Nocturnal Oxygen Desaturation Index Correlates with Respiratory Depression in Post-Surgical Patients Receiving Opioids - A Post-Hoc Analysis from the Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by Capnography (PRODIGY) Study.

Purpose: Postoperative monitoring of respiratory status on general care wards typically consists of intermittent checks of oxyhemoglobin saturation and respiratory rate, allowing substantial unmonitored time for severe opioid induced respiratory depression (RD) to develop unnoticed. Oxygen desaturation index (ODI) can be computed solely by continuous pulse oximetry monitoring. In this post-hoc analysis, we evaluate whether nocturnal ODI correlates with RD. Patients and Methods: The PRODIGY trial (NCT02811302) was a multinational study conducted where adult patients receiving parenteral opioids on the general care floor were continuously monitored by blinded pulse oximetry and capnography monitoring to detect episodes of RD. An RD episode was defined as: respiratory rate ≤5 breaths/min (bpm) for ≥3 minutes, oxygen saturation (SpO2) ≤85% for ≥3 minutes, end-tidal carbon dioxide (EtCO2) ≤15 or ≥60 mm Hg for ≥3 minutes, apnea episode lasting >30 seconds, or any respiratory opioid-related adverse event. Data were used to calculate nocturnal (00:00 ─ 06:00) ODI4% based on desaturation episodes (4% decrease from mean oxyhemoglobin saturation in the past 120 seconds, lasting ≥10 seconds). Continuous monitoring began after a patient received parenteral opioids, allowing identification of potential RD and ODI4% episodes during opioid therapy. The average number of ODI4% episodes (≥1, ≥5, ≥10, ≥15 episodes/hour) were analyzed. Logistic regression and area under the receiver operating characteristic curve (AUC) were computed. Results: A final cohort of 1072 (out of 1335) patients had sufficient data, with 76% (N=817/1072) having ≥1 episode of ODI4%. Multivariable logistic regression showed that ODI4% was strongly associated with RD, with greater risk for higher ODI4% scores: ≥5 episodes/hour odds ratio 2.59 (95% CI 1.72-3.89, p<0.0001); ≥10 episodes/hour 3.39 (95% CI 1.80-6.39, p=0.0002); ≥15 episodes/hour 4.71 (95% CI 1.93-11.47, p=0.0006).There was no significant association between ODI4% and respiratory adverse events. Conclusion: Nocturnal ODI4% was highly correlated with RD among hospitalized patients receiving parenteral opioids. Patients with a high ODI4%, especially with ≥15 episodes/hour, are more likely to experience RD and should be evaluated for the need of closer monitoring after opioid administration.

Posttraumatic Growth After Motor Vehicle Crashes.

The relationship between sub-dimensions of posttraumatic growth (PTG) and distress was investigated for survivors of motor vehicle crashes (MVC). PTG and symptoms of posttraumatic stress disorder (PTSD) for 1045 MVC survivors who attended the Accident and Emergency Services were examined with the Chinese versions of the Posttraumatic Growth Inventory (PTGI) and the Impact of Event Scale-Revised 1 week after the experience of a MVC. A factor structure, which was different from both the original English version of the PTGI and the Chinese version of PTGI for cancer survivors, was identified. Factors extracted were: (1) Life and Self Appreciation; (2) New Commitments; (3) Enlightenment; and (4) Relating to Others. However, correlation analyses indicated a functional similarity between factors from this study and those from previous studies. Relations between PTG sub-dimensions and PTSD symptoms were identified. Results from hierarchical multiple regression analysis and structural equation modeling show that there were different predictors for different PTG sub-dimensions. Findings suggest that different modes of relationship between PTSD symptoms and PTG sub-dimensions may co-exist.

Psychometric analysis of the Chinese version of the Posttraumatic Growth Inventory with cancer patients in Hong Kong and Taiwan.

OBJECTIVE: Cancer patients in Hong Kong and Taiwan share traditional Chinese as a written form of language, but each region has its own sociocultural background. This study examined if the four-factor model (self, spiritual, life orientation, and interpersonal) of the Chinese version of the Posttraumatic Growth Inventory (PTGI-C), developed for Hong Kong cancer survivors, could be applied to cancer survivors in Taiwan. METHODS: Multisample confirmatory factor analyses (MS-CFA) were used to examine the factorial invariance of the PTGI-C among cancer survivors in Taiwan (n = 217) and Hong Kong (n = 223). RESULTS: The goodness-of-fit of the four-factor model was satisfactory, χ²(180) = 372.36 (χ²/df = 2.07), goodness-of-fit index (GFI) = 0.90, adjusted GFI (AGFI) = 0.87, comparative fit index (CFI) = 0.92, Tucker-Lewis index (TLI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, Akaike information criterion (AIC) = 492.36. This result suggests that the factor structure of the PTGI-C developed in Hong Kong could be applied to cancer survivors in Taiwan. The internal reliabilities of the 15-item whole scale, as well as all the subscales, were good and similar to those reported previously. Interregion comparison revealed that the Taiwan sample had higher mean 'spiritual' and 'interpersonal' posttraumatic growth subscale scores than the Hong Kong sample. CONCLUSIONS: The four-factor model of the PTGI-C is invariant among cancer survivors using traditional Chinese as a written form of the language. The differences in the degree of some posttraumatic growth dimensions may be because of differences in cultural factors and in psychosocial support for cancer patients between the two regions.

Validation of the Chinese strengths and weaknesses of ADHD-symptoms and normal-behaviors questionnaire in Hong Kong.

OBJECTIVE: Unlike rating scales that focus on the severity of ADHD symptoms, the Strengths and Weaknesses of ADHD-symptoms and normal-behaviors (SWAN) rating scale is phrased in neutral or positive terms for carers to compare the index child's behaviors with that of their peers. This study explores its psychometric properties when applied to Chinese children in Hong Kong. METHOD: Ratings from the Chinese SWAN scale collected from parents and teachers of a community sample of 3,722 6- to 12-year-old students recruited by stratified random sampling were compared with 247 clinic children with a diagnosis of ADHD. Reliability, validity, factor structure, and cutoff scores were calculated. RESULTS: Favorable psychometrics and a two-factor structure identical to the original were reproduced. Cutoff scores were supported by satisfactory sensitivities and specificities. CONCLUSION: The SWAN scale is a reliable and valid instrument for the assessment of ADHD symptoms in Chinese children in Hong Kong.

Combined use of serum adiponectin and tumor necrosis factor-alpha receptor 2 levels was comparable to 2-hour post-load glucose in diabetes prediction.

BACKGROUND: Adipose tissue inflammation and dysregulated adipokine secretion are implicated in obesity-related insulin resistance and type 2 diabetes. We evaluated the use of serum adiponectin, an anti-inflammatory adipokine, and several proinflammatory adipokines, as biomarkers of diabetes risk and whether they add to traditional risk factors in diabetes prediction. METHODS: We studied 1300 non-diabetic subjects from the prospective Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS). Serum adiponectin, tumor necrosis factor-alpha receptor 2 (TNF-α R2), interleukin-6 (IL-6), adipocyte-fatty acid binding protein (A-FABP) and high-sensitivity C-reactive protein (hsCRP) were measured in baseline samples. RESULTS: Seventy-six participants developed diabetes over 5.3 years (median). All five biomarkers significantly improved the log-likelihood of diabetes in a clinical diabetes prediction (CDP) model including age, sex, family history of diabetes, smoking, physical activity, hypertension, waist circumference, fasting glucose and dyslipidaemia. In ROC curve analysis, "adiponectin + TNF-α R2" improved the area under ROC curve (AUC) of the CDP model from 0.802 to 0.830 (P = 0.03), rendering its performance comparable to the "CDP + 2-hour post-OGTT glucose" model (AUC = 0.852, P = 0.30). A biomarker risk score, derived from the number of biomarkers predictive of diabetes (low adiponectin, high TNF-α R2), had similar performance when added to the CDP model (AUC = 0.829 [95% CI: 0.808-0.849]). CONCLUSIONS: The combined use of serum adiponectin and TNF-α R2 as biomarkers provided added value over traditional risk factors for diabetes prediction in Chinese and could be considered as an alternative to the OGTT.

Distinct changes in serum fibroblast growth factor 21 levels in different subtypes of diabetes.

AIMS: Fibroblast growth factor (FGF) 21 is an endocrine factor with multiple beneficial effects on glucose and lipid metabolism in animals. This study aimed to investigate the association of serum FGF21 levels with type 1 diabetes, latent autoimmune diabetes in adults (LADA) and type 2 diabetes. METHODS: Serum FGF21 levels were determined by ELISA in patients with type 1 diabetes (n = 76), LADA (n = 68), type 2 diabetes (n = 77), and their age- and sex-matched controls. The association of serum FGF21 with markers of autoimmunity was studied. RESULTS: In type 1 diabetic patients, serum FGF21 levels were significantly lower than controls [108.3 (61.5-180.1) vs. 196.0 (103.7-330.9) pg/ml, P < 0.001]. In LADA patients, serum FGF21 levels were significantly lower than controls after adjustment for body mass index [210.9 (121.4-441.6) vs. 268.3 (159.5-443.6) pg/ml, P = 0.003]. By contrast, serum FGF21 levels in type 2 diabetic patients were significantly higher than controls [381.2 (244.7-531.3) vs. 301.4 (173.9-444.2) pg/ml, P = 0.006]. FGF21 levels increased progressively from type 1 diabetes, LADA, to type 2 diabetes (P < 0.001 for global trend). Furthermore, FGF21 levels correlated inversely with titers of glutamic acid decarboxylase and insulinoma-associated protein 2 autoantibodies in type 1 diabetic and LADA patients. CONCLUSIONS: Serum FGF21 level is increased in type 2 diabetes but decreased in type 1 diabetes and LADA. In autoimmune diabetes, the reduction in circulating FGF21 is closely associated with markers of pancreatic ß-cell autoimmunity.

Plasma concentration of pigment epithelium-derived factor is closely associated with blood pressure and predicts incident hypertension in Chinese: a 10-year prospective study.

OBJECTIVES: Pigment epithelium-derived factor (PEDF) is secreted from the adipose tissue. It circulates at high concentrations, and was reported to play a causal role in obesity-induced insulin resistance and metabolic dysfunctions in mice. Previous cross-sectional studies also demonstrated plasma PEDF concentration correlated positively with systolic blood pressure (BP) and pulse pressure, and inversely with small artery elasticity. Here we investigated the relationship of plasma PEDF concentration with BP and incident hypertension in a 10-year prospective study. METHODS: Baseline plasma PEDF concentrations were measured by ELISA in 520 Chinese subjects, aged 51 ± 12 years, followed up long-term from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study. The association between plasma PEDF concentration and BP was investigated in both cross-sectional and prospective studies, using multiple linear regression and path analyses. Cox proportional hazards analysis was used to determine whether baseline PEDF concentration was independently related to the subsequent development of hypertension over 10 years. RESULTS: Baseline plasma concentrations of PEDF were higher in men (P < 0·001), and were directly related to systolic BP at 2 and 5 years, and to diastolic BP at 2 years, after adjustment for covariates. Of the 386 normotensive subjects at baseline, high baseline PEDF concentration was predictive of incident hypertension, independent of the effects of age, sex, baseline BP and obesity parameters (hazard ratio: 1·135; 95% CI: 1·039-1·241; P = 0·005). CONCLUSION: Our data suggest that plasma PEDF concentration is significantly associated with BP, and incident hypertension. PEDF may be involved in the pathogenesis of hypertension in humans.

The KCNJ11 E23K polymorphism and progression of glycaemia in Southern Chinese: a long-term prospective study.

CONTEXT: The KCNJ11 E23K variant is associated with type 2 diabetes mellitus (T2DM) in cross-sectional studies, but conflicting findings have been reported from prospective studies. OBJECTIVE: This study aimed to evaluate whether the E23K variant could predict glycaemic progression in a Southern Chinese population. METHODS/PRINCIPAL FINDINGS: We performed a long-term prospective study on 1912 subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS). The KCNJ11 E23K variant was associated with the progression to prediabetes after a median interval of 12 years on multinomial logistic regression analysis, even after adjustment for traditional risk factors (OR 1.29, P(age, sex, BMI and fasting plasma glucose [FPG] adjusted) = 0.02). Based on Cox proportional hazard regression analysis, the E23K variant also predicted incident prediabetes (HR 1.18, P(age, sex, BMI and FPG adjusted)= 0.021). However, E23K was not associated with the progression to T2DM in either multinomial or Cox regression analysis, and the association of E23K with glycaemic progression to either prediabetes or T2DM was significant only in unadjusted Cox regression analysis (P = 0.039). In a meta-analysis of eight prospective studies including our own, involving 15680 subjects, the E23K variant was associated with incident T2DM (fixed effect: OR 1.10, P = 4×10(-3); random effect: OR 1.11, P = 0.035). CONCLUSIONS: Our study has provided supporting evidence for the role of the E23K variant in glycaemic progression in Chinese, with its effect being more evident in the early stage of T2DM, as the subjects progressed from normal glucose tolerance to prediabetes.

High plasma level of fibroblast growth factor 21 is an Independent predictor of type 2 diabetes: a 5.4-year population-based prospective study in Chinese subjects.

OBJECTIVE: To investigate whether circulating levels of fibroblast growth factor 21 (FGF21), which previously has been shown to be elevated in obesity, could predict the development of type 2 diabetes in a 5.4-year, population-based, prospective study. RESEARCH DESIGN AND METHODS: Baseline plasma FGF21 levels were measured using an enzyme-linked immunosorbent assay in 1,900 subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS). The prospective association of FGF21 with diabetes development over 5.4 years was analyzed using multiple logistic regression. RESULTS: At baseline, plasma levels of FGF21 increased progressively with worsening dysglycemia from normal glucose tolerance, through prediabetes, to diabetes (global trend, P < 0.001). Of 1,292 subjects without diabetes at baseline, a high baseline FGF21 level was a strong independent predictor for diabetes development (odds ratio 1.792; P < 0.01), together with waist circumference and fasting plasma glucose levels. CONCLUSIONS: Plasma FGF21 levels were significantly increased in subjects with prediabetes and diabetes and predicted the development of diabetes in humans.

Haemoglobin A1c is superior to fasting glucose in predicting the incidence of diabetes over 8 years among Chinese.

Baseline haemoglobin A1c had a higher standardized hazard ratio, and more optimal sensitivity and specificity than fasting glucose in predicting the 8-year incidence of diabetes among 530 non-diabetic Chinese from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study.

Genetic variants associated with persistent central obesity and the metabolic syndrome in a 12-year longitudinal study.

OBJECTIVE: Central obesity predisposes to various cardiometabolic diseases and is a key component of the metabolic syndrome (MetS). We have previously demonstrated that three obesity-susceptible single nucleotide polymorphisms (SNPs), rs10938397 (GNPDA2), rs8050136 (FTO) and rs17782313 (MC4R), were associated with obesity and waist circumference in cross-sectional studies in the Chinese population. In this study, we investigate whether these SNPs could also predict the persistence of central obesity and MetS in subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS) cohort. DESIGN AND METHODS: We genotyped these SNPs in i) 354 subjects with and 994 subjects without central obesity at both baseline and a 12-year follow-up, ii) 2214 subjects (816 cases and 1398 controls) in an MetS cross-sectional case-control study and iii) 225 subjects with and 1221 subjects without MetS at both baseline and the 12-year follow-up. RESULTS: Both FTO rs8050136 (P(age, sex-adjusted)=0.019; odds ratio (OR) (95% confidence intervals (CI)): 1.35 (1.05, 1.73)) and GNPDA2 rs10938397 (P(age, sex-adjusted)=3 × 10(-3); OR (95% CI): 1.34 (1.11, 1.63)) were significantly associated with persistent central obesity. GNPDA2 rs10938397 was also significantly associated with MetS (P(age, sex-adjusted)=0.011, OR (95% CI): 1.20 (1.04, 1.38)) in the case-control study. However, none of these SNPs showed an individual association with persistent MetS. In the combined genetic risk analyses for persistent central obesity and persistent MetS, the combined genetic risk score of the three SNPs showed an OR of 1.25 (95% CI: 1.10, 1.42; P(age, sex-adjusted)=4.92 × 10(-3)) and 1.19 (95% CI: 1.03, 1.38; P(age, sex-adjusted)=0.019) for each additional risk allele respectively. CONCLUSION: This study demonstrated that FTO and GNPDA2 variants predicted persistent central obesity in the Chinese population, further supporting their importance as obesity-susceptible genes.

Plasma level of pigment epithelium-derived factor is independently associated with the development of the metabolic syndrome in Chinese men: a 10-year prospective study.

OBJECTIVE: Pigment epithelium-derived factor (PEDF), a serine protease inhibitor, is secreted from the adipose tissue and circulates at high concentrations. A recent study found that PEDF played a causal role in obesity-induced insulin resistance and metabolic dysfunctions in mice. Here we investigated whether circulating PEDF levels predicted the development of the metabolic syndrome (MetS) in a 10-yr prospective study. RESEARCH DESIGN AND METHODS: Baseline plasma PEDF levels were measured with an ELISA in 520 nondiabetic subjects, recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort. Multiple logistic regression was used to analyze whether PEDF was an independent factor related to the MetS at baseline. The role of PEDF in predicting the development of the MetS over 10 yr was analyzed using Cox regression analysis. RESULTS: Plasma levels of PEDF were significantly higher in men than women. At baseline, sex-adjusted PEDF levels were significantly higher in subjects with MetS (P < 0.001), and the association remained significant (odds ratio: 1.17, P = 0.015), even after adjustment for covariates. Among the components of the MetS, PEDF was independently associated with hypertriglyceridemia (P = 0.026) and hypertension (P = 0.005). Of the 396 subjects without the MetS at baseline, a total of 80 had developed the MetS over 10 yr. High baseline sex-adjusted PEDF was an independent predictor of the development of the MetS in men (hazard ratio: 1.25, P = 0.034) but not in women. CONCLUSION: Plasma PEDF was significantly associated with the presence of the MetS and predicted the development of the MetS in Chinese men.

Sense of community in Hong Kong: relations with community-level characteristics and residents' well-being.

Sense of community (SOC) has been one of the most studied topics in community psychology. However, no empirical study to date has investigated SOC in Hong Kong and its relations with community characteristics and residents' psychological well-being. A representative sample of 941 Hong Kong Chinese based on a randomized household survey was conducted in all 18 districts in Hong Kong. Results of hierarchical linear modeling indicated that SOC was not associated with sociodemographic indicators on both the individual-level (i.e., gender, age, family income, education level, type of residence, and area-to-capita ratio of residence) and the community-level (i.e., proportion of individuals with tertiary education, median family income, ownership of residence, population density, and resident stability). SOC was negatively related to daily hassles and positively with social support and quality of life. Conceptualization of SOC in Hong Kong was discussed.

Combining education and video-based contact to reduce stigma of mental illness: "The Same or Not the Same" anti-stigma program for secondary schools in Hong Kong.

This study examined the effects of three versions of school-based stigma reduction programs against mental illness - education, education followed by video-based contact (education-video), and video-based contact followed by education (video-education). The participants, 255 students from three secondary schools in Hong Kong, completed measures of stigmatizing attitudes (Public Stigma Scale), social distance (Social Distance Scale), and knowledge about schizophrenia (Knowledge Test) at pre-test, post-test, and 1-month follow-up. Results suggested that adding video-based contact to education could significantly improve program effectiveness only when video-based contact was presented after but not prior to education. In comparison with the education condition, the education-video condition showed larger improvements in stigmatizing attitudes at post-test, in social distance at both post-test and follow-up, and in knowledge at follow-up. However, such differences were not observed when the education condition was compared with the video-education condition. Implications of these findings for future research are discussed.