Psychosocial correlates of mental health of university students in Hong Kong under COVID-19.

Although the COVID-19 pandemic has caused many problems for university students, there are several research gaps in the study of psychological well-being of Hong Kong university students. First, few studies have examined different ecological correlates of mental health in a single study. Second, few studies have used both psychological morbidity and positive well-being as indicators of mental health. Third, we know little about the relationships between university students' perceived need satisfaction, difficulties, service utilization, and their mental health. Hence, we conducted a study (N = 1,020 university students) in the later stage of the COVID-19 pandemic in Hong Kong. For mental health, we included measures of negative mental health (psychological morbidity) and positive mental health. We addressed several research questions in this study: (1) what is the mental health status of Hong Kong university students? (2) what is the relationship between COVID-19 stress and student mental health? (3) what are the intrapersonal correlates of student mental health? (4) are interpersonal factors related to student mental health? (5) are need satisfaction, difficulties encountered, and service utilization related to students' mental health? (6) are there gender differences in the effects of correlates in different ecological systems? Analyses using structural equation modeling showed several observations. First, the prevalence of mental health symptoms among university students was alarming. Second, COVID-19 related socio-economic stress positively predicted psychological morbidity but negatively predicted well-being. Third, beliefs about adversity, resilience, and emotional competence predicted mental health. Fourth, family functioning was related to psychological morbidity negatively but connected with well-being positively. Fifth, while need satisfaction predicted psychological morbidity negatively, difficulties encountered showed the opposite direction. Besides, the perceived usefulness of university services positively predicted mental health. Finally, there were no gender differences in the effects of different predictors. The present findings enable public health researchers to formulate theoretical models on different ecological determinants of university students' mental health under the pandemic. For public health practitioners, the study highlights the importance of reducing COVID-19 associated stress, strengthening internal and external developmental assets, and meeting the psychosocial needs of university students as strategies to promote their mental health under the pandemic.

Resolution of rabbit haemorrhagic disease virus 2 (RHDV2; Lagovirus europeus GI.2) outbreak in Singapore.

Rabbit haemorrhagic disease (RHD) is a highly contagious viral disease affecting lagomorphs. The first documented cases of RHD in Singapore occurred in adult pet European rabbits in September 2020. Singapore subsequently declared the outbreak resolved in December 2020. Epidemiological investigations ruled out introductions via importation of infected rabbits and contaminated feed. The source could not be definitively determined. However, the findings suggested that the incident involved both inter- and intra-household transmission and veterinary clinic-household transmission. This incident demonstrated the importance of sustained application of biosecurity measures, epidemiological investigations including active case finding, control measures such as expedient vaccine dissemination and risk communications. It showed that even without a wild lagomorph population, an urbanized city-state like Singapore could still encounter emerging diseases such as RHD. Given its social impact on rabbit owners, the National Parks Board, Singapore and private veterinarians worked together to communicate with rabbit owners in order to urge them to adopt biosecurity measures and to address their concerns.

First detection of rabbit haemorrhagic disease virus (RHDV2) in Singapore.

Rabbit haemorrhagic disease (RHD) is a significant viral disease caused by infection with Rabbit haemorrhagic disease virus (RHDV). The first documented cases of RHDV in Singapore occurred in adult pet European rabbits (Oryctolagus cuniculus) in September 2020. Rabbits presented with acute hyporexia, lethargy, huddled posture, and varying degrees of pyrexia and tachypnoea. Clinical pathology consistently reflected markedly elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALKP). Hepatic lobe torsion was ruled out using ultrasonography and colour Doppler studies in all patients. A total of 11 rabbits owned by 3 families were presented to the clinics; 8/11 rabbits died within 48 hr of presentation, while the remaining two rabbits had recovered after prolonged hospitalization and one rabbit was aclinical. Histopathology revealed acute, marked diffuse hepatocellular necrosis and degeneration, findings which were suggestive for RHDV infection and prompted the undertaking of further molecular diagnostics. Subsequent polymerase chain reaction of the liver samples detected RHDV RNA. Molecular characterization of viral genomes by whole genome sequencing revealed that the outbreak strain was of the genotype GI.2 (RHDV2/RHDVb). Nucleotide sequences of the VP60 gene were compared with various RHDV variants using phylogenetic analysis. The sample genome shared highest sequence identity with a GI.2-genotyped virus from GenBank (RHDV isolate Algarve 1 polyprotein and minor structural protein (VP10) genes, GenBank accession KF442961). The combination of clinical, histopathological, molecular and sequencing technologies enabled rapid detection and detailed genetic characterization of the RHDV virus causing the present outbreak for prompt implementation of disease control measures in Singapore. Further epidemiological investigations of potential virus introduction into Singapore are ongoing.

Promoting Service Leadership Qualities and Well-Being among University Students through an Online Course during COVID-19 Pandemic.

The COVID-19 pandemic is a great challenge to leadership education in universities. Although previous findings provide support for the effectiveness of online learning, the impact of online leadership course on students' learning outcomes and well-being has not been well documented. Using objective outcome and subjective outcome evaluation strategies, the present study examined students' perceived qualities and effectiveness of an online credit-bearing service leadership course adopting asynchronous mode (primarily online learning) and synchronous mode under COVID-19. Regardless of teaching modes, the subject yielded positive impacts. Specifically, pretest-posttest (N = 228) showed that there were positive changes in students' service leadership qualities, life satisfaction and psychological well-being. For students' perception of the course (N = 219), results indicated that most students were positive in their learning experience and satisfied with course design, lecturer quality and the benefits of the course to their development. Students' changes and subjective perceptions were positively correlated, but with a low effect size. The findings reflected that online service leadership course adopting asynchronous or synchronous mode was effective, and students were positive about their learning experience.

Closing the gap on causal processes of infection risk from cross-sectional data: structural equation models to understand infection and co-infection.

BACKGROUND: Epidemiological studies of disease exposure risk are frequently based on observational, cross-sectional data, and use statistical approaches as crucial tools for formalising causal processes and making predictions of exposure risks. However, an acknowledged limitation of traditional models is that the inferred relationships are correlational, cannot easily distinguish direct from indirect determinants of disease risk, and are often considerable simplifications of complex interrelationships. This may be particularly important when attempting to infer causality in patterns of co-infection through pathogen-facilitation. METHODS: We describe analyses of cross-sectional data using structural equation models (SEMs), a contemporary advancement on traditional regression approaches, based on our study system of feline gammaherpesvirus (FcaGHV1) in domestic cats. RESULTS: SEMs strongly supported a latent (host phenotype) variable associated with FcaGHV1 exposure and co-infection risk, suggesting these individuals are simply more likely to become infected with multiple pathogens. However, indications of pathogen-covariance (potential facilitation) were also variably detected: potentially among FcaGHV1, Bartonella spp and Mycoplasma spp. CONCLUSIONS: Our models suggest multiple exposures are primarily driven by host phenotypic traits, such as aggressive male phenotypes, and secondarily by pathogen-pathogen interactions. The results of this study demonstrate the application of SEMs to understanding epidemiological processes using observational data, and could be used more widely as a complementary tool to understand complex cross-sectional information in a wide variety of disciplines.

Felis catus gammaherpesvirus 1; a widely endemic potential pathogen of domestic cats.

Felis catus gammaherpesvirus 1 (FcaGHV1), recently discovered in the USA, was detected in domestic cats in Australia (11.4%, 95% confidence interval 5.9-19.1, n=110) and Singapore (9.6%, 95% confidence interval 5.9-14.6, n=176) using qPCR. FcaGHV1 qPCR positive cats were 2.8 times more likely to be sick than healthy. Risk factors for FcaGHV1 detection included being male, increasing age and coinfection with pathogenic retroviruses, feline immunodeficiency virus (FIV) or feline leukaemia virus. FcaGHV1 DNA was detected in multiple tissues from infected cats with consistently high virus loads in the small intestine. FcaGHV1 viral load was significantly higher in FIV-infected cats compared with matched controls, mimicking increased Epstein-Barr virus loads in human immunodeficiency virus-infected humans. FcaGHV1 is endemic in distant geographic regions and is associated with being sick and with coinfections. Horizontal transmission of FcaGHV1 is supported, with biting being a plausible route. A pathogenic role for FcaGHV1 in domestic cats is supported.

Physiological energetics of the fourth instar of Chinese horseshoe crabs (Tachypleus tridentatus) in response to hypoxic stress and re-oxygenation.

Hypoxia associated with eutrophication is a potential threat to the Chinese horseshoe crab Tachypleus tridentatus which inhabits intertidal sand flats in Asia. This study investigated the effect of dissolved oxygen level (DO) (6, 4 and 2 mg O2 l(-1)) on the physiological energetics in the juvenile T. tridentatus. They were exposed to various oxygen levels for three days and then transferred to normoxia for three days to examine the recovery from low oxygen stress. Feeding rate, respiration rate and scope for growth were reduced at lower DO levels while absorption efficiency and excretion rate were independent of DO levels. Although full recovery of the physiological responses and scope for growth from hypoxis stress was observed when normoxia resumed, their long term survival in suboptimal habitats with frequent occurrence of hypoxia deserves a close monitoring as hypoxia may be even more common in future in a warming world.

Communicating diabetes best practices to clients: a preliminary investigation of educator perspectives.

PURPOSE: The majority of people with type 2 diabetes do not meet dietary and physical activity recommendations. It is not well understood how diabetes educators translate diet and physical guidelines for their clients and if diabetes educators have sufficient resources to promote healthy eating and physical activity. This research addressed these questions through exploratory qualitative interviews. METHOD: A total of 13 diabetes educators who work in Alberta, Canada, were interviewed. RESULTS: The reasons for lack of client uptake of lifestyle recommendations were complex and interwoven. The strongest theme to emerge was the clients' prior knowledge and skills affecting their ability to uptake knowledge. However, educators recognized that clients are affected by social, environmental, cultural, and personal factors. CONCLUSIONS: Health system and societal issues cause a cascade effect resulting in difficulties for both educators and clients. To achieve appropriate treatment of type 2 diabetes, changes need to occur at a health systems level.

General practice and social service partnership for better clinical outcomes, patient self efficacy and lifestyle behaviours of diabetic care: randomised control trial of a chronic care model.

BACKGROUND: The International Diabetes Attitudes, Wishes, and Needs (DAWN) programmes have shown the existence of a critical gap in self management support and access to the support system. This study aims to evaluate the effectiveness of the diabetes mellitus (DM) self management programme, with partnership between general practice and social work, on clinical outcomes, patient self efficacy and lifestyle behaviours. METHODS: In this is single blind randomised controlled trial, subjects were recruited from patients attending general outpatient clinics in the Hospital Authority New Territory East Cluster of Hong Kong. 157 subjects meeting the inclusion criteria completed the study and were randomly assigned to the experimental or control group. The experimental group underwent the six sessions of weekly DM self management course with emphasis on self efficacy and participatory approach. The outcome measurements included HbA1c concentration, DM self efficacy scale, dietary behaviours, body mass index (BMI), and waist: hip ratio. RESULTS: Baseline assessment observed no significant differences between experimental and control groups for the variables related to outcomes. For the experimental group, the proportion of subjects with normal HbA1c increased from 4.5% (3/66) at baseline to 28.6% (19/66) at week 28 (p<0.001), but there was insignificant improvement in the control group (3.9% to 11.8%, p=0.13). Repeated measure of analysis of variance showed pronounced improvement in DM self efficacy scale and BMI among the experimental group with significant interaction. Dietary behaviours also improved significantly in the experimental group. CONCLUSION: The DM care model with partnership between general practice and social work demonstrated better diabetic control with improvement of self efficacy and minimisation of risk behaviours. TRIAL REGISTRATION: Current Controlled Trials ISRCTN78882965.

Daily steps are low year-round and dip lower in fall/winter: findings from a longitudinal diabetes cohort.

BACKGROUND: Higher walking levels lead to lower mortality in type 2 diabetes, but inclement weather may reduce walking. In this patient population, we conducted a longitudinal cohort study to objectively quantify seasonal variations both in walking and in two vascular risk factors associated with activity levels, hemoglobin A1C and blood pressure. METHODS: Between June 2006 and July 2009, volunteer type 2 diabetes patients in Montreal, Quebec, Canada underwent two weeks of pedometer measurement up to four times over a one year follow-up period (i.e. once/season). Pedometer viewing windows were concealed (snap-on cover and tamper proof seal). A1C, blood pressure, and anthropometric parameters were also assessed. Given similarities in measures for spring/summer and fall/winter, and because not all participants completed four assessments, spring and summer values were collapsed as were fall and winter values. Mean within-individual differences (95% confidence intervals) were computed for daily steps, A1C, and systolic and diastolic blood pressure, by subtracting spring/summer values from fall/winter values. RESULTS: Among 201 participants, 166 (82.6%) underwent at least one fall/winter and one spring/summer evaluation. Approximately half were women, the mean age was 62.4 years (SD 10.8), and the mean BMI was 30.1 kg/m2 (SD 5.7). Step counts averaged at a sedentary level in fall/winter (mean 4,901 steps/day, SD 2,464) and at a low active level in spring/summer (mean 5,659 steps/day, SD 2,611). There was a -758 (95% CI: -1,037 to -479) mean fall/winter to spring/summer within-individual difference. There were no significant differences in A1C or in anthropometric parameters. Systolic blood pressure was higher in fall/winter (mean 137 mm Hg, SD 16) than spring/summer (133 mm Hg, SD 14) with a mean difference of 4.0 mm Hg (95% CI: 2.3 to 5.7). CONCLUSIONS: Daily step counts in type 2 diabetes patients are low, dipping lower during fall/winter. In this medication-treated cohort, A1C was stable year-round but a fall/winter systolic blood pressure increase was detected. Our findings signal a need to develop strategies to help patients increase step counts year-round and prevent both reductions in step counts and increases in blood pressure during the fall and winter.

Walking behaviour and glycemic control in type 2 diabetes: seasonal and gender differences--study design and methods.

BACKGROUND: The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1% absolute increase in A1C is associated with an 18% increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels. METHODS: During this prospective cohort study being conducted in Montreal, Quebec, Canada, 100 men and 100 women with type 2 diabetes will undergo four assessments (once per season) over a one-year period of observation. These assessments include (1) use of a pedometer with a concealed viewing window for a two-week period to measure walking (2) a study centre visit during which venous blood is sampled for A1C, anthropometrics are assessed, and questionnaires are completed for measurement of other factors that may influence walking and/or A1C (e.g. food frequency, depressive symptomology, medications). The relationship between spring-fall A1C difference and winter-summer difference in steps/day will be examined through multivariate linear regression models adjusted for possible confounding. Interpretation of findings by researchers in conjunction with potential knowledge "users" (e.g. health professionals, patient groups) will guide knowledge translation efforts. DISCUSSION: Although we cannot alter weather patterns to favour active lifestyles, we can design treatment strategies that take seasonal and weather-related variations into account. For example, demonstration of seasonal variation of A1C levels among Canadian men and women with T2D and greater understanding of its determinants could lead to (1) targeting physical activity levels to remain at or exceed peak values achieved during more favourable weather conditions. Strategies may include shifting to indoor activities or adapting to less favourable conditions (e.g. appropriate outdoor garments, more frequent but shorter duration periods of activity) (2) increasing dose/number of glucose-lowering medications during the winter and reducing these during the summer, in anticipation of seasonal variations (3) examining the impact of bright light therapy on activity and A1C among T2D patients with an increase in depressive symptomology when sunlight hours decline.

The interface between phonetic and lexical abilities in early Cantonese language development.

Data from the Cantonese Communicative Development Inventory (CCDI) is used to review the phonological preferences of younger (16-22 months) and older (23-30 month) groups of children in the lexical items they are reported to be able to say. Analogous results to those found for English emerge from the Cantonese data: the younger group display selectivity in the initial consonants of words they say, and their preferences accord with developmental tendencies in Cantonese phonology. From children whose scores fell below the tenth percentile of the CCDI, a subset were followed up 1 year later and their linguistic progress evaluated. Only a proportion of these children were below still below the tenth percentile for vocabulary at follow-up. Their lexical immaturities were accompanied by limited phonetic abilities. The implications of the findings are discussed.

A survey of ovary-, testis-, and soma-biased gene expression in Drosophila melanogaster adults.

BACKGROUND: Sexual dimorphism results in the formation of two types of individuals with specialized reproductive roles and is most evident in the germ cells and gonads. RESULTS: We have undertaken a global analysis of transcription between the sexes using a 31,464 element FlyGEM microarray to determine what fraction of the genome shows sex-biased expression, what tissues express these genes, the predicted functions of these genes, and where these genes map onto the genome. Females and males (both with and without gonads), dissected testis and ovary, females and males with genetically ablated germlines, and sex-transformed flies were sampled. CONCLUSIONS: Using any of a number of criteria, we find extensive sex-biased expression in adults. The majority of cases of sex differential gene expression are attributable to the germ cells. There is also a large class of genes with soma-biased expression. There is little germline-biased expression indicating that nearly all genes with germline expression also show sex-bias. Monte Carlo simulations show that some genes with sex-biased expression are non-randomly distributed in the genome.

FlyGEM, a full transcriptome array platform for the Drosophila community.

We have constructed a DNA microarray to monitor expression of predicted genes in Drosophila. By using homotypic hybridizations, we show that the array performs reproducibly, that dye effects are minimal, and that array results agree with systematic northern blotting. The array gene list has been extensively annotated and linked-out to other databases. Incyte and the NIH have made the platform available to the community via academic microarray facilities selected by an NIH committee.