Activity Participation and Perceived Health Status in Patients with Severe Mental Illness: a Prospective Study.

OBJECTIVE: To examine associations between severe mental illness (SMI), general health symptoms, mental wellbeing, and different activity levels in patients with SMI. METHOD: Consecutive patients with SMI referred for occupational therapy were prospectively included. Their hours of activities per day during hospital stay were recorded as <1 hour, 1-3 hours, and >3 hours in three categories: basic self-care activities, interest-based activities, and role-specific activities. Patients were free to join or decline any activities. Patients' somatic and mental health were measured at admission, discharge, and 1 month after discharge using the Brief Psychiatric Rating Scale (BPRS), Patient Health Questionnaire-15 (PHQ-15), Pittsburgh Sleep Quality Index (PSQI), Chinese version of Short Warwick Edinburgh Mental Wellbeing Scale (C-SWEMWBS), and Chinese version of General Activity Motivation Measure (GAMM). RESULTS: 84 patients (35 men and 49 women) aged 16 to 63 years were assessed at the three timepoints. The mean length of hospital stay of current admission was 74.73 days. The most common diagnosis was schizophrenia (n=35), followed by depression (n=15), psychosis (n=14), bipolar affective disorder (n=10), others (n=8), and delusional disorder (n=2). The hours of activities per day was <1 hour in 32 (38.1%) patients, 1-3 hours in 34 (40%) patients, and >3 hours in 18 (21.2%) patients. Improvement in somatic and mental health was positively associated with hours of activities per day. Activities were associated with reduced psychiatric symptoms (measured by BPRS) at discharge (Z = 5.978, p < 0.01). Activities were associated with less somatic complaints (measured by PHQ-15) [χ2 = 23.478, p < 0.01], better sleep quality (measured by PSQI) [χ2 = 14.762, p < 0.01]. The BPRS score for psychiatric symptoms at discharge was inversely associated with C-SWEMWBS score for mental wellbeing (r = -0.233, p = 0.033) and C-GAMM score for activity motivation (r = -0.258, p = 0.018). Basic self-care activities were a predictor for psychiatric symptoms (measured by BPRS) at discharge (adjusted R2 = 0.091, F = 8.496, p = 0.005), whereas a combined group of badminton and Tai Chi was a predictor for general activity motivation (measured by GAMM) at 1 month after discharge (adjusted R2 = 0.047, F = 4.697, p < 0.05), and soccer alone was a predictor for somatic health (measured by PHQ-15) at 1 month after discharge (adjusted R2 = 0.06, F = 5.784, p < 0.05). CONCLUSION: Participating in activities of patients' own choice and interests is positively associated with patients' psychiatric and somatic health and subjective wellbeing. Outdoor soccer has added effect on patients' somatic health. The beneficial effects are maintained at 1 month after discharge. Daily participation of activity meaningful to patients can be a non-pharmacological treatment for patients with SMI to improve somatic and mental health.

Electrically reversible cracks in an intermetallic film controlled by an electric field.

Cracks in solid-state materials are typically irreversible. Here we report electrically reversible opening and closing of nanoscale cracks in an intermetallic thin film grown on a ferroelectric substrate driven by a small electric field (~0.83 kV/cm). Accordingly, a nonvolatile colossal electroresistance on-off ratio of more than 108 is measured across the cracks in the intermetallic film at room temperature. Cracks are easily formed with low-frequency voltage cycling and remain stable when the device is operated at high frequency, which offers intriguing potential for next-generation high-frequency memory applications. Moreover, endurance testing demonstrates that the opening and closing of such cracks can reach over 107 cycles under 10-µs pulses, without catastrophic failure of the film.

Recent advances in autosomal-dominant polycystic kidney disease.

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease in adults, affecting one in every 1000 Australians. It is caused by loss-of-function heterozygous mutations in either PKD1 or PKD2 , which encode the proteins, polycystin-1 and polycystin-2 respectively. The disease hallmark is the development of hundreds of microscopic fluid-filled cysts in the kidney during early childhood, which grow exponentially and continuously through life at varying rates (between 2% and 10% per year), causing loss of normal renal tissue and up to a 50% lifetime risk of dialysis-dependent kidney failure. Other systemic complications include hypertensive cardiac disease, hepatic cysts, intracranial aneurysms, diverticular disease and hernias. Over the last two decades, advances in the genetics and pathogenesis of this disease have led to novel treatments that reduce the rate of renal cyst growth and may potentially delay the onset of kidney failure. New evidence indicates that conventional therapies (such as angiotensin inhibitors and statins) have mild attenuating effects on renal cyst growth and that systemic levels of vasopressin are critical for promoting renal cyst growth in the postnatal period. Identifying and integrating patient-centred perspectives in clinical trials is also being advocated. This review will provide an update on recent advances in the clinical management of ADPKD.

Controlling Octahedral Rotations in a Perovskite via Strain Doping.

The perovskite unit cell is the fundamental building block of many functional materials. The manipulation of this crystal structure is known to be of central importance to controlling many technologically promising phenomena related to superconductivity, multiferroicity, mangetoresistivity, and photovoltaics. The broad range of properties that this structure can exhibit is in part due to the centrally coordinated octahedra bond flexibility, which allows for a multitude of distortions from the ideal highly symmetric structure. However, continuous and fine manipulation of these distortions has never been possible. Here, we show that controlled insertion of He atoms into an epitaxial perovskite film can be used to finely tune the lattice symmetry by modifying the local distortions, i.e., octahedral bonding angle and length. Orthorhombic SrRuO3 films coherently grown on SrTiO3 substrates are used as a model system. Implanted He atoms are confirmed to induce out-of-plane strain, which provides the ability to controllably shift the bulk-like orthorhombically distorted phase to a tetragonal structure by shifting the oxygen octahedra rotation pattern. These results demonstrate that He implantation offers an entirely new pathway to strain engineering of perovskite-based complex oxide thin films, useful for creating new functionalities or properties in perovskite materials.

Full Electroresistance Modulation in a Mixed-Phase Metallic Alloy.

We report a giant, ∼22%, electroresistance modulation for a metallic alloy above room temperature. It is achieved by a small electric field of 2 kV/cm via piezoelectric strain-mediated magnetoelectric coupling and the resulting magnetic phase transition in epitaxial FeRh/BaTiO_{3} heterostructures. This work presents detailed experimental evidence for an isothermal magnetic phase transition driven by tetragonality modulation in FeRh thin films, which is in contrast to the large volume expansion in the conventional temperature-driven magnetic phase transition in FeRh. Moreover, all the experimental results in this work illustrate FeRh as a mixed-phase model system well similar to phase-separated colossal magnetoresistance systems with phase instability therein.

Giant Controllable Magnetization Changes Induced by Structural Phase Transitions in a Metamagnetic Artificial Multiferroic.

The realization of a controllable metamagnetic transition from AFM to FM ordering would open the door to a plethora of new spintronics based devices that, rather than reorienting spins in a ferromagnet, harness direct control of a materials intrinsic magnetic ordering. In this study FeRh films with drastically reduced transition temperatures and a large magneto-thermal hysteresis were produced for magnetocaloric and spintronics applications. Remarkably, giant controllable magnetization changes (measured to be as high has ~25%) are realized by manipulating the strain transfer from the external lattice when subjected to two structural phase transitions of BaTiO3 (001) single crystal substrate. These magnetization changes are the largest seen to date to be controllably induced in the FeRh system. Using polarized neutron reflectometry we reveal how just a slight in plane surface strain change at ~290C results in a massive magnetic transformation in the bottom half of the film clearly demonstrating a strong lattice-spin coupling in FeRh. By means of these substrate induced strain changes we show a way to reproducibly explore the effects of temperature and strain on the relative stabilities of the FM and AFM phases in multi-domain metamagnetic systems. This study also demonstrates for the first time the depth dependent nature of a controllable magnetic order using strain in an artificial multiferroic heterostructure.

Effects of overweight and obesity on motor and mental development in infants and toddlers.

BACKGROUND: A consequence of childhood obesity may be poor developmental outcomes. OBJECTIVES: This study aimed to examine the relationship between weight and developmental delays in young children. METHODS: We conducted a secondary analysis of the Early Childhood Longitudinal Study Birth Cohort data. Logistic regression models quantified the association between different weight statuses (normal weight <85th, overweight ≥90th, obese ≥95th percentile for weight) and delays in motor and mental development. RESULTS: Children classified as overweight in both waves had higher percentages of delays in wave 2 (motor [7.5 vs. 6.2-6.4%], mental [8.6 vs. 5.9-6.7%]), as well as wave 1 and/or wave 2 (motor [14.8 vs. 10.9-13.0%], mental [11.9 vs. 9.0-10.1%]), compared with other children. This association was also found in children who were obese at both time points in wave 2 (motor delay [8.9 vs. 4.9-7.3%], mental delay [10.3 vs. 6.0-7.2%]), as well as wave 1 and/or wave 2 (motor delay [14.5 vs. 10.9-12.9%], mental delay [14.1 vs. 9.4-10.1%]). In the adjusted models, children classified as always obese were more likely to have a mental delay in wave 2 (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI]: 1.21-2.95) as well as wave 1 and/or wave 2 (aOR 1.56, 95% CI: 1.08-2.26). These children were also more likely to have motor delay (aOR 1.47, 95% CI: 1.02-2.13) in wave 1 and/or wave 2. CONCLUSION: Overweight children are more likely than their normal-weight peers to have motor and mental developmental delays. Preventing obesity during infancy may facilitate reducing developmental delays in young children.

Cervical Ripening Balloon for Induction of Labour in High Risk Pregnancies.

BACKGROUND: The Cervical Ripening Balloon (CRB) is a novel mechanical method for induction of labour (IOL), reducing the risks of hyperstimulation associated with pharmacological methods. However, there remains a paucity of literature on its application in high risk mothers, who have an elevated risk of uterine rupture, namely those with previous scars and grandmultiparity. METHODOLOGY: A retrospective study on IOL using the CRB in women with previous caesarean section or grandmultiparity between January 2014 and March 2015. All cases were identified from the Sarawak General Hospital CRB request registry. Individual admission notes were traced and data extracted using a standardised proforma. RESULTS: The overall success rate of vaginal delivery after IOL was 50%, although this increases to about two-thirds when sub analysis was performed in women with previous tested scars and the unscarred, grandmultiparous woman. There was a significant change in Bishop score prior to insertion and after removal of the CRB. The Bishop score increased by a score of 3.2 (95% CI 2.8-3.6), which was statistically significant (p<0.01) and occurred across both subgroups, not limited to the grandmultipara. There were no cases of hyperstimulation but one case of intrapartum fever and scar dehiscence each (1.4%). Notably, there were two cases of change in lie/presentation after CRB insertion. CONCLUSION: CRB adds to the obstetricians' armamentarium and appears to provide a reasonable alternative for the IOL in women at high risk of uterine rupture. Rates of hyperstimulation, maternal infection and scar dehiscence are low and hence appeals to the user.

Association between skeletal muscle fat content and very-low-density lipoprotein-apolipoprotein B-100 transport in obesity: effect of weight loss.

AIMS: Ectopic deposition of fat in skeletal muscle is a feature of metabolic syndrome, but its specific association with very-low-density lipoprotein (VLDL)-apolipoprotein (apo) B-100 metabolism remains unclear. METHODS: We examined the association between skeletal muscle fat content and VLDL-apoB-100 kinetics in 25 obese subjects, and the responses of these variables to weight loss. The fat contents of liver, abdomen and skeletal muscle were determined by magnetic resonance imaging, and VLDL-apoB-100 kinetics were assessed using stable isotope tracers. RESULTS: In obese subjects who were insulin sensitive (homeostasis model assessment, HOMA, score ≤ 2.6, n = 12), skeletal muscle fat content was significantly associated with hepatic fat content (r = 0.636), energy intake (r = 0.694), plasma triglyceride (r = 0.644), apoB-100 (r = 0.529), glucose (r = 0.622), VLDL-apoB-100 concentrations (r = 0.860), VLDL-apoB-100 fractional catabolic rate (FCR; r = -0.581) and VLDL-apoB-100 secretion rate (r = 0.607). These associations were not found in obese subjects who were insulin resistant (HOMA score >2.6, n = 13). Of these 25 subjects, 10 obese subjects underwent a 16-week weight loss program. The low-fat diet achieved significant reduction (p < 0.05) in body weight, visceral and subcutaneous fat areas, liver and skeletal muscle fat, energy intake, triglyceride, insulin, HOMA score, VLDL-apoB100 concentrations and VLDL-apoB100 secretion rate. The percentage reduction of skeletal muscle fat with weight loss was significantly associated with the corresponding changes in VLDL-apoB100 concentration (r = 0.770, p = 0.009) and VLDL-apoB-100 secretion (r = 0.682, p = 0.030). CONCLUSIONS: Skeletal muscle fat content is associated with VLDL-apoB-100 transport. Weight loss lowers skeletal muscle fat and VLDL-apoB-100 secretion.

Translation and validation of the Chinese version of the short Warwick-Edinburgh Mental Well-being Scale for patients with mental illness in Hong Kong.

OBJECTIVE: Quality of life outcomes are useful in the assessment of mental and social wellbeing and for informed health care decision-making, especially in the choice of interventions in psychiatric rehabilitation. In its original form, the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a proven reliable and valid tool for assessing quality of life in normal adults, but not in adults from Asian countries. A shortened 7-item version of WEMWBS (SWEMWBS) with good internal construct validity was used for this study. The present study describes the translation of WEMWBS from English to Chinese and its validation in a sample of Chinese-speaking patient population. METHODS: Participants included patients admitted to the inpatient units, and those attending the day hospital and outpatient units of the Kowloon Hospital (n = 126). Translation was performed using the multiple forward and backward translation protocol. Patients also completed the 5-item World Health Organization Well-being Index (WHO5) questionnaire. A case therapist completed the Brief Psychiatric Rating Scale within 2 days. A total of 20 patients were selected for test-retest measurements performed after 2 weeks. RESULTS: The sample displayed a normal distribution of the Chinese version of SWEMWBS (C-SWEMWBS) scores (mean ± standard deviation, 23.16 ± 5.39; skewness, -0.068; kurtosis, -0.355). Internal reliability coefficient (Cronbach's alpha) for C-SWEMWBS was 0.89 which was consistent with that of English version. The corrected item-total correlation was high with Spearman's rank correlation coefficients ranging from 0.57 (item 6) to 0.75 (item 5). Good test-retest reliability was observed (r = 0.677; p = 0.001). Principal components factor analysis identified a single component (eigenvalues, 4.28; 61.1% variance), similar to the English version. Scores of C-SWEMWBS were positively correlated with the scores of WHO5 (r = 0.49; p < 0.001), suggesting good concurrent validity. Few item scores including 'feeling useful', 'dealing with problems well', 'able to make decisions', and the total score were significantly correlated with diagnostic groups (p < 0.05). Education and diagnosis of mental illness were valid predictors for C-SWEMWBS (F = 5.41; p = 0.01). There were no effects due to age and gender. CONCLUSION: The C-SWEMWBS showed high levels of internal consistency and reliability against accepted criteria. It is short, acceptable, and culturally meaningful to clients with mental illness. Further large-scale studies in normal subjects and varied patient groups are recommended to generalise the findings.

Prevalence and risk factors for Chlamydia trachomatis infection among cross-border truck drivers in Hong Kong.

OBJECTIVES: To determine the prevalence and risk factors for chlamydial infection in cross-border truck drivers. METHODS: 225 Hong Kong-based cross-border truck drivers were screened for chlamydial infection. Associations between infection and potential risk factors were determined by questionnaire. RESULTS: 8.5% of drivers were positive for chlamydial infection. Of 62% of drivers reporting recent sex with commercial sex workers (CSW), 39% had not used condoms. 75% of drivers with extramarital sex partners (ESP) also frequented CSW and 47% of this group had not used condoms with CSW. 43.3% PCR-positive cases reported symptoms. No risk factor was associated with chlamydial infection after adjustment, although "had sex with ESP" approached significance. CONCLUSIONS: The prevalence of chlamydial infection among cross-border truck drivers was not strikingly high, although drivers engaged in sex with both ESP and CSW, with many admitting unprotected intercourse. The findings highlight the importance of promoting safe sex to truck drivers.

Clinical characteristics of nosocomial norovirus outbreaks in Hong Kong.

Norovirus outbreaks occur worldwide every year and have become more frequent over the last few years. There were extensive outbreaks in Hong Kong from May to July 2006 and our aim was to describe nosocomial outbreaks from 1 May 2006 to 31 July 2006 in this retrospective observational study. A total of 38 confirmed norovirus outbreaks involving 218 patients were identified. Most of these patients were elderly with a mean age of 74.5 years (range: 3 months to 97 years); 62% of them were either totally or partially dependent for help with daily activities, 83.9% had underlying chronic medical problems and 56% had limited mobility. In all, 97.2% of individuals presented with diarrhoea and only 46.3% of them had vomiting. The median duration for diarrhoea was 3 days and the longest 24 days. The median duration of vomiting was one day and the longest 15 days. Fever occurred in one-third of all cases. Reverse transcriptase-polymerase chain reaction was positive for norovirus in 72.6% cases. We conclude that nosocomial norovirus infection often involves frail elderly patients with limited mobility and that these patients may have more prolonged symptoms.

Oral health-related quality of life and severe hypodontia.

The aims of the study were to assess oral health-related quality of life (ohqol) impact among patients with severe hypodontia and to determine the association between ohqol and the number of missing teeth. Twenty-five patients with severe hypodontia (four or more missing permanent teeth) self-completed the child perception questionnaire (CPQ) to assess oral symptoms (OS), functional limitation (FL), emotional well-being (EWB) and social well-being (SWB). Correlation between CPQ scores (overall and at domain level) and the number of missing teeth was assessed. All participants reported ohqol impact, 100% reported experiencing OS, 88% FL, 55% EWB and 100% SWB impacts. The correlation between the number of missing permanent teeth and the CPQ scores was moderate: overall CPQ score (r = 0.54), OS (r = 0.41), FL (0.52), EWB (0.52), SWB (0.49), P < 0.05. Having accounted for retained primary teeth (where a retained primary tooth was considered to have compensated for a missing permanent tooth), the correlation between the number of missing teeth and CPQ scores was strong: overall CPQ score (r = 0.94), OS (r = 0.78), FL (0.88), EWB (0.92), SWB (0.70), P < 0.001. Subjects with severe hypodontia report considerable ohqol impact. The number of missing permanent teeth was moderately correlated with ohqol. However, when retained primary teeth were taken into account, the number of missing teeth was highly correlated with ohqol. This study has implications in understanding the impact of hypodontia on quality of life and highlights the importance of retaining primary teeth in children and adolescents with severe hypodontia.

Oral health of southern Chinese children and adolescents with severe hypodontia.

OBJECTIVE: The aim of this study was to assess the oral health condition of southern Chinese children and adolescents with severe hypodontia. METHODS: This was a cross-sectional clinical study in the dental teaching hospital in Hong Kong. Twenty-five children and adolescents with severe hypodontia, and a comparison group of 25 age- and gender-matched controls took part. Verified clinical examination techniques were used to assess the pattern of missing teeth, tooth spacing, dental caries, periodontal condition, enamel defects, and tooth wear. Statistical comparisons were made between groups using independent Student t-tests and chi-square tests. RESULTS: The mean number of congenitally missing permanent teeth in the severe hypodontia group was 9.1 (SD = 5.0), with the maxillary lateral incisor being the most common missing tooth (14.5%). There were significant space discrepancies in both jaws between groups (P < 0.001). Caries prevalence was low with no difference between groups. There was no difference in periodontal condition between groups, with about half of the participants having no gingival inflammation. The severe hypodontia group had more enamel defects (P = 0.043), enamel hypoplasia (P = 0.044) and tooth wear (P = 0.005) than the comparison group. Three of the severe hypodontia group had ectodermal dysplasia. CONCLUSIONS: The oral health condition of southern Chinese children and adolescents with severe hypodontia was good in terms of caries experience and periodontal health. However, the increased prevalence of developmental defects of enamel and tooth wear complicates already complex interim and definitive prosthodontic management, and may increase psychosocial impact.

Multimodal approach in the management of 1163 ureteric stone cases.

One thousand one hundred and sixty three patients (male-852, female-311) with ureteric calculi requiring intervention were treated between April 1988 to July 1992. Four hundred and eleven cases were treated by ESWL Monotherapy, 414 by stone manipulation plus ESWL, 301 by retrograde ureteroscopic lithotripsy, 36 by percutaneous antegrade ureteroscopic lithotripsy and 1 case by open ureterolithotomy. There were 25 failures of the initial procedures. Only three cases that failed primary procedures required open surgery. Other complications include minor ureteric mucosal perforation (3%), infection (3%), transient moderate to gross haematuria (20%), loin ache (26.4%), irritative urination (34.4%) and low grade fever (30.1%). Current modalities used in the treatment of ureteric calculi produce good results and there is generally no primary role for any open surgery.

Expression of epithelial and extracellular matrix protein markers in meningiomas.

In an attempt to characterize the dual mesenchymal and epithelial differentiating potential of meningiomas, cryostat sections from 50 meningiomas of diverse histological subtypes were examined immunohistochemically with a panel of markers for epithelial and mesenchymal differentiation. The overall positivities were: keratins 50%, epithelial membrane antigen 94%, human milk fat globules 38%, carcinoembryonic antigen 4% (secretory meningiomas only), desmoplakins 64%, collagen I 82%, procollagen I 96%, collagen III 74%, collagen IV 60%, laminin 54%, fibronectin 98% and vimentin 98%. Such production of keratins was not found in many previous immunohistochemical analyses of meningiomas with paraffin sections. The extracellular matrix proteins were present in a pericellular distribution suggestive of their being produced by the tumour cells. The potential of dual epithelial and mesenchymal differentiation in meningiomas was further examined in seven cases established on short-term cultures. Morphologically, subcultured tumour cells resembled fibroblasts and in five cases revealed similar epithelial and mesenchymal immunohistochemical profiles as for direct tumour immunostaining. In two cases, cells from the primary cultures revealed a fine skeleton of intercellular matrix proteins stainable by immunohistochemical methods, providing further proof that meningioma cells possess the capability to elaborate extracellular matrix proteins, a major mesenchymal function akin to that of fibroblasts.

Effects of Eight Herbicides on In Vitro Hatching of Heterodera glycines.

Laboratory studies were conducted to evaluate effects of selected herbicides on hatching of free eggs of the soybean cyst nematode, Heterodera glycines. The herbicides used were Atrazine (atrazine), Basagran (bentazon), Bladex (cyanazine), Blazer (acifluorfen), Command (clomazone), Lasso (alachlor), Sonalan (ethalfluralin), and Treflan (trifluralin). Treatments comprised two concentrations of commercial herbicide formulations and deionized water and 3.14 mM zinc sulfate as negative and positive controls, respectively. Eggs were extracted from females and cysts, surface disinfested, and incubated in herbicide or control solutions at 25 +/- 2 C in darkness. Hatched second-stage juveniles were counted every other day for 24 days. Hatching of H. glycines eggs in 50 and 500 mug/ml Blazer was 42 to 67% less than that in deionized water and 6l to 78% less than that in zinc sulfate solution. Zinc sulfate significantly increased hatching activity in 50 mug/ml but not 500 mug/ml Blazer. The other herbicides tested at various concentrations had no significant effect on egg hatching. The specific component of Blazer inhibiting egg hatching is unknown. Suppression of hatching by Blazer indicates that this postemergence soybean herbicide may have a potential role in managing H. glycines.