Introduction:
The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) and dipeptidyl peptidase-4 inhibitors (DPP4I) on new-onset cognitive dysfunction in type 2 diabetes mellitus remain ...unknown. This study aimed to evaluate the effects of the two novel antidiabetic agents on cognitive dysfunction by comparing the rates of dementia between SGLT2I and DPP4I users.
Methods:
This was a population-based cohort study of type 2 diabetes mellitus patients treated with SGLT2I and DPP4I between January 1, 2015 and December 31, 2019 in Hong Kong. Exclusion criteria were <1-month exposure or exposure to both medication classes, or prior diagnosis of dementia or major neurological/psychiatric diseases. Primary outcomes were new-onset dementia, Alzheimer's, and Parkinson's. Secondary outcomes were all-cause, cardiovascular, and cerebrovascular mortality.
Results:
A total of 13,276 SGLT2I and 36,544 DPP4I users (total
n
= 51,460; median age: 66.3 years old interquartile range (IQR): 58–76, 55.65% men) were studied (follow-up: 472 120–792 days). After 1:2 matching (SGLT2I:
n
= 13,283; DPP4I:
n
= 26,545), SGLT2I users had lower incidences of dementia (0.19 vs. 0.78%,
p
< 0.0001), Alzheimer's (0.01 vs. 0.1%,
p
= 0.0047), Parkinson's disease (0.02 vs. 0.14%,
p
= 0.0006), all-cause (5.48 vs. 12.69%,
p
< 0.0001), cerebrovascular (0.88 vs. 3.88%,
p
< 0.0001), and cardiovascular mortality (0.49 vs. 3.75%,
p
< 0.0001). Cox regression showed that SGLT2I use was associated with lower risks of dementia (hazard ratio HR: 0.41, 95% confidence interval CI: 0.27–0.61,
P
< 0.0001), Parkinson's (HR:0.28, 95% CI: 0.09–0.91,
P
= 0.0349), all-cause (HR:0.84, 95% CI: 0.77–0.91,
P
< 0.0001), cardiovascular (HR:0.64, 95% CI: 0.49–0.85,
P
= 0.0017), and cerebrovascular (HR:0.36, 95% CI: 0.3–0.43,
P
< 0.0001) mortality.
Conclusions:
The use of SGLT2I is associated with lower risks of dementia, Parkinson's disease, and cerebrovascular mortality compared with DPP4I use after 1:2 ratio propensity score matching.
PurposeDue to lack of motivation, individuals often fail to perform regular exercise. In view of this, we developed a virtual trainer system (VTS) to encourage users to perform simple exercise ...routines regularly.Design/methodology/approachA design science approach is adopted to develop a VTS to motivate users to exercise. Study findings are based on a field experiment with 91 participants recruited from a university in Hong Kong.FindingsOutcome-oriented reminders foster stronger perceived risks of health and perceived value of exercises, whereas virtual trainer attractiveness has insignificant effect. Perceived value of exercises is positively related to exercise participation, which has a positive relationship with work productivity.Research limitations/implicationsThe findings answer question of how to motivate people to continue exercising.Practical implicationsFindings provide insights for fitness companies to design online exercise training for users.Social implicationsVTS can promote regular exercise and healthy life.Originality/valueThis research shows that interactive virtual agents can motivate users to exercise regularly. It contributes to the burgeoning research on the use of IT artifacts for improving exercise participation and provides practical insights into VTS designs.
Previous coronavirus, 2019 (COVID-19) research has applied network analysis to examine relationships between psychopathological symptoms but rarely extended to potential risk and protective factors ...or the influence of COVID-19 infection history. This study examined complex inter-relationships between psychopathological symptoms, COVID-19-related stressors, perceived social support, and COVID-19 infection history among Chinese university/college students during the peak of fifth pandemic wave using a network analysis approach.
A Least Absolute Shrinkage and Selection Operator-regularized partial correlation network using Gaussian graphical model was constructed in 1,395 Chinese university/college students in Hong Kong who completed a survey between 15 March and 3 April, 2022. Depressive, anxiety, and acute/traumatic stress symptoms were measured by Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Impact of Event Scale-6, respectively. COVID-19-related stressors and perceived social support were measured. Network differences by COVID-19 infection history (COVID-network vs. no_COVID-network) and network communities were examined.
Our results showed that the most influential nodes were depressed mood, uncontrollable worries, and uncontrollable thoughts about COVID-19. The main bridging symptoms were concentration problems and psychomotor problems. The COVID-network, comprising participants with a history of COVID-19 infection only, was significantly stronger than the no_COVID-network. Perceived social support and stress from conflicts with family/friends formed a unique community with negative cognition and suicidal idea in the COVID-network only.
Our findings indicate that specific interventions targeting interpersonal conflicts and concentration problems as well as facilitating stress buffering effects of social support may represent effective strategies to reduce psychological distress in university/college students during COVID-19 and should be considered for future pandemic preparedness.
6 These variations in results have led to investigations of drug-induced liver injury by individual DOACs in observational studies. 7-11 Nevertheless, limited data are available for edoxaban, given ...its comparative late entry into the international market. ...we conducted this territory-wide study to assess the risk of liver injury in edoxaban users who have no prior history of liver diseases. ...1213 edoxaban users were included (Table 1, left), with 19 developing liver injury after its prescription, which corresponded to an incidence of 1.5% (Figure 2). ...a follow-up analysis of the ENGAGE AF-TIMI 48 trial demonstrated that a history of liver disease did not significant affect the efficacy of safety of edoxaban compared to warfarin and the rates of hepatic adverse events were similar between edoxaban or warfarin users. 15 Future observational studies should examine the efficacy and safety outcomes in this specific subgroup to complement findings from this important trial.
Introduction
Neutrophil‐to‐lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and ...atrial fibrillation (AF) in patients with type 2 diabetes mellitus.
Methods
This was a population‐based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between 1 January 1st, 2009, and 31 December, 2009, at government‐funded hospitals/clinics in Hong Kong. Follow‐up was until 31 December, 2019, or death.
Results
A total of 85,351 patients (age = 67.6 ± 13.2 years old, male = 48.8%, follow‐up = 3101 ± 1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new‐onset ischemic stroke (hazard ratio HR: 1.28 1.20–1.37, p < .001, HR: 1.41 1.32–1.51, p < .001 and HR: 1.38 1.29–1.47, p < .001) and AF (HR: 1.09 1.02–1.17, p < .015; HR: 1.28 1.20–1.37, p < .001; HR: 1.39 1.31–1.49, p < .001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 1.05, 1.22, p = .001; quartile 3: HR: 1.14 1.06, 1.23, p < .001) but not quartile 4 (HR: 1.08 0.994, 1.17, p = .070). NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 0.874, 1.07, p = .499; quartile 3: HR: 0.978 0.884, 1.08, p = .661; quartile 4: HR: 1.05 0.935, 1.16, p = .462).
Conclusion
NLR is a significant predictor of new‐onset ischaemic stroke after adjusting for significant confounders in Chinese type 2 diabetes patients.
NLR is a significant predictor of new onset ischaemic stroke but not AF after adjusting for significant confounders in diabetes melltius.
Literature reveals increased suicidal ideation in the general population during pandemic. However, few COVID-19 studies comprehensively assessed factors associated with suicidal ideation, and mixed ...findings were observed. We aimed to examine prevalence and correlates of suicidal ideation in general public during the peak of fifth COVID-19 wave in Hong Kong based on a broad array of relevant measures.
This survey assessed 14,709 community-dwelling adults during March 15-April 3, 2022. Comprehensive assessment was administered including socio-demographics, pre-existing mental/physical morbidity, mental-health symptoms, resilience, loneliness, coping strategies, and pandemic-related factors. Presence of suicidal ideation was evaluated by ratings of item 9 on Patient-Health-Questionnaire-9.
A total of 2,249 (15.3%) participants exhibited suicidal ideation. Multivariable-regression analysis found that being single and unemployed, pre-existing mental disorder, more severe depressive and anxiety symptoms, higher levels of loneliness and engagement in avoidant coping were significantly associated with suicidal ideation. Conversely, attaining tertiary educational level or above, greater resilience and adopting problem-focused coping were associated with lower likelihood of suicidal ideation. Although univariate-analyses revealed that a number of pandemic-related factors were linked to suicidal ideation, none remained significant in the multivariable model.
A significant proportion of people experienced suicidal ideation during the peak of fifth COVID-19 wave. Risk and protective factors identified would facilitate early identification of high-risk individuals and provision of targeted interventions to minimize suicidal ideation and risk of self-harm. Caution should be exercised due to study limitations of a cross-sectional design which precluded establishing causality among variables, and reliance on self-reported data.
ObjectivesTo examine the 15-year secular trends of self-rated health (SRH) and correlates in Chinese adolescents in Hong Kong.DesignA territory-wide population-based panel data ...study.SettingAnonymised records of the annual health examination from the Student Health Service, Department of Health in Hong Kong.Participants397 324 students in Secondary 2 (US grade 8), 335 902 in Secondary 4 and 113 892 in Secondary 6 during the academic year 1999/2000 and 2014/15.Outcome measuresSRH and lifestyles were self-reported using standardised questionnaires. Sex-standardised and age-standardised prevalence of very poor/poor SRH and its secular annual changes across sex, grade, weight status, breakfast habits, and frequency/duration of aerobic exercises were examined. Their disparities over time were examined by interactions with the academic year in generalised estimating equations.ResultsThe overall prevalence of very poor/poor SRH increased from 9.3% (95% CI: 8.9% to 9.7%) in 1999/2000 to 15.5% (15.1% to 15.8%) in 2014/15. Very poor/poor SRH was more prevalent in girls (adjusted OR: 1.02), in those having unemployed parents (1.29), being overweight (1.42) or obese (2.62), eating breakfast away from home (1.27) and skipping breakfast (1.49) or doing <1 time/week or ≤60 min/week aerobic exercises (1.78 and 1.88, respectively) than others. The corresponding disparities increased over time (ratios of OR: 1.006–1.042).ConclusionsIncreasing prevalence of very poor/poor SRH from 1999/2000 to 2014/15 was found among Hong Kong Chinese adolescents, which was greater in girls, adolescents being overweight/obese and those having unemployed parents or unhealthy lifestyles. Strategies to reduce health inequality should consider multiple factors, especially modifiable factors including lifestyles.
Purpose
This study aimed to discover intra-tumor heterogeneity signature and validate its predictive value for adjuvant chemotherapy (ACT) following concurrent chemoradiotherapy (CCRT) in ...locoregionally advanced nasopharyngeal carcinoma (LA-NPC).
Materials and methods
397 LA-NPC patients were retrospectively enrolled. Pre-treatment contrast-enhanced T1-weighted (CET1-w) MR images, clinical variables, and follow-up were retrospectively collected. We identified single predictive radiomic feature from primary gross tumor volume (GTVnp) and defined predicted subvolume by calculating voxel-wised feature mapping and within GTVnp. We independently validate predictive value of identified feature and associated predicted subvolume.
Results
Only one radiomic feature, gldm_DependenceVariance in 3 mm-sigma LoG-filtered image, was discovered as a signature. In the high-risk group determined by the signature, patients received CCRT + ACT achieved 3-year disease free survival (DFS) rate of 90% versus 57% (HR, 0.20; 95%CI, 0.05–0.94;
P
= 0.007) for CCRT alone. The multivariate analysis showed patients receiving CCRT + ACT had a HR of 0.21 (95%CI: 0.06–0.68,
P
= 0.009) for DFS compared to those receiving CCRT alone. The predictive value can also be generalized to the subvolume with multivariate HR of 0.27 (
P
= 0.017) for DFS.
Conclusion
The signature with its heterogeneity mapping could be a reliable and explainable ACT decision-making tool in clinical practice.
Introduction
The extent of cognitive impairment and its association with psychological distress among people with pre-existing mental illness during COVID-19 is understudied. This study aimed to ...investigate prevalence and correlates of subjective cognitive impairment (SCI) in Chinese psychiatric patients during fifth-wave of COVID-19 in Hong Kong (HK).
Methods
Four-hundred-eight psychiatric outpatients aged 18–64 years were assessed with questionnaires between 28 March and 8 April 2022, encompassing illness profile, psychopathological symptoms, coping-styles, resilience, and COVID-19 related factors. Participants were categorized into moderate-to-severe and intact/mild cognitive impairment (CI+ vs. CI-) groups based on severity of self-reported cognitive complaints. Univariate and multivariate regression analyses were conducted to determine variables associated with CI+ status.
Results
One-hundred-ninety-nine participants (48.8%) experienced CI+. A multivariate model on psychopathological symptoms found that depressive and post-traumatic-stress-disorder (PTSD)-like symptoms were related to CI+, while a multivariate model on coping, resilience and COVID-19 related factors revealed that avoidant coping, low resilience and more stressors were associated with CI+. Final combined model demonstrated the best model performance and showed that more severe depressive and PTSD-like symptoms, and adoption of avoidant coping were significantly associated with CI+.
Conclusion
Almost half of the sample of psychiatric patients reported cognitive complaints during fifth-wave of COVID-19 in HK. Greater depressive and PTSD-like symptom severity, and maladaptive (avoidant) coping were found as correlates of SCI. COVID-19 related factors were not independently associated with SCI in psychiatric patients. Early detection with targeted psychological interventions may therefore reduce psychological distress, and hence self-perceived cognitive difficulties in this vulnerable population.
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