Non-surgical treatment of knee osteoarthritis.

Knee osteoarthritis is one of the most common degenerative diseases causing disability in elderly patients. Osteoarthritis is an increasing problem for ageing populations, such as that in Hong Kong. It is important for guidelines to be kept up to date with the best evidence-based osteoarthritis management practices available. The aim of this study was to review the current literature and international guidelines on non-surgical treatments for knee osteoarthritis and compared these with the current guidelines in Hong Kong, which were proposed in 2005. Internationally, exercise programmes for non-surgical management of osteoarthritis have been proven effective, and a pilot programme in Hong Kong for comprehensive non-surgical knee osteoarthritis management has been successful. Long-term studies on the effectiveness of such exercise programmes are required, to inform future changes to guidelines on osteoarthritis management.

Evaluation of a Clostridium difficile infection management policy with clinical pharmacy and medical microbiology involvement at a major Canadian teaching hospital.

WHAT IS KNOWN AND OBJECTIVE: Clostridium difficile infection (CDI) represents a spectrum of disease and is a significant concern for healthcare institutions. Our study objective was to assess whether implementation of a regional CDI management policy with Clinical Pharmacy and Medical Microbiology and Infection Control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based CDI disease severity assessment and pharmacological treatment algorithm. METHODS: Conducted at a tertiary care teaching hospital, this two-phase quality assurance study consisted of a baseline retrospective healthcare record review of patients with CDI prior to the implementation of a regional CDI management policy followed by a prospective evaluation post-implementation. RESULTS AND DISCUSSION: One hundred and forty-one CDI episodes in the pre-implementation group were compared to 283 episodes post-implementation. Overall treatment concordance to the CDI treatment algorithm was achieved in 48 of 141 cases (34%) pre-implementation compared with 136 of 283 cases (48·1%) post-implementation (P = 0·01). The median time to treatment with vancomycin was reduced from five days to one day (P < 0·01), with median length of hospital stay decreasing from 30 days to 21 days (P = 0·01) post-implementation. There was no difference in 30-day all-cause mortality. WHAT IS NEW AND CONCLUSION: A comprehensive approach with appropriate stakeholder involvement in the development of clinical pathways, education to healthcare workers and prospective audit with intervention and feedback can ensure patients diagnosed with CDI are optimally managed and prescribed the most appropriate therapy based on CDI disease severity.

A 5-week whole body vibration training improves peak torque performance but has no effect on stretch reflex in healthy adults: a randomized controlled trial.

AIM: This study aimed to investigate the neuromuscular adaptation following a 5-week high frequency and low amplitude whole body vibration (WBV) exercise training. METHODS: The study is a prospective, double blind, randomized controlled intervention design with a total of 19 subjects volunteered to participate in the study. They were randomly assigned either to WBV exercise training or control group. Both groups participated in a 5-week training program. The intervention group received WBV in semi-squat position on a device with an amplitude of 0.76 mm, frequency of 40Hz, and peak acceleration of 23.9 m/s2. Each vibration training session consisted of 6 series of 60s on with 30s rest period in between. The control group underwent the same statically mini-squatting position without exposure to WBV. The effectiveness of the vibration program was evaluated by vertical jump test and the isokinetic knee extensor peak torque. The possible neural factors that contributed to the improved muscular performance were evaluated by the stretch induced knee jerk reflex. RESULTS: WBV training significantly enhanced the isokinetic knee extensor peak torque performance. Two-way mixed repeated measures analysis of variance revealed significant time effect of the changes in the peak torque (P=0.043) and the effect was significantly different between the intervention and control group (P=0.042). WBV did not affect vertical jump height, reflex latency of VL, EMGVL, and knee jerk angle. CONCLUSION: The results of this study do not support the hypothesis that the improvement in the muscular performance when subjects exposed to WBV training is attributed by neuromuscular efficiency via modulation of the muscle spindle sensitivity.

Subjective wellbeing and emotion regulation strategies: How are they associated with student engagement in online learning during Covid-19?

BACKGROUND: The COVID-19 pandemic has brought unprecedented challenges to the world, creating significant impact on people's lives and subjective wellbeing. While previous studies have shown that students' wellbeing and how they manage their emotions are critical to students' learning, less research has considered their specific impacts on student engagement in online learning. AIMS: The aim of this study is to examine how students' subjective wellbeing and emotion regulation strategies (viz cognitive reappraisal and expressive suppression) are associated with student engagement in online learning during the pandemic. SAMPLE: A total of 965 students from a university in China participated in the study. METHODS: The data were collected online during the COVID-19 from March to July 2020, which included measures of wellbeing, emotion regulation strategie, and online learning engagement. RESULTS: Structural equation modelling results showed that wellbeing was positively associated with both the use of reappraisal and suppression. Moreover, mediation analysis showed that reappraisal partially mediated the relationship between wellbeing and all types of online learning engagement (including cognitive, emotional and behavioural engagements). Conversely, suppression was found to have a small mediating effect between wellbeing and behavioural engagement of online learning only. No such effect was found on cognitive and emotional engagements. CONCLUSIONS: The findings provide evidence on the positive relationship between wellbeing and both the strategies of suppression and reappraisal during the pandemic. However, only reappraisal has positive impact on learning, suggesting the importance of effective regulation strategies on students' online engagement. Theoretical and practical implications of the findings are discussed.

Dietary Patterns and Intrinsic Capacity in Community-Dwelling Older Adults: A Cross-Sectional Study.

OBJECTIVES: Few studies have investigated the link between diet and intrinsic capacity (IC), and the potential sex difference in such association. This study examined the association between dietary patterns and IC and its sub-domains in Chinese community-dwelling older adults. DESIGN: Cross-sectional analysis using baseline data from the MrOs and MsOs study. SETTING: Community. PARTICIPANTS: Chinese community-dwelling older adults aged ≥65 years in Hong Kong. MEASUREMENTS: Dietary intake was assessed using a validated food frequency questionnaire and priori and posteriori dietary pattern scores were generated. IC including measures of cognitive, locomotor, vitality, sensory and psychological domains was assessed. Multiple logistic regression was performed to examine the associations between dietary pattern scores and the likelihood of greater IC and sub-domain scores with adjustment for sociodemographic and lifestyle factors. RESULTS: Data of 3730 participants (aged 72.2±5.0 years, 50.4% men) was available. In men, higher Diet Quality Index-International (DQI-I) and Okinawan diet scores, and lower "meat-fish" pattern scores were associated with greater IC. A higher DQI-I score was associated with greater locomotion, whereas higher "snacks-drinks-milk products" pattern score was associated with a greater sensory function. In women, none of the dietary pattern scores was associated with IC. Higher DQI-I score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score and "vegetables-fruits" pattern score were associated with greater psychological function. CONCLUSION: Various dietary patterns were associated with greater IC and its sub-domains in Chinese community-dwelling older adults, and more associations were observed in men than women. Strategies to improve diet and IC should take sex differences into account.

Predictive Value of the GLIM Criteria in Chinese Community-Dwelling and Institutionalized Older Adults Aged 70 Years and Over.

OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults. DESIGN: A prospective cohort study of Chinese older adults in a healthy ageing study. SETTING: Participants' place of residence. PARTICIPANTS: Community-dwelling and institutionalized Chinese older adults aged ≥70 years living in Hong Kong. MEASUREMENTS: Malnutrition at baseline was classified according to selected GLIM criteria. Adverse outcomes including poor self-rated health, functional limitation (Barthel Index), falls, frailty (FRAIL scale), hospitalization and mortality were assessed after a 3-year follow-up. Associations between malnutrition and components of selected GLIM criteria (weight loss, low body mass index (BMI), low muscle mass and disease burden) and each adverse outcome were examined using adjusted binary logistic regression and Cox proportional hazards model. Odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) are presented. RESULTS: Data of 1576 community-dwelling (45.5% female, 78.1±6.5 years) and 427 institutionalized (69.6% female, 85.5±6.4 years) older adults were included at baseline. Among community-dwelling older adults, malnutrition was associated with frailty (n=899, OR: 2.44, 95% CI: 1.05-5.70) and mortality (n=1007, HR: 1.37, 95% CI: 1.12-1.66). No association was found for other outcomes. Among institutionalized older adults, malnutrition was not associated with any outcomes. Low BMI and low muscle mass were risk factors of frailty; while weight loss was a risk factor of mortality in community-dwelling older adults. Weight loss and disease burden were risk factors of mortality among institutionalized older adults. CONCLUSION: The association between malnutrition and frailty and mortality was observed in community but not in institutional settings. Further studies are required to draw more definitive conclusions on the use of GLIM criteria in institutional settings.

Prospective Analysis of Fruit and Vegetable Variety on Health Outcomes in Community-Dwelling Chinese Older Adults.

OBJECTIVES: Evidence on the topic regarding fruit and vegetable (FV) variety and health outcomes among older adults is limited. This study explored the prospective association of fruit variety, vegetable variety and combined FV variety with the risk of sarcopenia, frailty, all-cause and cause-specific mortality in community-dwelling Chinese older adults. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: Community-dwelling Chinese older adults aged ≥65 years in Hong Kong. MEASUREMENTS: Fruit variety, vegetable variety and combined FV variety at baseline were assessed using a validated food frequency questionnaire and the variety scores were stratified into tertiles. Sarcopenia (Asian Working Group for Sarcopenia 2019), frailty (Cardiovascular Health Study) and all-cause and cause-specific mortality (retrieved from an official database) were assessed at 14-year follow-up. Adjusted binary logistic regression or Cox proportional hazards model were performed to examine the association of fruit variety, vegetable variety and combined FV variety with each health outcome. Data are presented as hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Baseline dietary data of 3992 participants (median age: 72 years (interquartile range: 68-76), 49.9% women) was available. There were 436 and 371 participants who were newly identified as having sarcopenia and frailty respectively, and 1654 all-cause mortality, 367 cardiovascular diseases (CVD) mortality and 534 cancer mortality over 14-year. Tertiles of fruit variety, vegetable variety and combined FV variety were not associated with sarcopenia, frailty, CVD mortality and cancer mortality. Participants in the highest tertile of fruit variety (HR 0.81, 95% CI 0.70-0.95, p-trend 0.010), vegetable variety (HR 0.77, 95% CI 0.67-0.89, p-trend <0.001) and combined FV variety (HR 0.77, 95% CI 0.67-0.89. p-trend <0.001) showed lower risk of all-cause mortality compared with participants in the lowest tertile. CONCLUSION: Among community-dwelling Chinese older adults, FV variety was not associated with sarcopenia, frailty, CVD mortality and cancer mortality over 14-year. Higher fruit variety, vegetable variety and combined FV variety were associated with a lower risk of all-cause mortality. Promoting a wide FV variety might be recommended to benefit the health and longevity of this population.

A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor.

BACKGROUND: Hamstring injuries are common in sprinters. Identifying preseason risk factors is essential to target injury-prone athletes and develop injury preventive measures. OBJECTIVE: To investigate the incidence of hamstring muscle injury in sprinters over an athletic season and to explore the preseason predictor of this injury. DESIGN: Prospective cohort study. PARTICIPANTS: 44 sprinters from the Hong Kong Sports Institute, the Hong Kong Amateur Athletic Association and intercollegiate athletic teams were recruited. METHODS: Preseason assessment of hamstring flexibility, concentric and eccentric isokinetic peak torque and peak torque angle were obtained at the beginning of an athletic season. The athletes were followed over 12 months and were asked to report all injuries resulting from training and competition. RESULTS: Eight athletes sustained hamstring injuries over the season. The injury rate was 0.87 per 1000 h of exposure. The incidence of injuries was higher at the beginning of the season, with 58.3% injuries occurring in the first 100 h of exposure. Cox regression analysis revealed that athletes with a decrease in the hamstring : quadriceps peak torque ratio of less than 0.60 at an angular velocity of 180 degrees/s have a 17-fold increased risk of hamstring injury. CONCLUSION: Performing preseason hamstring : quadriceps peak torque ratio assessments may be useful to identify sprinters susceptible to hamstring injury.

The 100-km ultradistance race in Hong Kong: physical fitness profile and team performance outcomes.

AIM: The aim of this study was to determine different variables leading to a successful completion of a 100-km ultradistance team event. METHODS: Regular physical activity patterns, self-perceptions of fitness level and physical fitness profile were determined in subjects (n=253) registered for Trailwalker 2000. The battery of fitness tests included cardiopulmonary fitness, flexibility, muscular strength, muscular endurance and body fat composition. RESULTS: The physical fitness data reveals that the subjects in this study have an above average fitness level compared with the norm. There was association of self-perceived fitness with physical fitness parameters (P=0) and significant correlation of the total fitness score with the completion time (P=0.02). More importantly, the team member with the lowest fitness total score was correlated with the finish time at the event (P=0). Logistic regression model identified that total fitness score and years of experience in Trailwalker were predictive of a successful completion in the event (r=0.37; P=0.007). However, the low variance suggested that the selected physical fitness tests have low prediction sensitivity to characterize the specific population in the study. CONCLUSIONS: There is a strong need to determine a combination of physical fitness tests that could accurately predict the performance of participants in the Trailwalker event.