Outcomes of a two-tiered multifaceted elderly suicide prevention program in a Hong Kong Chinese community.

OBJECTIVES: 1) To compare the 2-year completed suicide and reattempt rates in a preintervention group of Hong Kong Chinese suicide attempters (aged 65 years and older) who received standard care and a postintervention group enrolled in a regional elderly suicide prevention program (ESPP) that adopts a two-tiered multifaceted care management model and 2) to examine the trend of suicide rates in older adults aged 65 years and older in the pre- and postintervention periods. DESIGN: The first part is an observational cohort study with baseline, follow-up, and outcome data being identified from a clinical electronic registry. The second part examines changes in suicide rates from official mortality statistics. SETTING: A government-funded suicide intervention program serving catchment population (852,796 people aged 65 years and older) in Hong Kong, China. PARTICIPANTS: Suicide attempters (aged 65 years and older) presenting to old-age psychiatric service in the pre- and postintervention phases. MEASUREMENTS: 1) Two-year rates of completed suicide and suicide reattempt and 2) changes in population suicide rates in the pre- and postintervention periods. RESULTS: The 2-year completed suicide rate was 7.58% in the preintervention group (N = 66) and 1.99$% in the ESPP group (N = 351) Χ = 6.192; p value: 0.028; df = 1). Reattempt rates were not different. At a population level, suicide rate dropped significantly only in women aged 85 years and older, relative to the preintervention period. CONCLUSIONS: The ESPP was associated with a reduced rate of completed suicide in old-age suicide attempters and might have contributed to a fall of suicide rate in women aged 85 years and older.

Screening of dementia in Chinese elderly adults by the clock drawing test and the time and change test.

OBJECTIVES: To assess the usefulness, relative ease of administration, and patient acceptance of the clock drawing test as well as the time and change test for detecting dementia in Chinese elderly adults. DESIGN: Prospective case-controlled study. SETTING: Memory clinic and geriatric clinic of a district hospital, Hong Kong. PARTICIPANTS: A convenient sample of 85 subjects aged 65 years or older attending the two clinics during the period from September 2002 to June 2003. MAIN OUTCOME MEASURES: The clock drawing test scored according to Lam's method; the time and change test with modification to the making change task; and the Chinese version of the Mini-Mental State Examination. RESULTS: Demented subjects were matched with non-demented ones with respect to age, sex, educational level, and co-morbidity status. The clock drawing test had a comparable sensitivity (89.4%) but a lower specificity (47.1%) when compared with that of the Chinese version of the Mini-Mental State Examination (96.0 and 76.5%, respectively). In contrast, the time and change test had a lower sensitivity (62.7%) but higher specificity (94.1%). Both tests took significantly less time to complete than the Chinese version of the Mini-Mental State Examination. All except four subjects completed the clock drawing test while all subjects accepted the time and change test well. CONCLUSIONS: The Chinese version of the Mini-Mental State Examination is still the best among the three tests despite the longer time to completion. The clock drawing test may be a good alternative to the Mini-Mental State Examination as an effective screening test for dementia when time does not permit. The time and change test, although time-saving, is not suitable to be used alone because of its low sensitivity.

Morphometric identification of luminal narrowing of myocardial capillaries after cardioplegic arrest.

BACKGROUND: Because there is no smooth muscle cell surrounding the capillary endothelial cells, the effect of coronary microcirculation at the capillary level following cardioplegic arrest and reperfusion would be much different from that of resistant arterioles. We therefore studied the effect of hypothermic blood cardioplegic arrest and subsequent reperfusion on the myocardial capillaries in cardiac operation patients. METHODS: Twenty-seven patients who underwent cardiac operations were included in this study. Three sequential biopsies (preischemia, ischemia, and reperfusion) were obtained from the right atrium. This study was restricted to blood vessels with a diameter of less than 8 microns. Ten randomly selected capillaries from each biopsy were measured for luminal surface area, endothelial cytoplasmic surface area, and total cross-sectional surface area of capillaries. RESULTS: From stereologic morphometric studies, the serial changes in total cross-sectional surface area were not statistically significant (p = 0.152). However, there was a significant swelling of endothelial cytoplasm following ischemia and reperfusion (p = 0.0007). Meanwhile, changes in luminal surface area of capillaries following ischemia and reperfusion were also remarkable (p = 0.0008). CONCLUSIONS: The most striking finding of this study was the progressive decrease in capillary lumen during ischemia and after reperfusion. The swelling of endothelial cells is a major determinant of luminal narrowing of capillaries in patients receiving cardioplegic arrest.

In vivo antimicrobial activity of an essential oil-containing mouthrinse on interproximal plaque bacteria.

This study determined the in vivo interproximal bactericidal efficacy of an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) following toothbrushing. Thirty-four generally healthy adults, aged 23-64 years, completed this evaluator-blind, randomized, controlled, crossover designed study. Subjects rinsed for 30 seconds with 20 ml of either the essential oil rinse or a negative control rinse. Five minutes later, interproximal plaque was collected using paper points, and recoverable bacterial counts were quantified using both end point dilution and spectrophotometric methods. The results from the end point dilution demonstrated a statistically significant (p < 0.001) 43.8% reduction in recoverable plaque bacteria from interproximal spaces following rinsing with the essential oil mouthrinse. This study suggests that the clinical effectiveness of the essential oil mouthrinse against plaque and gingivitis may be attributable to the rapid kill and plaque permeabilizing properties of the formulation.

A randomized placebo controlled trial of homocysteine lowering to reduce cognitive decline in older demented people.

INTRODUCTION: Whether homocysteine lowering by B vitamins can reduce cognitive decline in Alzheimer disease and vascular dementia patients is unclear. METHODS AND MATERIALS: 140 subjects with mild to moderate Alzheimer disease or vascular dementia were randomly assigned to take 1 mg of methylcobalamin and 5 mg of folic acid, or placebo once daily for 24 months. The primary outcome was Mattis dementia rating scale (MDRS). Secondary outcomes were MDRS domain scores, neuropsychiatric inventory and Cornell scale for depression in dementia. Measurements were performed at baseline and every six months during the study. Fasting plasma tHCY concentrations were measured at baseline and month 18. RESULTS: Trial groups were well matched in baseline characteristics. The average plasma tHCY concentration of subjects was 14.1 ± 3.8 µmol/L. 80% of subjects completed the trial. The supplement group had average plasma tHCY reduced to 9.3 ± 2.7 µmol/L. There was no significant group difference in changes in any of the neuropsychological scores, but among those with elevated plasma tHCY (>13 µmol/L), the decline in MDRS (construction domain) was significantly smaller in the supplement group (median 0 versus 2 points in placebo group, P = 0.003). CONCLUSION: Homocysteine lowering in dementia patients did not significantly reduce global cognitive decline.

Functional disabilities profile of chinese elderly people with Alzheimer's disease - a validation study on the chinese version of the disability assessment for dementia.

This study aimed to determine the validity and applicability of the Chinese version of the Disability Assessment for Dementia (CDAD) in the Chinese elderly population. The original English version was translated and modified to a 47-item scale to suit the societal and cultural background of the Chinese population. The CDAD was administered to 169 community-residing Chinese elderly people with Alzheimer's disease (AD) and demonstrated high internal consistency (Cronbach's alpha=0.91), excellent test-retest reliability (intraclass correlation, ICC=0.99) and excellent interrater reliability (ICC=0.98). The functional disabilities profile of the same sample was examined. The CDAD had a high negative correlation with the Global Deterioration Scale (GDS; Spearman's rho=-0.89, p<0.001). ANOVA and post hoc comparisons showed there were significant differences in the mean CDAD scores across different GDS stages. To study the construct validity, the CDAD was administered concurrently with several instruments. The Instrumental Activities of Daily Living subscore of the CDAD had a high correlation with the Instrumental Activities of Daily Living Scale (r=0.94,p<0.001), and the Activities of Daily Living subscore of the CDAD had a high correlation with the Modified Barthel Index (r=0.82, p<0.001). A moderate correlation (r=0.60, p<0.001) with the Cantonese version of the Mini Mental State Examination was also found. Analysis of the relationship with sociodemographic factors indicated that the CDAD was not correlated with gender and education, and that the correlation with age was low. The CDAD was shown to be a reliable and valid instrument in assessing the functional disabilities of community-residing elderly subjects with AD in the Chinese population.

Patterns of psychogeriatric referral and attendance at three different settings in Hong Kong.

In order to analyze whether the referral system and nature of care exert any effect on the characteristics of patients, subjects aged 60 or above attending three medical centers on the Hong Kong Island between August and December 1990 were studied with respect to their age, sex, and psychiatric diagnosis. Psychiatric diagnoses were made in 98% of subjects at the psychogeriatric assessment service (PAC) (predominantly chronic organic brain syndrome), in 79.6% at the university psychiatric unit (mainly acute psychiatric problems, substance abuse, and deliberate self-harm), and in 20% at the general outpatient clinic (largely sleep and anxiety-related disorders). There was overrepresentation of the very old (above 80) and underutilization of counseling service at PAC. In Hong Kong, the psychogeriatric needs of the very old and of those with minor emotional disturbances associated with aging, retirement, and bereavement deserve reassessment.

Liquid phase synthesis of arylamines and its application to the benzimidazolone via nucleophilic aryl substitution.

A method for soluble, inexpensive polymer-supported synthesis of aryl amines and benzimidazolone on the basis of nucleophilic aryl substitution (S(N)Ar) is described. This method involves a direct coupling reaction between resin bound aryl fluoride and amines at ambient temperature. The products are isolated in quantitative yields and excellent purity by simple precipitation and washing. This liquid phase method proves to be a useful tool for constructing combinatorial arylamine and benzimidazolone libraries.

Clinical characteristics, health beliefs and compliance with maintenance treatment: a comparison between regular and irregular attenders at a depot clinic.

This study investigated the relationship between clinical characteristics, health beliefs and compliance with depot neuroleptic maintenance treatment in schizophrenic patients by comparing a group of 40 irregular clinic attenders with another group of regular attenders matched by age and sex. While the 2 groups showed no difference in drug-induced extrapyramidal effects, the former were significantly more often depressed than the latter. Test-retest reliability coefficients of a 4-section health belief questionnaire showed marked variation in individual items. The 2 groups showed no difference in their perception of past effect of illness, likelihood of a relapse if maintenance treatment was stopped and effects of maintenance treatment.

A comparison of the validity of GHQ-12 and CHQ-12 in Chinese primary care patients in Manchester.

The present study compares the efficacy of the GHQ-12 and the Chinese Health Questionnaire (CHQ-12) in Cantonese speaking Chinese primary-care patients living in Greater Manchester, using relative operating characteristic (ROC) analysis. We did not find that the Chinese version offered any advantage over the conventional version of the GHQ in this population. Stepwise discriminant analysis however confirmed the value of individual items in the former pertaining to specific somatic symptoms and interpersonal relationships in differentiating cases from non-cases. Information biases, arising from the lack of a reliability study on the second-stage case identifying interview and the unique linguistic characteristics of the Chinese language may have affected the overall validity indices of the questionnaires. The study also examines the effects of using different criteria to define a case, and shows that with increasing levels of severity, there is an improvement in the diagnostic performance of the two questionnaires as reflected by areas under ROC curves and traditional validity indices. Possible explanations of these findings are discussed. The scoring method proposed by Goodchild & Duncan-Jones (1985) when used on these questionnaires had no demonstrable advantage over the conventional scoring method.

A comparison between male and female parasuicides in Hong Kong.

The epidemiological, social and clinical characteristics of 259 male and 475 female parasuicides in Hong Kong were compared. The majority are young adults, with an overall female: male ratio of 1.83. Compared to male subjects, females are more likely to be married or cohabiting, of higher social-economic status, born in places in the Far East apart from Mainland China, and of lower educational level. Their parasuicidal acts are more often motivated by interpersonal difficulties, especially with spouses or friends of the opposite sex, and take the form of self-poisoning. Male subjects on the other hand are more often single, immigrants from Mainland China, and of lower socio-economic status. Their problems are more often personal, and they are more likely to employ physical methods in their parasuicidal acts. In both sexes, age specific parasuicidal rates showed a second peak in senescence. Both the overall prevalence of psychiatric disorders and the rate of repeated parasuicide 2 years following the index admissions were low. The implications of these findings are explored.

A role for the Drosophila Toll/Cactus pathway in larval hematopoiesis.

In the Drosophila larva, blood cells or hemocytes are formed in the lymph gland. The major blood cell type, called plasmatocyte, is small, non-adhesive and phagocytic. Plasmatocytes differentiate into adhesive lamellocytes to form multilayered capsules around foreign substances or, in mutant melanotic tumor strains, around self tissue. Mutations in cactus or Toll, or constitutive expression of dorsal can induce lamellocyte differentiation and cause the formation of melanotic capsules. As maternally encoded proteins, Toll, Cactus and Dorsal, along with Tube and Pelle, participate in a common signal transduction pathway to specify the embryonic dorsal-ventral axis. Using the maternal pathway as a paradigm, we investigated if these proteins have additional roles in larval hemocyte formation and differentiation. Analysis of cactus mutants that lack Cactus protein revealed that almost all of these animals have an overabundance of hemocytes, carry melanotic capsules and die before reaching pupal stages. In addition, the lymph glands of cactus larvae are considerably enlarged. The number of mitotic cells in the cactus and TollD hemolymph is higher than that in the wild-type hemolymph. The hemocyte density of mutant Toll, tube or pelle hemolymph is significantly lower than that of the wild type. Lethality of mutant cactus animals could be rescued either by the selective expression of wild-type Cactus protein in the larval lymph gland or by the introduction of mutations in Toll, tube or pelle. Cactus, Toll, Tube and Pelle proteins are expressed in the nascent hemocytes of the larval lymph gland. Our results suggest that the Toll/Cactus signal transduction pathway plays a significant role in regulating hemocyte proliferation and hemocyte density in the Drosophila larva. These findings are discussed in light of similar hematopoietic functions of Rel/I(kappa)B-family proteins in mice.

Posttranslational cleavage of rat intestinal lactase occurs at the luminal side of the brush border membrane.

The intestinal sucrase-isomaltase precursor is cleaved at the brush border membrane by luminal proteases. Whether the lactase precursor also is cleaved by luminal proteases is uncertain. Lactase synthesis and processing was studied in 0- and 15-day-old rats after IP administration of [35S]methionine, and changes in precociously cortisone-induced sucrase-isomaltase were used as an internal control. Mucosal lactase and sucrase-isomaltase were separately immunoprecipitated and analyzed by autoradiography after electrophoresis. In both 0- and 15-day-old rats, mucosal lactase appeared as a 200K lactase precursor band at 30 minutes and as 200K and 225K lactase precursor bands at 60 minutes and was cleaved to form a 130K lactase band 120-240 minutes after labeling; sucrase-isomaltase similarly appeared as 210K and 220K bands at 30-60 minutes and was cleaved to form 140K I and 120K S subunits by 240 minutes in day 15 rats. To determine the role of luminal proteases, intestinal segments were isolated in situ and the luminal contents were flushed 30 minutes after labeling. Unflushed segments were used as controls. Only lactase precursor and sucrase-isomaltase precursor were present 240 minutes after labeling in flushed intestinal segments, but lactase precursor and sucrase-isomaltase precursor were cleaved in unflushed segments. Addition of trypsin or elastase into the lumen of flushed segments resulted in partial cleavage of lactase precursor but not of sucrase-isomaltase precursor. Luminal contents collected from the small intestine of day 15 rats 120 and 240 minutes after labeling showed 35S-labeled 130K and 80K polypeptides in lactase immunoprecipitates. It is concluded that intestinal lactase is synthesized as lactase precursor and transported to brush border membrane and cleaved by luminal proteases, and the amino end polypeptide cleaved from lactase precursor is released into the lumen.

Can the Hospital Anxiety and Depression (HAD) Scale be used on Chinese elderly in general practice?

A study was carried out in a general practice in Hong Kong to find out if the Hospital Anxiety and Depression (HAD) Scale could be used to detect psychological problems in Chinese elderly. The HAD Scale was translated into Cantonese and administered by an interviewer to 298 Chinese aged 60 or above before their doctor consultations. The acceptance rate of the Scale was 96% and each interview took only 5-10 min to complete. All 298 elderly understood and completed the HAD Scale. Validation of the results of the HAD Scale by the Clinical Interview Schedule (CIS) was done on a random sample of 100 elderly. Relative operating characteristic (ROC) analysis showed that the optimal cut-off points of the HAD Scale was a depression score of 6 and an anxiety score of 3. The sensitivity was 80%, specificity was 90%, OMR (overall misclassification rate) was 12%, positive predictive value was 67% and negative predictive value was 95%. Thirty-six per cent of the elderly had scores above these cut-off points. More females than males had high anxiety scores. Nearly half of those with positive HAD scores were not known to have any psychological illness. The HAD Scale has great potential to be used as a screening instrument for psychological illnesses in Cantonese-speaking Chinese elderly all over the world.

Psychiatry as compared to other career choices: a survey of medical students in Hong Kong.

A questionnaire was administered to two groups of medical students, one preclinical and the other clinical, to assess their career choices, opinions of six specialties (including internal medicine, general practice, obstetrics and gynaecology, paediatrics and psychiatry as well as surgery) and anxieties about psychiatry. It was found that both groups of students conceptualized clinicians according to stereotypes which were modified but not abated by clinical exposure. Although the clinical students compared to preclinical students attributed more positive personality traits to psychiatrists, students interested in taking up careers in psychiatry were few in both groups. Compared to the preclinical class, clinical students were less worried about disturbed patients and emotional involvement with patients, but were more concerned about their deficiency in knowledge and skills relevant to psychiatry.