer health-related quality of life.
Conclusions
Screening for trypophobia in young people may facilitate early risk detection and intervention, particularly among those with recent stress exposure. Nevertheless, the generally small effect sizes suggest that other factors have more prominent roles in determining recent mental health outcomes in population-based samples; these should be explored in future work.
For an integer $b\geq 2$, a positive integer is called a b-Niven number if it is a multiple of the sum of the digits in its base-b representation. In this article, we show that every arithmetic progression contains infinitely many b-Niven numbers.