The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep ...disturbances during the early phase of COVID-19 pandemic.
This web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census.
The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05).
A high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak.
•Around 30-40% of respondents felt their sleep worsened since the local outbreak.•The prevalence of insomnia in Hong Kong during the COVID-19 pandemic was high.•An insufficient store of masks for one-month was associated with worsening of sleep.•A stable supply of masks may play a role in sleep health during an outbreak.
Background
Periodontitis, a chronic systemic inflammatory disease, is a common health problem in the elderly. With increasing recognition that inflammation plays a key role in the pathophysiology of ...Alzheimer's disease (AD), our research team has been studying how systemic inflammation affects the brain immune responses. Aging is a major risk factor for both periodontitis and AD. As aging causes dysregulation of immune responses, we aimed to define the roles of cytokines in the pathogenesis of periodontitis and AD.
Methods
To induce experimental periodontitis, female WT mice were injected with heat‐killed P. gingivalis into their buccal mucosa three times per week every other week for a total of 5 weeks. Another group of mice were injected with IL‐1b and TNF‐a following the same timeline as above. Sickness Behavior and cognitive functions were assessed through open field and puzzle box test. Mandibular jaws were harvested for Micro‐CT scan. Different brain regions were harvested for biochemical analysis.
Results
Mice injected with heat‐killed bacteria had worsened long‐term memory functions. It also significantly increased periodontal bone loss, which was accompanied by increased gene expression levels of IL‐1b and TNF‐a in the gums. Significant elevated levels of pro‐inflammatory cytokines in the liver as well as different brain regions were also observed. Immunostaining revealed increased levels of phospho‐tau in WT mice injected with heat‐killed bacteria, suggesting that elevated systemic cytokine levels caused by the injection of heat‐killed bacteria can lead to the appearance of AD pathology. Another group of mice injected with IL‐1b and TNF‐a displayed hyperactivity and worsened short‐term memory functions. Injections of cytokines also induced periodontal bone loss, which was accompanied by elevated levels of inflammatory cytokines in the liver as well as different brain regions.
Conclusion
Taken together, our study revealed that increased cytokine immune response in the gums led to periodontal bone loss, brain inflammation and modulated the cognitive functions of WT mice. This research demonstrated that cytokines play a crucial role in the pathogenesis of both periodontitis and AD.
Acknowledgement: The study is supported by Health and Medical Research Fund (HMRF 04151216) to RCCC. RPHW is awarded by Hong Kong PhD Fellowship.
To evaluate the feasibility and clinical effects of a lifestyle-integrated exercise, namely zero-time exercise (ZTEx), on improving insomnia in inactive adults with insomnia disorder.
In this pilot ...randomized controlled trial, 37 physically inactive adults (mean age: 49.9 years; SD: 13.6 91.9% female) fulfilling the diagnostic criteria of insomnia disorder recruited from the community were randomly assigned to ZTEx training or sleep hygiene education (SHE) groups. Subjects in the ZTEx group (n = 18) attended two 2-hour training lessons to learn ZTEx which they then practiced daily for eight weeks. Subjects in the SHE group (n = 19) attended two lessons of the same schedule and duration. The primary outcome measure was the Insomnia Severity Index (ISI).
The ZTEx group had lower ISI scores than the SHE group, with a large between-group effect size of 0.93–1.10 at weeks two, four, six, and eight, but the difference became non-significant at week eight, suggesting a loss of efficacy two months after the training. For secondary outcomes, no significant between-group differences were found in sleep parameters by sleep diary or objective actigraphy. The adherence to the ZTEx training course was satisfactory, with 83% of the group completing two sessions and 78% continuing to practice ZTEx for five days or more per week during the eight-week intervention period.
The simple and brief ZTEx training showed high acceptability and exercise compliance and the first evidence of efficacy in reducing insomnia severity in inactive adults with insomnia disorder. Confirmatory trials with longer follow-up are justified.
ClinicalTrials.gov, #NCT03155750
•Training inactive subjects with insomnia to do zero-time exercise is feasible.•Zero-time exercise reduces insomnia severity in inactive subjects.•Subjects showed high acceptability and compliance with the zero-time exercise.•The zero-time exercise can be delivered by briefly trained instructors.
This systematic review examined whether the general public are aware of the influence of modifiable cardiovascular risk factors (CVRFs) on dementia.
Following PRISMA guidelines, five electronic ...databases (PubMed, Medline, CINAHL, ProQuest, and Scopus) were searched for studies published from
2009
-2019, using the key terms "knowledge," "modifiable cardiovascular risk factors," and "dementia." Standardized critical appraisal instruments were used to evaluate the quality of the studies.
Of the 1,533 articles that were screened, 26 were included in this review. Modifiable CVRFs of dementia included behavioral factors (physical inactivity, poor dietary practices, high alcohol consumption, and heavy smoking) and medical conditions (hypertension, diabetes mellitus, hypercholesterolemia, and obesity). Although the association between CVRFs and dementia was identified (pooled prevalence is 24-50%), overall knowledge about this relationship in the general public was low. Sociodemographic variables, such as higher education, better economic status, and prior contact with a person with dementia, positively influenced dementia risk knowledge. Ethnic minorities showed good awareness of dementia risk from cardiovascular-related conditions.
Despite dementia is considered as a public health priority by World Health Organization, knowledge of the modifiable CVRFs and dementia is low in the general population. Public health policymakers should develop appropriate educational programs and interventions to equip the communities and vulnerable groups with this understanding so that they can be prepared to reduce dementia risk.
Background
Autophagy via formation of the autophagosome is a major cellular degradation pathway for long‐lived proteins and organelles. Dysfunction in autophagic processes are prominently linked to ...neurodegenerative disorders associated with an aggregation of misfolded protein. However, the underlying cellular mechanisms of how amyloid‐β (Aβ) promotes autophagy in Alzheimer’s Disease remains elusive.
Method
To investigate this, primary culture rat hippocampal neurons were transfected with GFP‐KDEL construct at DIV5 and treated with 15 µM ABO at DIV7. Either an AMPKα activator (1 mM AICAR) or inhibitor (10 µM Dorsomorphin) was applied at timed 2, 8, 24 h intervals. Cells were fixed and analysed using confocal imaging and biochemical data.
Result
Aβ‐induced autophagy was shown to begin from recruitment of ULK‐1 via an AMPK‐dependent pathway to the endoplasmic reticulum (ER). Pharmacological inhibition of AMPKα by Dorsomorphin in Aβ‐treated primary hippocampal neurons demonstrated reduced recruitment of ULK‐1 to the ER, while AMPKα activation by AICAR resulted in increased ULK‐1 recruitment to the ER. Live cell confocal imaging demonstrated intracellular interactions between ULK‐1 and the Atg14L‐Beclin1‐Vps34 complex. There were visible aggregation and ubiquitination on the ER promoting the formation of omegasomes and ultimately kick‐starting the autophagic pathway. In parallel, p62 was also found to translocate to ER aggregation sites after Aβ treatment aside from its known roles in protein shuttling towards mature autophagosomes.
Conclusion
This study demonstrates that Aβ‐induced autophagy is an AMPK‐dependent process and begins with recruitment and aggregation of important proteins such as ULK‐1 and PI3K‐III complex to the ER thereby pushing off the formation of mature autophagosomes.
Abstract
Background
Autophagy via formation of the autophagosome is a major cellular degradation pathway for long‐lived proteins and organelles. Dysfunction in autophagic processes are prominently ...linked to neurodegenerative disorders associated with an aggregation of misfolded protein. However, the underlying cellular mechanisms of how amyloid‐β (Aβ) promotes autophagy in Alzheimer’s Disease remains elusive.
Method
To investigate this, primary culture rat hippocampal neurons were transfected with GFP‐KDEL construct at DIV5 and treated with 15 µM ABO at DIV7. Either an AMPKα activator (1 mM AICAR) or inhibitor (10 µM Dorsomorphin) was applied at timed 2, 8, 24 h intervals. Cells were fixed and analysed using confocal imaging and biochemical data.
Result
Aβ‐induced autophagy was shown to begin from recruitment of ULK‐1 via an AMPK‐dependent pathway to the endoplasmic reticulum (ER). Pharmacological inhibition of AMPKα by Dorsomorphin in Aβ‐treated primary hippocampal neurons demonstrated reduced recruitment of ULK‐1 to the ER, while AMPKα activation by AICAR resulted in increased ULK‐1 recruitment to the ER. Live cell confocal imaging demonstrated intracellular interactions between ULK‐1 and the Atg14L‐Beclin1‐Vps34 complex. There were visible aggregation and ubiquitination on the ER promoting the formation of omegasomes and ultimately kick‐starting the autophagic pathway. In parallel, p62 was also found to translocate to ER aggregation sites after Aβ treatment aside from its known roles in protein shuttling towards mature autophagosomes.
Conclusion
This study demonstrates that Aβ‐induced autophagy is an AMPK‐dependent process and begins with recruitment and aggregation of important proteins such as ULK‐1 and PI3K‐III complex to the ER thereby pushing off the formation of mature autophagosomes.
Background
Some traditional Chinese medicine (TCM)–based integrated health interventions have been used for depression, but pooled efficacy remains unknown.
Aims and Objectives
This study aimed to ...systematically evaluate the efficacy of TCM‐based integrated health interventions for relieving depression.
Design
Systematic review and meta‐analysis.
Methods
A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk‐of‐bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.
Results
Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM‐based integrated health interventions. The pooled results showed that TCM‐based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = −2.05; 95% CI: −2.74, −1.37; p < .00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p = .31). However, the overall evidence was low.
Conclusions
The meta‐analysis results indicated that TCM‐based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM‐based integrated health interventions in treating depression.
Relevance to clinical practice
TCM‐based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM‐based integrated nursing interventions for patients with depression.
No patient or public contribution
This is a systematic review and meta‐analysis based on data from previous studies.
Background
Alzheimer’s disease (AD) is the most common form of dementia characterized by the presence of amyloid plaques, neurofibrillary tangles and the activation of the brain immune system. ...Studies from the public health have shown that activation of the immune cells in the periphery can lead to neuroimmune responses, which can initiate or perpetuate neurodegenerative brain changes that underlie cognitive impairment. One of the common sources of chronic systemic inflammation is periodontitis, which is an inflammatory disease that destroys gums and teeth. We hypothesize that periodontal bone loss due to periodontitis gums may intensify the neuroimmune responses in AD and exacerbate the disease conditions.
Method
A 5‐0 silk ligature was placed around the maxillary upper second molars in female 3xTg mice for 5 weeks to induce periodontal bone loss. Open field test was performed to assess the sickness behavior; Spontaneous Y maze and puzzle box test were used to assess the cognitive functions of the mice. Following behavioral testing, the upper maxillary jaws were dissected out and subjected to histological analysis to examine periodontal bone loss. Different brain regions were harvested for biochemical analysis.
Result
After 5 weeks, ligature‐induced periodontitis led to a significant loss of periodontal bone level in 3xTg mice. It also induced inflammation in the hippocampus and frontal cortex regions. A significant reduction of exploratory motivation was also observed in ligated AD mice compared to WT control. No impairment of short‐term memory was observed in ligated AD mice, but they exhibited significant reduction in the total arm entries, which is also an indicator of a reduction in exploratory behavior. In the puzzle box test, ligature‐induced periodontitis induced long‐term memory impairment in ligated AD mice
Conclusion
Altogether, ligature‐induced periodontitis led to increase neuroimmune responses in the brains of AD mice, a reduction of exploratory motivation as well as long term memory impairment. As bone loss induced by ligation led to increased neuroinflammation. Future work will aim to elucidate the mechanism of how periodontal bone loss and the cytokine innate response lead to neuroimmune response. Acknowledgement: The study is supported by Health and Medical Research Fund (HMRF 04151216) to RCCC.
Abstract
Background
Alzheimer’s disease (AD) is the most common form of dementia characterized by the presence of amyloid plaques, neurofibrillary tangles and the activation of the brain immune ...system. Studies from the public health have shown that activation of the immune cells in the periphery can lead to neuroimmune responses, which can initiate or perpetuate neurodegenerative brain changes that underlie cognitive impairment. One of the common sources of chronic systemic inflammation is periodontitis, which is an inflammatory disease that destroys gums and teeth. We hypothesize that periodontal bone loss due to periodontitis gums may intensify the neuroimmune responses in AD and exacerbate the disease conditions.
Method
A 5‐0 silk ligature was placed around the maxillary upper second molars in female 3xTg mice for 5 weeks to induce periodontal bone loss. Open field test was performed to assess the sickness behavior; Spontaneous Y maze and puzzle box test were used to assess the cognitive functions of the mice. Following behavioral testing, the upper maxillary jaws were dissected out and subjected to histological analysis to examine periodontal bone loss. Different brain regions were harvested for biochemical analysis.
Result
After 5 weeks, ligature‐induced periodontitis led to a significant loss of periodontal bone level in 3xTg mice. It also induced inflammation in the hippocampus and frontal cortex regions. A significant reduction of exploratory motivation was also observed in ligated AD mice compared to WT control. No impairment of short‐term memory was observed in ligated AD mice, but they exhibited significant reduction in the total arm entries, which is also an indicator of a reduction in exploratory behavior. In the puzzle box test, ligature‐induced periodontitis induced long‐term memory impairment in ligated AD mice
Conclusion
Altogether, ligature‐induced periodontitis led to increase neuroimmune responses in the brains of AD mice, a reduction of exploratory motivation as well as long term memory impairment. As bone loss induced by ligation led to increased neuroinflammation. Future work will aim to elucidate the mechanism of how periodontal bone loss and the cytokine innate response lead to neuroimmune response. Acknowledgement: The study is supported by Health and Medical Research Fund (HMRF 04151216) to RCCC.
Background: Acupuncture is an alternative treatment for improving sleep, and it may attenuate oxidative stress, which is a possible pathophysiological factor in insomnia. The aim of this study was to ...examine the efficacy and safety of a semi-individualized acupuncture in improving sleep and explore its effect on oxidative stress parameters in adults with insomnia disorder. Methods: In this randomized sham-controlled trial, 140 participants were randomly assigned to either a 4-week semi-individualized traditional acupuncture (TA) or noninvasive sham acupuncture (SA). The primary outcome measure was the sleep-diary-derived sleep efficiency. Other outcomes included sleep diary and actigraphy, Insomnia Severity Index, anxiety and depressive symptoms, and quality of life. Blood samples were taken to measure oxidative stress parameters (malondialdehyde, glutathione peroxidase, paraoxonase, and arylesterase). Results: Although no significant difference was found in the primary outcome measure, both sleep-diary-derived and actigraphy-derived total sleep time (TST) were significantly increased in the TA group at 1-week posttreatment (mean difference in sleep diary = 22.0 min, p = 0.01, actigraphy = 18.8 min, p = 0.02). At 5-week posttreatment follow-up, a significantly higher proportion of participants in the TA group showed sleep-diaryderived sleep efficiency (SE) greater than or equal to 85% than in the SA group (55.6% versus 36.4%, p = 0.03). Conclusion: TA and SA did not significantly differ in improving subjective sleep efficiency in individuals with insomnia disorder. However, the TA group showed a short-term effect on improving TST as measured by both sleep diary and actigraphy at 1-week posttreatment, but there were no differences in the oxidative stress parameters. Clinical Trial Registration: Registry: ClinicalTrials.gov; Title: Acupuncture in the Modulation of Peripheral Oxidative Stress Insomnia; Identifier NCT03447587; URL: Keywords: sleep, electroacupuncture, oxidative stress, placebo, Chinese medicine, acupoints
PDF
