Enhancing Subjective Well-Being Through Qigong: A Randomized Controlled Trial in Older Adults in Hong Kong With Chronic Physical Illness.

Context: Eight-section Brocades, a qigong protocol, has been shown to reduce depressive symptoms in older adults with chronic physical illness, but its positive effects on quality of life, such as subjective well-being, aren't known. Objective: This study intended to evaluate the efficacy of qigong for increasing subjective well-being in older adults with chronic physical illness. Design: A randomized controlled trial was conducted. Setting: A governmental family clinic in Hong Kong. Participants: Participants were 47 older adults, 19 males and 28 females, with chronic physical illness. Intervention: Participants were randomly assigned to an Eight-section Brocades group (n = 25) or a cognitive training group (n = 22). The groups received 12 weeks of the Eight-section Brocades intervention or of cognitive training, respectively. Outcome Measures: The primary outcome-subjective well-being-and the secondary outcomes-functional independence, sleep quality, mobility, and hand grip strength-were assessed at baseline, postintervention, and at a one-month follow-up. Results: No significant between-group differences were observed in improvements in subjective well-being or any of the secondary outcomes. Significant improvements in subjective sleep quality and decreases in daytime dysfunction over time were reported by participants in both groups. Conclusions: The findings didn't support 12 weeks of Eight-section Brocades qigong as an effective treatment to enhance the subjective well-being of older adults with chronic physical illness. These null findings may be due to the possibilities that: (1) the treatment may have minimal effects on positive psychology outcomes; (2) the primary outcome measure showed possible ceiling effects for the groups; (3) the current study used an active control condition that may have had more benefits than the control conditions used in previous studies; (4) the current study may have been underpowered; (5) more than 12 weeks (24 sessions) of qigong may be required to impact well-being; or (6) some combination of these factors may have affected the results.

Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis.

The outbreak of the novel coronavirus disease 2019 (COVID-19) changed lifestyles worldwide and subsequently induced individuals' sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID-19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta-analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID-19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Newcastle-Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N = 67,722) in the female subgroup and 45 papers (N = 45,718) in the male subgroup were pooled in the meta-analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%-29%) for female participants and 27% (95% CI 24%-30%) for male participants. Although in both gender subgroups, patients with COVID-19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta-regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action.

Non-invasive brain stimulation combined with psychosocial intervention for depression: a systematic review and meta-analysis.

OBJECTIVES: This review investigates the efficacy and safety of non-invasive brain stimulation (NIBS) combined with psychosocial intervention on depressive symptoms. MATERIALS AND METHODS: We systematically searched five electronic databases from their inception to June 2021: PubMed, Embase, PsycINFO, Web of Science, and Medline. Randomized or non-randomized clinical trials in which NIBS plus psychosocial intervention was compared to control conditions in people with depressive symptoms were included. RESULTS: A total of 17 eligible studies with 660 participants were included. The meta-analysis results showed that NIBS combined with psychosocial therapy had a positive effect on moderate to severe depression ([SMD = - 0.46, 95%CI (- 0.90, - 0.02), I2 = 73%, p < .01]), but did not significantly improve minimal to mild depression ([SMD = - 0.12, 95%CI (- 0.42, 0.18), I2 = 0%, p = .63]). Compared with NIBS alone, the combination treatment had a significantly greater effect in alleviating depressive symptoms ([SMD = - 0.84, 95%CI (- 1.25, - 0.42), I2 = 0%, p = .93]). However, our results suggested that the pooled effect size of ameliorating depression of NIBS plus psychosocial intervention had no significant difference compared with the combination of sham NIBS [SMD = - 0.12, 95%CI (- 0.31, 0.07), I2 = 0%, p = .60] and psychosocial intervention alone [SMD = - 0.97, 95%CI (- 2.32, 0.38), I2 = 72%, p = .01]. CONCLUSION: NIBS when combined with psychosocial intervention has a significant positive effect in alleviating moderately to severely depressive symptoms. Further well-designed studies of NIBS combined with psychosocial intervention on depression should be carried out to consolidate the conclusions and explore the in-depth underlying mechanism.

Psychometric Properties of the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF): Systematic Review.

BACKGROUND: The Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) is among the best with regard to its psychometric properties. Therefore, clinical psychologists are likely guided to use the IGDS9-SF if they want to assess or screen the disordered gaming in their practice. However, the information, especially psychometric evidence, concerning the IGDS9-SF has not been fully examined and summarized. OBJECTIVE: This systematic review evaluated the psychometric properties of different language versions of the IGDS9-SF and assessed its methodological quality in order to improve the clinicians' understanding of the IGDS9-SF and facilitate its use. METHODS: Systematic literature searches were carried out using Embase, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science. The review included English-language studies of any research design that have reported at least one psychometric property of the IGDS9-SF, as defined by the COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN), and have aimed at testing the psychometric properties of the IGDS9-SF. RESULTS: In total, 21 studies comprising 15 language versions of the IGDS9-SF were included. Overall, the IGDS9-SF showed adequate internal consistency (although some items did not have satisfactory item-total correlation [IT]), excellent criterion validity, and the ability to distinguish different subgroups with measurement invariance being supported across gender and age. In terms of factor structure, the IGDS9-SF was shown to have a unidimensional factor structure across all 21 studies. CONCLUSIONS: Although there is insufficient evidence regarding the responsiveness and properties of the IGDS9-SF using item response theory, the existing evidence supports its use in assessing disordered gaming among individuals.

Therapeutic Effect and Mechanisms of Essential Oils in Mood Disorders: Interaction between the Nervous and Respiratory Systems.

Essential oils (EOs) are extracted from plants and contain active components with therapeutic effects. Evidence shows that various types of EOs have a wide range of health benefits. In our previous studies, the potential of lavender EO for prevention and even treatment of depression and anxiety symptoms was demonstrated. The favourable outcomes may be due to multiple mechanisms, including the regulation of monoamine level, the induction of neurotrophic factor expression, the regulation of the endocrine system and the promotion of neurogenesis. The molecules of EOs may reach the brain and exert an effect through two distinctive pathways, namely, the olfactory system and the respiratory system. After inhalation, the molecules of the EOs would either act directly on the olfactory mucosa or pass into the respiratory tract. These two delivery pathways suggest different underlying mechanisms of action. Different sets of responses would be triggered, such as increased neurogenesis, regulation of hormonal levels, activation of different brain regions, and alteration in blood biochemistry, which would ultimately affect both mood and emotion. In this review, we will discuss the clinical effects of EOs on mood regulation and emotional disturbances as well as the cellular and molecular mechanisms of action. Emphasis will be put on the interaction between the respiratory and central nervous system and the involved potential mechanisms. Further evidence is needed to support the use of EOs in the clinical treatment of mood disturbances. Exploration of the underlying mechanisms may provide insight into the future therapeutic use of EO components treatment of psychiatric and physical symptoms.

Qigong for the treatment of depressive symptoms: Preliminary evidence of neurobiological mechanisms.

OBJECTIVES: Qigong has been shown to effectively reduce depressive symptoms in older adults with chronic physical illness. Here, we sought to evaluate the effects of qigong on serotonin, cortisol, and Brain-derived Neurotropic Factors (BDNF) levels and test their roles as potential mediators of the effects of qigong on depressive symptoms. METHODS: Thirty older adults with chronic physical illness participated in a randomized clinical trial. They were randomly assigned to a qigong group (n = 14) or a control group for cognitive training of executive function and memory (n = 16). The participants provided blood and saliva samples at baseline and post-intervention. Levels of cortisol were measured from the salvia samples, and serotonin and BDNF were measured from the blood samples. RESULTS: Consistent with the study findings presented in the primary outcome paper, a significant Group × Time interaction effect emerged on depressive symptoms, explained by greater reductions in the qigong group than the control group. Qigong participants had significantly larger increases in serotonin and BDNF, and decreases in cortisol levels, compared with control group participants. Moreover, treatment-related changes in cortisol levels (but not serotonin or BDNF) fully mediated the beneficial effects of qigong on depressive symptoms. CONCLUSION: The findings provide preliminary evidence that treatment-related changes in cortisol may mediate the benefits of qigong on depressive symptoms. Given the limitation of small sample size of the present study, future studies with larger sample sizes and more extended follow-up assessment are warranted to determine the reliability of these findings.

Bibliometric study of research productivity in occupational therapy and physical therapy/physiotherapy in four Western countries and five Asian countries/regions.

INTRODUCTION: High-quality research is the foundation of occupational therapy and physical therapy/physiotherapy. A bibliometric study on the research productivity of occupational therapy and physical therapy/physiotherapy scholars in different Western and Asian countries/regions could provide a snapshot of current research achievement in rehabilitation science. METHOD: On the basis of an understanding of the leading role of rehabilitation research in Western countries and a recognition of achievements made by Asian occupational therapy and physical therapy/physiotherapy scholars, the current bibliometric study examined the research productivity of occupational therapy and physical therapy/physiotherapy professors and associate professors from four Western countries (Australia, Canada, the United States and the United Kingdom) and five Asian countries/regions (Hong Kong, Japan, Taiwan, Singapore and South Korea). The h-indices of these scholars were retrieved online and aggregated to quantify the research productivity of institutions and countries/regions. RESULTS: Australia, Canada, Hong Kong and the United States were identified as countries/regions with higher research productivity in occupational therapy and physical therapy/physiotherapy. The institutions were ranked on the basis of the median h-indices of their professors and associate professors; the top 20 productive institutions with occupational therapy programmes had a median h-index of 17.5 or higher, whereas the benchmark of the top 20 institutions with physical therapy/physiotherapy programmes was 25. CONCLUSION: Professors and associate professors in Australia, Canada, Hong Kong and the United States are productive in occupational therapy and physical therapy/physiotherapy research. The number of faculty members and university connections are regarded as important for research achievement. Recommendations for various levels of collaboration are provided.

Measuring perceived rehabilitation needs of Caregivers of People with Schizophrenia in mainland China.

This paper reports the development and validation of the Wuxi version of the Rehabilitation Needs Questionnaire for Caregivers of People with Schizophrenia (PRNQ-C-WX) based on the original Hong Kong version (PRNQ-C-HK). PRNQ-C-WX was validated by exploratory factor analysis (EFA) using a convenience sample consisting of 200 caregivers of people with schizophrenia. EFA yielded an eight-factor solution accounting for 63.8 % of the total variance which resulted in a 50-item PRNQ-C-WX. The questionnaire has excellent internal consistencies. Its factor structure is similar to the Hong Kong version. Some suggestions for policy, service and research development in mental health in mainland China are made.

Measuring perceived rehabilitation needs of people with schizophrenia in mainland China.

This paper reports the development and validation of the Wuxi version of the Rehabilitation Needs Questionnaire for People with Schizophrenia (PRNQ-S-WX) based on the original Hong Kong version. PRNQ-S-WX was validated by exploratory factor analysis (EFA) using a convenience sample of 250 people with schizophrenia. EFA yielded a 17-factor solution accounting for 81.3 % of the total variance which resulted in a 75-item PRNQ-S-WX. The questionnaire has sound internal consistencies. Its factor structure is similar to the Hong Kong version. Some suggestions for policy, service and research development in mental health in mainland China are made.

Assessing validity of the EQ-5D-5L proxy in children and adolescents with Duchenne muscular dystrophy or spinal muscular atrophy.

OBJECTIVE: To assess the psychometric properties of the EuroQol-5-Dimension five-level instrument (EQ-5D-5L) proxy in caregivers of children and adolescents with Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA). METHOD: Data were collected using the EQ-5D-5L proxy for individuals with DMD or SMA, as reported by their caregivers. Ceiling and floor effects, reliability (Cronbach's alpha), convergent and divergent validity (Spearman's correlation coefficient and Bland-Altman plot) and known-group validity (analysis of variance) was used to assess the instrument's psychometric properties. RESULTS: Totally, 855 caregivers completed the questionnaire. Significant floor effects were observed for most dimensions of the EQ-5D-5L in both SMA and DMD samples. The EQ-5D-5L was strongly correlated with the hypothesized subscales of the SF-12, which confirmed satisfactory convergent and divergent validity. The EQ-5D-5L can significantly differentiate between impaired functional groups for individuals, demonstrating satisfactory discriminative ability. The agreement between the EQ-5D-5L utility and EQ-VAS scores was poor. CONCLUSIONS: Based on the measurement properties assessed in this study, the EQ-5D-5L proxy is a valid and reliable tool for measuring the health-related quality of life of individuals with DMD or SMA rated by caregivers. Further studies should examine the content validity of the EQ-5D as well as the performance of its young version in these two patient groups.

Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial.

BACKGROUND AND AIMS: Novel approaches to improve sleep disturbance in older adults are needed. Our study comprises a pioneering attempt to test the efficacy of Tai Chi (TC) combined with repetitive transcranial magnetic stimulation (rTMS) in improving sleep disturbance in older adults. The influence of baseline depressive symptoms was tested in a subset of the sample. METHOD: In the randomized controlled trial, 152 participants were each allocated to one of the following groups: (1) TC plus active rTMS (n = 38), (2) TC plus sham rTMS (n = 38), (3) TC alone (n = 38), and (4) low-intensity physical exercise (PE) control group (n = 38). Four-week interventions were conducted for each group. The outcomes included insomnia severity, actigraphy-assessed and self-reported sleep parameters, mood states, and quality of life. Assessments were carried out at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). RESULTS: Of the 152 randomized participants, the mean (SD) age was 67.68 (4.98) years, with 112 female (73.68%). The findings revealed that TC plus active rTMS induced a significant reduction in actigraphy-assessed sleep onset latency compared to TC plus sham rTMS at T1 and T2. In the subsample without depressive symptoms, the combination treatment exhibited a greater benefit in actigraphy-assessed sleep efficiency and wake time after sleep onset compared to both variables in the PE group and in the sham comparator group at T1, respectively. The other subsample with depressive symptoms showed the improvements with TC plus active rTMS, TC plus sham rTMS, and TC alone differed significantly from PE at T1 and T2. CONCLUSIONS: This study has demonstrated the positive effect of TC combined with rTMS on sleep disturbance in older adults. Specific sample characteristics should be considered when applying TC, either alone or combined with rTMS.

A review on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasia.

BACKGROUND: This evidence-based review reports an updated evaluation and critical appraisal of available studies that investigated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasia rehabilitation. METHODS: A literature search was performed to identify studies that investigated the therapeutic effects of rTMS on post-stroke aphasia in various electronic databases, from their inception to 2011. The selected studies were classified according to the types of participants, types of interventions, outcome measures, and results. The methodological qualities of the selected studies were evaluated using the Physiotherapy Evidence Database scale. RESULTS: The current review was based on 12 studies, including open-label designs and controlled trials, that showed a positive effect of rTMS, with or without conventional rehabilitation, on post-stroke aphasia compared with sham or conventional rehabilitation alone. About 41% of the selected studies reported the long-term effect of rTMS on aphasia recovery. No adverse effect was reported. CONCLUSIONS: The current review reveals that rTMS with or without conventional rehabilitation has positive effects on post-stroke aphasia. The studies also contributed to the plausible mechanisms of stroke recovery. However, with the concerns over the methodology of the selected studies in this review, a larger-scale, multicenter, well-designed randomized controlled trial involving different phases and types of aphasia needs to be carried out before recommending rTMS as a complementary treatment for post-stroke aphasia.

Psycho-physical and neurophysiological effects of qigong on depressed elders with chronic illness.

This randomized controlled trial examined the psychological, physical, and neurophysiological effects of a qigong exercise program on depressed elders with chronic medical illness. The experimental group (n = 21, 80 ± 7 years) was given a 12-week qigong exercise program, while the comparison group (n = 17, 81 ± 8 years) participated in a newspaper reading program with the same duration and frequency. Measurement of depression symptoms, psychosocial functioning, muscle strengths, salivary cortisol, and serum serotonin was conducted. At 12 weeks, the qigong group had significant reduction in depressive symptoms (F = 11.68; p < 0.025). Improvement in self-efficacy (F = 4.30; p < 0.050), self-concept of physical well-being (F = 6.82; p < 0.025), and right-hand grip strength (F = 5.25; p = 0.034) was also found when compared with the comparison group. A change in salivary cortisol level was found marginally insignificant between groups (F = 3.16; p = 0.087). However, a decreasing trend of cortisol level was observed. The results provided preliminary evidence for the hypotheses that the antidepressive effect of qigong exercise could be explained by improvement in psychosocial functioning and possibly down-regulation of hyperactivity of the hypothalamic-pituitary-adrenal axis.

The perceived rehabilitation needs of people with schizophrenia in Hong Kong: perspectives from consumers and care-givers.

A quantitative survey was conducted to investigate the perceived rehabilitation needs based on people with schizophrenia and their caregivers. A total of 194 persons with schizophrenia and 83 caregivers were recruited by convenience sampling to complete the two newly developed questionnaires for this purpose which included the Perceived Rehabilitation Needs Questionnaire for People with Schizophrenia and the Perceived Rehabilitation Needs Questionnaire for Caregivers towards People with Schizophrenia respectively. The findings deepened the understanding of this area. Some policy and service development suggestions for mental health strategies in Hong Kong and the Asian-Pacific region were made.

Development and validation of perceived rehabilitation require questionnaires for caregivers of people with schizophrenia.

OBJECTIVE: This study aimed at developing and validating the Perceived Rehabilitation Needs Questionnaires for Caregivers (PRNQ-Cs) of people with schizophrenia. METHODS: The items of PRNQ-C were generated based on focus group discussion and literature review. A validation study was conducted to examine its psychometric properties among 98 caregivers who were recruited via convenience sampling. RESULTS: Through the use of direct oblique rotation, exploratory factor analysis yielded an eight-factor solution which accounted for 64.39% of the total variance. Its internal consistency and test-retest reliability were satisfactory. CONCLUSION: Through cross-cultural validation, the PRNQ-C is applicable in other Chinese communities with huge population of schizophrenia.

The neurobiological effects of mind-body exercise: a systematic review and meta-analysis of neuroimaging studies.

The neurobiological effects of mind-body exercise on brain activation, functional neural connections and structural changes in the brain remain elusive. This systematic review and coordinate-based meta-analysis investigated the changes in resting-state and task-based brain activation, as well as structural brain changes before and after mind-body exercise compared to waitlist or active controls based on published structural or functional magnetic resonance imaging randomized controlled trials or cross-sectional studies. Electronic database search and manual search in relevant publications yielded 34 empirical studies with low-to-moderate risk of bias (assessed by Cochrane risk-of-bias tool for randomized trials or Joanna Briggs Institute's critical appraisal checklist for analytical cross-sectional studies) that fulfilled the inclusion criteria, with 26 studies included in the narrative synthesis and 8 studies included in the meta-analysis. Coordinate-based meta-analysis showed that, while mind-body exercise enhanced the activation of the left anterior cingulate cortex within the default mode network (DMN), it induced more deactivation in the left supramarginal gyrus within the ventral attention network (uncorrected ps < 0.05). Meta-regression with duration of mind-body practice as a factor showed that, the activation of right inferior parietal gyrus within the DMN showed a positive association with increasing years of practice (voxel-corrected p < 0.005). Although mind-body exercise is shown to selectively modulate brain functional networks supporting attentional control and self-awareness, the overall certainty of evidence is limited by small number of studies. Further investigations are needed to understand the effects of both short-term and long-term mind-body exercise on structural changes in the brain.PROSPERO registration number: CRD42021248984.

Leveraging the glymphatic and meningeal lymphatic systems as therapeutic strategies in Alzheimer's disease: an updated overview of nonpharmacological therapies.

Understanding and treating Alzheimer's disease (AD) has been a remarkable challenge for both scientists and physicians. Although the amyloid-beta and tau protein hypothesis have largely explained the key pathological features of the disease, the mechanisms by which such proteins accumulate and lead to disease progression are still unknown. Such lack of understanding disrupts the development of disease-modifying interventions, leaving a therapeutic gap that remains unsolved. Nonetheless, the recent discoveries of the glymphatic pathway and the meningeal lymphatic system as key components driving central solute clearance revealed another mechanism underlying AD pathogenesis. In this regard, this narrative review integrates the glymphatic and meningeal lymphatic systems as essential components involved in AD pathogenesis. Moreover, it discusses the emerging evidence suggesting that nutritional supplementation, non-invasive brain stimulation, and traditional Chinese medicine can improve the pathophysiology of the disease by increasing glymphatic and/or meningeal lymphatic function. Given that physical exercise is a well-regarded preventive and pro-cognitive intervention for dementia, we summarize the evidence suggesting the glymphatic system as a mediating mechanism of the physical exercise therapeutic effects in AD. Targeting these central solute clearance systems holds the promise of more effective treatment strategies.

The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis.

Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD = - 0.73, 95% CI (- 1.01, - 0.45), I2 = 90%] and large effects on anxiety [SMD = - 0.90, 95% CI (- 1.19, - 0.60), I2 = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.

The relationship between liver function and neurophysiological factors in depressed individuals: a cross-sectional study using an integrated "East meets West" medicine approach.

Introduction: Depression is a common mental disorder worldwide. The pathology of depression may involve the dysregulation of neurotransmitters and immunity and produce genetic and environmental effects. Traditional Chinese Medicine (TCM) has been practiced for several thousand years and has a different understanding of depression compared to Western medicine. However, this approach has not been widely accepted by scientific communities as TCM mainly focuses on clinical practice. Methods: In this study, we conducted a cross-sectional study among 100 participants in a rehabilitation hospital to analyze the plausible pathways linking TCM-based liver function and depression, which we hypothesized in a prior theoretical review. Results: A significant relationship between adrenocorticotropic hormone and TCM-based liver function was found (r = 0.211, p = 0.041). Cortisol was significantly associated with norepinephrine (r = 0.243, p = 0.015) and adrenocorticotropic hormone (r = 0.302, p < 0.001). A positive significant relationship was also found between norepinephrine and adrenocorticotropic hormone (r = 0.272, p < 0.001). There was no significant relationship between the ratio from low frequency to high frequency and TCM-based liver function (p = 0.690). Discussion: These results suggest that TCM-based liver function can be interpreted using the hypothalamic-pituitary-adrenal axis. This is a pioneering study to examine the mechanisms of depression in relation to liver function by integrating Eastern and Western medical approaches. The findings of this study are valuable for a deeper understanding of depression and public education.

Sino-American employer perspective about behavioral-driven health conditions: predictive analyses.

OBJECTIVE: A large-scale quantitative study was conducted by stratified representative samples from Chicago (prototype of the United States; N = 293), Beijing (prototype of urbanized China; N = 302), and Hong Kong (prototype of East-meets-West culture; N = 284) to explore factors that might lead to their stigmatizing attitudes towards hiring individuals with (mental illness, alcohol abuse, drug abuse, and HIV/AIDS) and without (bone cancer) behavioral-driven health conditions. METHODS: Consented employers completed the Employer Survey pertaining to their attitudes towards specific health conditions, previous hiring experiences, resources, assets of applicants, and hiring concerns. RESULTS: The findings suggested that employers in Hong Kong and Beijing were more willing to hire individuals with alcohol abuse, whereas employers in Chicago were more willing to hire those with HIV/AIDS or bone cancer. Logistic regression suggested that the type of health conditions, assets of applicants, and perceived level of dangerousness of applicants were significant predictors that contributed to employers' hiring preference. CONCLUSION: Employers express different hiring preference towards individuals with or without behavioral-driven health conditions. Their hiring preference towards specific type of health conditions is discussed.