IMPORTANCE: Clinical practice guidelines support exercise for patients with Parkinson disease (PD), but to our knowledge, no randomized clinical trials have tested whether yoga is superior to ...conventional physical exercises for stress and symptom management. OBJECTIVE: To compare the effects of a mindfulness yoga program vs stretching and resistance training exercise (SRTE) on psychological distress, physical health, spiritual well-being, and health-related quality of life (HRQOL) in patients with mild-to-moderate PD. DESIGN, SETTING, AND PARTICIPANTS: An assessor-masked, randomized clinical trial using the intention-to-treat principle was conducted at 4 community rehabilitation centers in Hong Kong between December 1, 2016, and May 31, 2017. A total of 187 adults (aged ≥18 years) with a clinical diagnosis of idiopathic PD who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Eligible participants were randomized 1:1 to mindfulness yoga or SRTE. INTERVENTIONS: Mindfulness yoga was delivered in 90-minute groups and SRTE were delivered in 60-minute groups for 8 weeks. MAIN OUTCOMES AND MEASURES: Primary outcomes included anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes included severity of motor symptoms (Movement Disorder Society Unified Parkinson’s Disease Rating Scale MDS-UPDRS, Part III motor score), mobility, spiritual well-being in terms of perceived hardship and equanimity, and HRQOL. Assessments were done at baseline, 8 weeks (T1), and 20 weeks (T2). RESULTS: The 138 participants included 65 men (47.1%) with a mean (SD) age of 63.7 (8.7) years and a mean (SD) MDS-UPDRS score of 33.3 (15.3). Generalized estimating equation analyses revealed that the yoga group had significantly better improvement in outcomes than the SRTE group, particularly for anxiety (time-by-group interaction, T1: β, −1.79 95% CI, −2.85 to −0.69; P = .001; T2: β, −2.05 95% CI, −3.02 to −1.08; P < .001), depression (T1: β, −2.75 95% CI, −3.17 to −1.35; P < .001); T2: β, −2.75 95% CI, −3.71 to −1.79; P < .001), perceived hardship (T1: β, −0.92 95% CI, −1.25 to −0.61; P < .001; T2: β, −0.76 95% CI, −1.12 to −0.40; P < .001), perceived equanimity (T1: β, 1.11 95% CI, 0.79-1.42; P < .001; T2: β, 1.19 95% CI, 0.82-1.56; P < .001), and disease-specific HRQOL (T1: β, −7.77 95% CI, −11.61 to −4.38; P < .001; T2: β, −7.99 95% CI, −11.61 to −4.38; P < .001). CONCLUSIONS AND RELEVANCE: Among patients with mild-to-moderate PD, the mindfulness yoga program was found to be as effective as SRTE in improving motor dysfunction and mobility, with the additional benefits of a reduction in anxiety and depressive symptoms and an increase in spiritual well-being and HRQOL. TRIAL REGISTRATION: Centre for Clinical Research and Biostatistics identifier: CUHK_CCRB00522
To evaluate the psychometric properties of the traditional Chinese version of the Childbirth Experience Questionnaire (CEQ 2.0) and assess the childbirth experiences of Chinese women.
A ...cross-sectional survey was conducted in Hong Kong from July 2020 to February 2021. In total, 975 mothers, who could read traditional Chinese and gave birth in 2020 or 2021, were included in the analysis. Data were fitted into the model proposed by the original developers using the confirmatory factor analysis. The data were then randomly split into training and validation sets for exploratory and confirmatory factor analyses. Childbirth experiences were assessed. Factor structure, internal construct validity, internal consistency, and known-group validity were assessed.
The originally proposed CEQ2.0 model showed a poor fit. An exploratory factor analysis identified a revised four-factor model (CEQ2.0-R) on a randomly split sample, which showed a satisfactory fit (CFI=0.912; TLI=0.884; SRMR=.053; RMSEA=0.072) on the other split sample. The revised scale comprised 13 items and four domains: (1)"Own capacity" (6 items), (2) "General support" (3 items), (3) "Perceived safety" (2 items), and (4) "Professional support" (2 items). CEQ2.0-R showed high internal construct validity and reliability. It can differentiate between participants with different characteristics, including parity, oxytocin augmentation, and companionship during labour. The childbirth experiences of the participants were merely positive, and participants reported that more support from midwives is needed.
CEQ2.0-R can adequately describe the childbirth experiences of women in Hong Kong. The questionnaire is easy to be administer and can be used to assess several domains of the childbirth experiences. It may be useful to evaluate the aspects of support needed during childbirth.
With mobile technologies becoming more advanced and accessible, mobile health (mHealth) has been incorporated in delivering timely and convenient breastfeeding support. However, its feasibility and ...potential efficacy remain to be examined. Therefore, the primary objective of this study is to assess the feasibility and acceptability of an online instant messaging peer support group for breastfeeding. The secondary objective is to evaluate the effect of the intervention on breastfeeding outcomes.
A pilot randomized controlled trial was conducted. A total of 33 primiparous women were recruited in the antenatal clinic at a public hospital in Hong Kong between March and April 2021. They were randomized to receive either standard care (n = 18) or standard care and receive peer-group support in an online instant messaging app (n = 15). Participants received telephone follow-up for up to six months postpartum or until they stopped breastfeeding. After completing the study, six participants in the intervention group were interviewed to understand their perceptions of the intervention.
This pilot study shows that online messaging peer support group is feasible and acceptable to women. In total, 54.4% of the eligible women agreed to participate, and 97.0% completed the follow-up. Participants perceived that providing peer support through instant messaging app is appropriate. It serves as a channel for the participants to ask questions and obtain information. Furthermore, meetings of the peer supporters and group members can be held to enhance the effectiveness of the intervention. In addition, no significant differences were found in any and exclusive breastfeeding rates, breastfeeding attitude, and breastfeeding self-efficacy between the two groups.
This study shows that online messaging peer support group is feasible and acceptable. A full-scale study should be conducted to understand the effect of the online instant messaging peer support group on breastfeeding outcomes.
The study protocol is registered on Clinicaltrial.gov (NCT04826796) on 1 April 2021.
Aims/hypothesis
Genome-wide association studies (GWASs) have identified many common type 2 diabetes-associated variants, mostly at the intronic or intergenic regions. Recent advancements of ...exome-array genotyping platforms have opened up a novel means for detecting the associations of low-frequency or rare coding variants with type 2 diabetes. We conducted an exomechip association analysis to identify additional type 2 diabetes susceptibility variants in the Chinese population.
Methods
An exome-chip association study was conducted by genotyping 5640 Chinese individuals from Hong Kong, using a custom designed exome array, the Asian Exomechip. Single variant association analysis was conducted on 77,468 single nucleotide polymorphisms (SNPs). Fifteen SNPs were subsequently genotyped for replication analysis in an independent Chinese cohort comprising 12,362 individuals from Guangzhou. A combined analysis involving 7189 cases and 10,813 controls was performed.
Results
In the discovery stage, an Asian-specific coding variant rs2233580 (p.Arg192His) in
PAX4
, and two variants at the known loci,
CDKN2B-AS1
and
KCNQ1,
were significantly associated with type 2 diabetes with exome-wide significance (
p
discovery
< 6.45 × 10
−7
). The risk allele (T) of
PAX4
rs2233580 was associated with a younger age at diabetes diagnosis. This variant was replicated in an independent cohort and demonstrated a stronger association that reached genome-wide significance (
p
meta-analysis
p
meta
=
3.74 × 10
−15
) in the combined analysis.
Conclusions/interpretation
We identified the association of a
PAX4
Asian-specific missense variant rs2233580 with type 2 diabetes in an exome-chip association analysis, supporting the involvement of
PAX4
in the pathogenesis of type 2 diabetes. Our findings suggest
PAX4
is a possible effector gene of the 7q32 locus, previously identified from GWAS in Asians.
Information about the level of distrust in healthcare systems is very limited in Chinese populations, and no validated instrument has been developed to measure this distrust. Therefore, to begin ...addressing this research gap, this study evaluated the psychometric properties of a traditional Chinese version of the Revised Health Care System Distrust Scale and used it to assess the level of distrust in a healthcare system. The study involved a community‐based personal interview survey of individuals in Hong Kong. A total of 340 men were randomly recruited. In addition to the distrust instrument, the two‐item Trust in Physician Scale and the Patient Health Questionnaire‐9 were used. The two‐factor structure of the distrust scale was confirmed. The item‐total correlations corrected for overlap were >0.4 for both the Competence and Values Distrust subscales, confirming the internal construct validity of the scale. The Cronbach's alpha coefficient was 0.77 for both subscales. The scores of both the Competence and Values subscales were moderately negatively correlated with the total score of the Trust in Physician Scale, providing support for convergent validity. Regarding known‐group validity, the scale could differentiate people according to marital status, monthly personal income and severity of depressive symptoms. Moreover, we found that men who had previously undergone prostate cancer screening had higher Values Distrust scores than those who had not. The descriptive analysis showed that only about half of the participants reported that they received high‐quality medical care and that the healthcare system provided excellent medical care, suggesting that more effort is needed to improve the quality of care and people's satisfaction with healthcare in Hong Kong. In summary, the translated traditional Chinese version of the Revised Health Care System Distrust Scale used in this study is a valid and reliable scale for assessing the level of distrust in a healthcare system.
Abstract
Newborns can acquire immunological protection to SARS-CoV-2 through vaccine-conferred antibodies in human breast milk. However, there are some concerns around lactating mothers with regards ...to potential short- and long-term adverse events and vaccine-induced changes to their breast milk microbiome composition, which helps shape the early-life microbiome. Thus, we sought to explore if SARS-CoV-2 mRNA vaccine could change breast milk microbiota and how the changes impact the levels of antibodies in breast milk. We recruited 49 lactating mothers from Hong Kong who received two doses of BNT162b2 vaccine between June 2021 and August 2021. Breast milk samples were self-collected by participants pre-vaccination, one week post-first dose, one week post-second dose, and one month post-second dose. The levels of SARS-CoV-2 spike-specific IgA and IgG in breast milk peaked at one week post-second dose. Subsequently, the levels of both antibodies rapidly waned in breast milk, with IgA levels returning to baseline levels one month post-second dose. The richness and composition of human breast milk microbiota changed dynamically throughout the vaccination regimen, but the abundances of beneficial microbes such as
Bifidobacterium
species did not significantly change after vaccination. Additionally, we found that baseline breast milk bacterial composition can predict spike-specific IgA levels at one week post-second dose (Area Under Curve: 0.72, 95% confidence interval: 0.58–0.85). Taken together, our results identified specific breast milk microbiota markers associated with high levels of IgA in the breast milk following BNT162b2 vaccine. Furthermore, in lactating mothers, BNT162b2 vaccines did not significantly reduce probiotic species in breast milk.
Little attention has been paid to understanding the impact of the coronavirus disease 2019 (COVID-19) pandemic on sexual practices and dating app usage among the Chinese population. To fill this gap, ...we examined the sexual practices and dating app usage of Hong Kong residents during the COVID-19 pandemic.
An online survey was developed to collect data, and the participants were recruited via online social media. The respondents were asked to report on their sexual practices and dating app usage during the COVID-19 pandemic.
In total, 249 participants met the inclusion criteria for the analysis. We found that more than 70% of the participants began masturbating more. Almost half of the participants reported decreases in various sexual activities with sexual partners, including vaginal, anal and oral sex. The vast majority of the study participants also reported a decline in sexual activities with casual partners, regular non-romantic partners and sex workers. Meanwhile, dating apps were used more frequently for chatting/texting, swapping photos, sexting and virtual dating. More than 50% of the participants reported less use of dating apps for face-to-face dates and sexual encounters.
It is evident that the COVID-19 pandemic and its corresponding public health measures impacted the sexual practices and dating app usage of Hong Kong residents.
Elevated circulating levels of pigment epithelium-derived factor (PEDF) have been reported in patients with type 2 diabetes (T2D) and its associated microvascular complications. This study aimed to
) ...identify the genetic determinants influencing circulating PEDF levels in a clinical setting of T2D,
) examine the relationship between circulating PEDF and diabetes complications, and
) explore the causal relationship between PEDF and diabetes complications. An exome-chip association study on circulating PEDF levels was conducted in 5,385 Chinese subjects with T2D. A meta-analysis of the association results of the discovery stage (
= 2,936) and replication stage (
= 2,449) was performed. The strongest association was detected at
(p.Met72Thr;
= 2.06 × 10
; β SE -0.33 0.02). Two missense variants of
(p.Arg131Ile;
= 7.56 × 10
; β SE 0.21 0.02) and
(p.Arg33Trp;
= 8.22 × 10
; β SE -0.15 0.02) showed novel associations at genome-wide significance. Elevated circulating PEDF levels were associated with increased risks of diabetic nephropathy and sight-threatening diabetic retinopathy. Mendelian randomization analysis showed suggestive evidence of a protective role of PEDF on sight-threatening diabetic retinopathy (
= 0.085). Our study provided new insights into the genetic regulation of PEDF and further support for its potential application as a biomarker for diabetic nephropathy and sight-threatening diabetic retinopathy. Further studies to explore the causal relationship of PEDF with diabetes complications are warranted.
Fibroblast growth factor 21 (FGF21) is increasingly recognized as an important metabolic regulator of glucose homeostasis. Here, we conducted an exome-chip association analysis by genotyping 5,169 ...Chinese individuals from a community-based cohort and two clinic-based cohorts. A custom Asian exome-chip was used to detect genetic determinants influencing circulating FGF21 levels. Single-variant association analysis interrogating 70,444 single nucleotide polymorphisms identified a novel locus,
, significantly associated with circulating FGF21 levels at genome-wide significance. In the combined analysis, the common missense variant of
, rs1260326 (p.Pro446Leu), showed an association with FGF21 levels after adjustment for age and sex (
= 1.61 × 10
; β SE = 0.14 0.02), which remained significant on further adjustment for BMI (
= 3.01 × 10
; β SE = 0.15 0.02).
Leu446 may influence FGF21 expression via its ability to increase glucokinase (GCK) activity. This can lead to enhanced FGF21 expression via elevated fatty acid synthesis, consequent to the inhibition of carnitine/palmitoyl-transferase by malonyl-CoA, and via increased glucose-6-phosphate-mediated activation of the carbohydrate response element binding protein, known to regulate FGF21 gene expression. Our findings shed new light on the genetic regulation of FGF21 levels. Further investigations to dissect the relationship between GCKR and FGF21, with respect to the risk of metabolic diseases, are warranted.
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