Publications by authors named "Mei Chong"

151 Publications

Cohort profile: development and characteristics of a retrospective cohort of individuals dispensed prescription opioids for non-cancer pain in British Columbia, Canada.

BMJ Open 2021 Apr 13;11(4):e043586. Epub 2021 Apr 13.

BC Centre for Disease Control, Vancouver, British Columbia, Canada.

Purpose: Prescription opioids (POs) are widely prescribed for chronic non-cancer pain but are associated with several risks and limited long-term benefit. Large, linked data sources are needed to monitor their harmful effects. We developed and characterised a retrospective cohort of people dispensed POs.

Participants: We used a large linked administrative database to create the Opioid Prescribing Evaluation and Research Activities cohort of individuals dispensed POs for non-cancer pain in British Columbia (BC), Canada (1996-2015). We created definitions to categorise episodes of PO use based on a review of the literature (acute, episodic, chronic), developed an algorithm for inferring clinical indication and assessed patterns of PO use across a range of characteristics.

Findings To Date: The current cohort includes 1.1 million individuals and 3.4 million PO episodes (estimated to capture 40%-50% of PO use in BC). The majority of episodes were acute (81%), with most prescribed for dental or surgical pain. Chronic use made up 3% of episodes but 88% of morphine equivalents (MEQ). Across the acute to episodic to chronic episode gradient, there was an increasing prevalence of higher potency POs (hydromorphone, oxycodone, fentanyl, morphine), long-acting formulations and chronic pain related indications (eg, back, neck, joint pain). Average daily dose (MEQ) was similar for acute/episodic but higher for chronic episodes. Approximately 7% of the cohort had a chronic episode and chronic pain was the characteristic most strongly associated with chronic PO use. Individuals initiating a chronic episode were also more likely to have higher social/material deprivation and previous experience with a mental health condition or a problem related to alcohol or opioid use. Overall, these findings suggest our episode definitions have face validity and also provide insight into characteristics of people initiating chronic PO therapy.

Future Plans: The cohort will be refreshed every 2 years. Future analyses will explore the association between POs and adverse outcomes.
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http://dx.doi.org/10.1136/bmjopen-2020-043586DOI Listing
April 2021

Virtual Group Exercises and Psychological Status among Community-Dwelling Older Adults during the COVID-19 Pandemic-A Feasibility Study.

Geriatrics (Basel) 2021 Mar 22;6(1). Epub 2021 Mar 22.

Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur 50603, Malaysia.

Social isolation, magnified by the restriction of movement order during the COVID-19 pandemic, may lead to negative psychosocial health impacts among community-dwelling older adults. We, therefore, aimed to evaluate recruitment rates, data collection, and group exercises conducted through virtual technology among individuals aged 60 years and over in Malaysia. Participants were recruited from the Promoting Independence in Seniors with Arthritis (PISA) pilot cohort through social media messaging. A four-week course of virtual group exercise was offered. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS) during the last attended follow-up of the cohort study (pre-pandemic), pre-intervention, and post-intervention. Exercise adherence was recorded using diaries with daily entries and attendance to the virtual group exercise sessions were also captured electronically daily. The outcomes of interest were changes in anxiety and depression scores from baseline to pre-intervention (pandemic-related) and post-intervention (virtual exercise related). Forty-three individuals were recruited. A significant increase in anxiety scores from baseline to pre-intervention was observed. Comparisons using repeated-measures analysis of variance between those who attendance ≥14 and <14 group exercise sessions revealed no between-within subject differences in depression scores. There was a 23% dropout rate in the post intervention survey and 60.5% of diaries were returned. Virtual group exercises could be conducted among older adults residing in a middle-income country, though recruitment would have been limited to those with internet access.
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http://dx.doi.org/10.3390/geriatrics6010031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005958PMC
March 2021

Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis.

CMAJ Open 2021 Jan-Mar;9(1):E242-E251. Epub 2021 Mar 17.

Department of Emergency Medicine (Moe, Purssell), Vancouver General Hospital; British Columbia Centre for Disease Control (Moe, Chong, Zhao, Slaunwhite); Department of Emergency Medicine (Scheuermeyer), St. Paul's Hospital; British Columbia Drug and Poison Information Centre (Purssell); Department of Emergency Medicine (Moe, Scheuermeyer, Purssell), The University of British Columbia, Vancouver, BC.

Background: Visits to the emergency department are critical opportunities to engage individuals after an overdose. We sought to estimate and compare the 12-month mortality between persons with visits to the emergency department related to opioid overdose and those with non-overdose-related visits.

Methods: We conducted a retrospective cohort study using the Provincial Overdose Cohort, which contains data for patients in British Columbia who had an opioid-related overdose between 2015 and 2017, along with a 20% random sample of BC residents for comparison. We examined all nonfatal visits to the emergency department between Jan. 1, 2015, and Dec. 31, 2016, among persons aged 14 to 74 years and compared the 12-month mortality between those with overdose-related visits and those with non-overdose-related visits. We estimated the hazard ratio for death, with adjustment for age, sex, comorbidity and disposition (discharged or left against medical advice).

Results: We included 3593 persons with overdose-related visits and 216 453 with non-overdose-related visits to the emergency department. Those with overdose-related visits were younger, were predominantly male and had more mental health conditions. The 12-month crude mortality probability was 5.4% (95% confidence interval [CI] 4.7%-6.2%) in this group and 1.7% (95% CI 1.6%-1.8%) among those with non-overdose-related visits. After adjustment, for persons who were discharged, the 12-month mortality hazard was 3.5 (95% CI 3.0-4.2) times higher among those with overdose-related visits than those with non-overdose-related visits. For persons who left against medical advice, the mortality hazard was 7.1 (95% CI 4.0-12.5) times higher among those with opioid overdose.

Interpretation: Among persons with overdose-related visits to the emergency department, 12-month mortality was higher than among those with non-overdose-related visits. Overdose-related visits should prompt urgent evidence-based interventions (e.g., take-home naloxone kits, buprenorphine-naloxone induction) to prevent future deaths.
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http://dx.doi.org/10.9778/cmajo.20200169DOI Listing
March 2021

Informal carer's knowledge of traumatic brain injury questionnaire: Initial development and validation.

Nurs Open 2021 Mar 17. Epub 2021 Mar 17.

Faculty of Nursing, Univeristas Airlangga, Surabaya, Indonesia.

Aim: To develop and psychometrically test the instrument for measuring the knowledge of traumatic brain injury of informal carers.

Design: Instrument development.

Method: Focus group discussions were conducted among informal carers and healthcare specialists in March 2017. The content validity was determined by the mean of the item content validity index. A reliability test was performed by the Kuder-Richardson 20 and Pearson's correlation coefficient among 40 informal carers of patients with a traumatic brain injury in the rehabilitation medicine department of a tertiary hospital from August-September 2017.

Results: The final 34-item questionnaire covers the nature of traumatic brain injury, the consequences of traumatic brain injury, the rehabilitation process, and the role of the caregiver. The item content means ranged from 0.8-1.00, and the difficulty of knowledge items ranged from 0.18-0.98. The internal consistency reliability and correlation coefficient were 0.70 and 0.84, respectively.
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http://dx.doi.org/10.1002/nop2.833DOI Listing
March 2021

Mitigation of COVID-19 Risk Among Older Adults in Nursing Homes: A Public Survey.

J Gerontol Nurs 2021 Mar;47(3):23-28

The current study examines the public's perception on the mitigation of COVID-19 risk and knowledge of disease symptoms among older adults in nursing homes, with the intention to address gaps in knowledge using mobile technologies. An online survey questionnaire was completed by 611 adults residing in Malaysia. The four domains, derived from factor analysis, affirmed the supportive perception among the public (score range = 4.42 to 4.64/5.0). However, among the gaps identified were the perception toward hand sanitizing and susceptibility of older adults to COVID-19. Public knowledge on symptoms of COVID-19 was limited (e.g., 41.4% to 53.4% incorrect responses to anosmia, diarrhea, confusion). Multivariate analysis of variance found that males and participants with less education had significantly lower supportive perceptions (p < 0.05). With >86% of participants having access to internet communication technology, mobile interventions tailored to gender and educational level are recommended to promote long-term pandemic preparedness among stakeholders and the public. [Journal of Gerontological Nursing, 47(3), 23-28.].
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http://dx.doi.org/10.3928/00989134-20210209-04DOI Listing
March 2021

Supravalvular Aortic Stenosis and the Risk of Premature Death Among Patients With Homozygous Familial Hypercholesterolemia.

Am J Cardiol 2021 04 14;145:58-63. Epub 2021 Jan 14.

Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address:

Patients with homozygous familial hypercholesterolemia (HoFH) have a high risk for premature death. Supravalvular aortic stenosis (SVAS) is a common and the feature lesion of the aortic root in HoFH. The relation between SVAS and the risk of premature death in patients with HoFH has not been fully investigated. The present study analysis included 97 HoFH patients with mean age of 14.7 (years) from the Genetic and Imaging of Familial Hypercholesterolemia in Han Nationality Study. During the median (±SD) follow-up 4.0 (±4.0) years, 40 (41.2%) participants had SVAS and 17 (17.5%) participants experienced death. The proportion of premature death in the non-SVAS and SVAS group was 7.0% and 32.5%, respectively. Compared with the non-SVAS group, SVAS group cumulative survival was lower in the HoFH (log-rank test, p <0.001). This result was further confirmed in the multivariable Cox regression models. After adjusting for age, sex, low density lipoprotein cholesterol (LDL_C)-year-score, lipid-lowering drugs, cardiovascular disease, and carotid artery plaque, SVAS was an independent risk factor of premature death in HoFH on the multivariate analysis (hazard ratio 4.45; 95% confidence interval, 1.10 to 18.12; p = 0.037). In conclusion, a significantly increased risk of premature death was observed in HoFH patients with SVAS. Our study emphasized the importance of careful and aggressive management in these patients when appropriate.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.080DOI Listing
April 2021

Equivalent Loading of Directed Arenes in Pd(II)-Catalyzed Oxidative Cross-Coupling of Aryl C-H Bonds at Room Temperature.

J Org Chem 2021 Feb 14;86(3):2714-2733. Epub 2021 Jan 14.

Department of Chemistry, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.

The unsymmetrical biaryls (Ar-Ar) produced by the catalytic cross-couplings of aryl halides (Ar-halo) with aryl metallics (Ar-M) in the loading ratio of 1:1 are popular in chemical synthesis. In contrast, there has been less precedence on the same biaryls produced effectively from two normal aryl C-H bonds with equivalent loading. Here, we report that, in a palladium/oxidant/acid catalytic system at room temperature, one arene (Ar-H, 1 equiv) can highly selectively couple with the other one (Ar-H, 1 equiv) to afford the target Ar-Ar just by controlling the directing groups and the substituted groups on their phenyl rings. The utility of this one-one cross-coupling is also demonstrated by synthesis of a few bioactive molecules.
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http://dx.doi.org/10.1021/acs.joc.0c02722DOI Listing
February 2021

The effect of peer learning on professional competence development among Indonesian undergraduate nursing students: A quasi-experimental study.

J Prof Nurs 2020 Nov - Dec;36(6):477-483. Epub 2020 Mar 19.

School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia. Electronic address:

Background: Peer learning has enabled undergraduate nursing students to develop competence and clinical skills. It is rare to find quantitative studies examining the effect of peer learning on professional competence development among undergraduate nursing students comprehensively.

Objective: To examine the effect of peer learning on professional competence development among Indonesian undergraduate nursing students.

Design: A quasi-experimental study with non-equivalent control group pre-test post-test design.

Participants: Convenience sampling was used to recruit participants. Seventy-five students completed the study (37 in the intervention group and 38 in the control group).

Methods: The intervention group received the peer learning program, while the control group received conventional learning during clinical practice. The Nurse Professional Competence (NPC) was used to collect data at pre-test and post-test measurement. Data were analysed using descriptive and inferential statistics.

Results: Professional competence had significantly increased in the intervention group. A significant interaction effect of time (pre-test and post-test) and group on professional competence development was also found. The effect of peer learning on professional competence development was significantly greater than the conventional method.

Conclusion: Peer learning was demonstrated as an innovative learning method to develop professional competence during clinical practice among Indonesian undergraduate nursing students. It is recommended for nurse educators to consider implementing peer learning during clinical education.
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http://dx.doi.org/10.1016/j.profnurs.2020.03.008DOI Listing
March 2020

Hemicrania Continua With Scintillating Scotoma: A Rare Presentation.

Cureus 2020 Sep 27;12(9):e10680. Epub 2020 Sep 27.

Neurology, Hospital Raja Permaisuri Bainun, Ipoh, MYS.

Headache can be a primary or secondary disorder. The characteristics of headache and its associated features, especially the presence of red flag signs, are important in distinguishing secondary from primary causes. Hemicrania continua is a type of primary headache disorder characterized by a continuous unilateral headache with episodes of exacerbations and association with cranial autonomic symptoms, which include several ocular symptoms. The absolute response to indomethacin remains the hallmark of this disease. We would like to report a rare case of hemicrania continua with scintillating scotoma during exacerbations apart from the typical autonomic features of conjunctival injection, ptosis, eyelid edema, and lacrimation.
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http://dx.doi.org/10.7759/cureus.10680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593128PMC
September 2020

Effect of intimal flap motion on flow in acute type B aortic dissection by using fluid-structure interaction.

Int J Numer Method Biomed Eng 2020 Dec 28;36(12):e3399. Epub 2020 Sep 28.

Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.

A monolithic, fully coupled fluid-structure interaction (FSI) computational framework was developed to account for dissection flap motion in acute type B aortic dissection (TBAD). Analysis of results included wall deformation, pressure, flow, wall shear stress (WSS), von Mises stress and comparison of hemodynamics between rigid wall and FSI models. Our FSI model mimicked realistic wall deformation that resulted in maximum compression of the distal true lumen (TL) by 21.4%. The substantial movement of intimal flap mostly affected flow conditions in the false lumen (FL). Flap motion facilitated more flow entering the FL at peak systole, with the TL to FL flow split changing from 88:12 in the rigid model to 83:17 in the FSI model. There was more disturbed flow in the FL during systole (5.8% FSI vs 5.2% rigid) and diastole (13.5% FSI vs 9.8% rigid), via a λ -criterion. The flap-induced disturbed flow near the tears in the FSI model caused an increase of local WSS by up to 70.0% during diastole. This resulted in a significant reduction in the size of low time-averaged WSS (TAWSS) regions in the FL (113.11 cm FSI vs 177.44 cm rigid). Moreover, the FSI model predicted lower systolic pressure, higher diastolic pressure, and hence lower pulse pressure. Our results provided new insights into the possible impact of flap motion on flow in aortic dissections, which are particularly important when evaluating hemodynamics of acute TBAD. NOVELTY STATEMENT: Our monolithic fully coupled FSI computational framework is able to reproduce experimentally measured range of flap deformation in aortic dissection, thereby providing novel insights into the influence of physiological flap motion on the flow and pressure distributions. The drastic flap movement increases the flow resistance in the true lumen and causes more disturbed flow in the false lumen, as visualized through the λ criterion. The flap-induced luminal pressure is dampened, thereby affecting pressure measures, which may serve as potential prognostic indicators for late complications in acute uncomplicated TBAD patients.
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http://dx.doi.org/10.1002/cnm.3399DOI Listing
December 2020

The quality of work life and turnover intentions among Malaysian nurses: the mediating role of organizational commitment.

J Egypt Public Health Assoc 2020 Aug 14;95(1):20. Epub 2020 Aug 14.

Institute of Educational Leadership & Unit for the Enhancement of Academic Performance, University of Malaya, Kuala Lumpur, Malaysia.

Background: Understanding the factors influencing nurses' turnover intention, particularly the work life quality and commitment to organization, is important to all countries suffering from nursing shortage. The study aims to determine the mediating role of commitment to organization on work life quality and its relationship with turnover intention among Malaysian nurses.

Methods: A descriptive cross-sectional design, using a self-report survey was conducted on 430 nurses from a teaching hospital from February to April 2019. A structural equation model version 3 was used for testing study hypotheses.

Results: The mediating effect (indirect effect) of organizational commitment on the relationship between work life quality and turnover intention (QWL→OC→IT) was negative with path coefficient - 0.234, whereas the direct effect of work life quality on turnover intention (QWL→IT) was negative with smaller path coefficient - 0.228. This means that the relationship between work life quality and turnover intention was partially mediated by the organizational commitment (P < 0.001).

Conclusion: Organizational commitment has a negative partial mediating effect between work life quality of nurses and intention of turnover in teaching hospitals where the organizational commitment significantly reduced the nurses' intention to leave. The study findings can guide nursing managers to be carefully attended to the levels of nurses' commitment to their organization.
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http://dx.doi.org/10.1186/s42506-020-00048-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427667PMC
August 2020

The development and validation of a prototype mobility tracker for assessing the life space mobility and activity participation of older adults.

BMC Geriatr 2020 07 22;20(1):251. Epub 2020 Jul 22.

Geriatric Education and Research Institute Ltd, 2 Yishun Central 2, Singapore, 768024, Singapore.

Background: There is increasing interest in examining the life space mobility and activity participation of older adults in the community using sensor technology. Objective data from these technologies may overcome the limitations of self-reported surveys especially in older adults with age-associated cognitive impairment. This paper describes the development and validation of a prototype hybrid mobility tracker for assessing life space mobility and out-of-home activities amongst 33 community-ambulant older adults in Singapore.

Methods: A hybrid mobility tracker was developed by combining a passive Global Positioning System logger, tri-axial accelerometer and radio-frequency identification. Objective measures of life space, derived from 1 week of tracking data using Geographic Information Systems, were the maximum Euclidean distance from home (Max Euclid) and the area of the minimum convex polygon surrounding all GPS waypoints (MCP area). Out-of-home activities were quantified by visually identifying the total number of activity nodes, or places where participants spent ≥5 min, from mobility tracks. Self-reported measure of life space in 4 weeks was obtained using the University of Alabama at Birmingham Study of Life Space Assessment (UAB-LSA) questionnaire. Self-reported out-of-home activities were recorded daily in a travel diary for 1 week. Bivariate correlations were used to examine convergent validity between objective and subjective measures of life space and out-of-home activities.

Results: The mean age of participants was 69.2 ± 7.1 years. The mean UAB-LSA total score was 79.1 ± 17.4. The median (range) Max Euclid was 2.44 km (0.26-7.50) per day, and the median (range) MCP area was 3.31 km (0.03-34.23) per day. The UAB-LSA total score had good correlation with Max Euclid (r = 0.51, p = 0.002), and moderate correlation with MCP area (r = 0.46, p = 0.007). The median (range) total number of activity nodes measured by tracker of 20 (8-47) per week had a good correlation with the total activity count recorded in the travel diaries of 15 (6-40) per week (r = 0.52, p = 0.002).

Conclusions: The tracking system developed to understand out-of-home travel was feasible and reliable. Comparisons with the UAB-LSA and travel diaries showed that it provided reliable and valid spatiotemporal data to assess the life space mobility and activity participation of older adults.
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http://dx.doi.org/10.1186/s12877-020-01649-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374961PMC
July 2020

In vivo [U-C]glucose labeling to assess heart metabolism in murine models of pressure and volume overload.

Am J Physiol Heart Circ Physiol 2020 08 10;319(2):H422-H431. Epub 2020 Jul 10.

King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, United Kingdom.

Alterations in the metabolism of substrates such as glucose are integrally linked to the structural and functional changes that occur in the remodeling heart. Assessment of such metabolic changes under in vivo conditions would provide important insights into this interrelationship. We aimed to investigate glucose carbon metabolism in pressure-overload and volume-overload cardiac hypertrophy by using an in vivo [U-C]glucose labeling strategy to enable analyses of the metabolic fates of glucose carbons in the mouse heart. Therefore, [U-C]glucose was administered in anesthetized mice by tail vein infusion, and the optimal duration of infusion was established. Hearts were then excised for C metabolite isotopomer analysis by NMR spectroscopy. [U-C]glucose infusions were performed in mice 2 wk following transverse aortic constriction (TAC) or aortocaval fistula (Shunt) surgery. At this time point, there were similar increases in left ventricular (LV) mass in both groups, but TAC resulted in concentric hypertrophy with impaired LV function, whereas Shunt caused eccentric hypertrophy with preserved LV function. TAC was accompanied by significant changes in glycolysis, mitochondrial oxidative metabolism, glucose metabolism to anaplerotic substrates, and de novo glutamine synthesis. In contrast to TAC, hardly any metabolic changes could be observed in the Shunt group. Taken together, in vivo [U-C]glucose labeling is a valuable method to investigate the fate of nutrients such as glucose in the remodeling heart. We find that concentric and eccentric cardiac remodeling are accompanied by distinct differences in glucose carbon metabolism. This study implemented a method for assessing the fate of glucose carbons in the heart in vivo and used this to demonstrate that pressure and volume overload are associated with distinct changes. In contrast to volume overload, pressure overload-induced changes affect the tricarboxylic acid cycle, glycolytic pathways, and glutamine synthesis. A better understanding of cardiac glucose metabolism under pathological conditions in vivo may provide new therapeutic strategies specific for different types of hemodynamic overload.
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http://dx.doi.org/10.1152/ajpheart.00219.2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473922PMC
August 2020

Prescription-related risk factors for opioid-related overdoses in the era of fentanyl contamination of illicit drug supply: A retrospective case-control study.

Subst Abus 2020 May 22:1-7. Epub 2020 May 22.

Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, Canada.

We sought to quantify the association between clinical, physiological, and contextual factors and opioid-related overdose, specifically focusing on current and past use of select prescription medications. We conducted a case-control study of individuals who experienced a non-fatal opioid-related overdose between January 2015 and November 2016 in British Columbia, Canada. We matched 8,831 cases to 44,155 controls on birth year, sex, and local health area of residence and examined 5-year prescribing history for opioids for pain, medications for opioid use disorder (MOUD), benzodiazepines/z-drugs, and other psychoactive medications. The overall prevalence of prescription opioid drug use was generally low in the study population. Cases had a relatively higher use of selected prescription medications, a higher physical and mental morbidity burden, and were less connected to health services compared with controls. For opioids for pain, current therapy was associated with experiencing an overdose (OR = 8.5, 95%CI: 7.3-10); history of long-term use had a stronger association than history of short-term use (OR = 2.9, 95%CI: 2.6-3.3 vs OR = 1.7, 95%CI: 1.5-1.8, respectively). While persons on MOUD were more likely to overdose compared to persons who were not on therapy (OR = 2.0, 95%CI 1.7-2.4), recent discontinuation of MOUD greatly increased the likelihood of overdose (OR = 25.6, 95%CI 17.5-37.4). Active therapy of benzodiazepines/z-drugs and other sedating medications also significantly increased the likelihood of overdose. While this study supports expansion of efforts to prevent overdoses among individuals actively using opioids for pain and improve retention among those on MOUD, it is also important to address other clinical, physiological, and contextual risk and protective factors to help curb the current overdose crisis.
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http://dx.doi.org/10.1080/08897077.2020.1748162DOI Listing
May 2020

Features of Sitosterolemia in Children.

Am J Cardiol 2020 05 8;125(9):1312-1316. Epub 2020 Feb 8.

Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address:

Sitosterolemia is a rare lipid metabolism disease with heterogeneous manifestations. Atherosclerosis can occur in children, and therefore, early detection, diagnosis, and treatment of this disease are important. We studied 18 pediatric patients with sitosterolemia who showed a significant increase in plasma lipid levels and analyzed their clinical, biochemical, and genetic characteristics. We recorded the initial serum lipid results and clinical manifestations of the patients. Lipid and plant sterol levels were measured after homozygous or compound heterozygous mutations of ABCG5 or ABCG8 were identified by genetic testing. Plasma plant sterol levels were analyzed by gas chromatography. Fourteen cases of sitosterolemia were examined by ultrasound and echocardiography. The initial total cholesterol and low-density lipoprotein levels of the children were significantly increased, but then markedly decreased after diet control or drug treatment, and even reached normal levels. Carotid atherosclerosis and aortic valve regurgitation were present in three of 14 patients. Serum lipid levels of children with sitosterolemia and xanthomas were notably higher than those without xanthomas. There were no significant differences in clinical manifestations between patients with different genotypes. In conclusion, sitosterolemia should be considered in children with hyperlipidemia who do not present with xanthomas, especially with a significant increase in total cholesterol and low-density lipoprotein levels. There does not appear to be a correlation between clinical phenotype and genotype.
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http://dx.doi.org/10.1016/j.amjcard.2020.01.048DOI Listing
May 2020

Enzymatic pretreatment to enhance anaerobic bioconversion of high strength wastewater to biogas: A review.

Sci Total Environ 2020 Apr 30;713:136373. Epub 2019 Dec 30.

Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Zhongxiao E Rd, Da'an District, 106 Taipei City, Taiwan, ROC. Electronic address:

Oil and grease, carbohydrate, protein, and lignin are the main constituents of high strength wastewaters such as dairy wastewater, cheese whey wastewater, distillery wastewater, pulp and paper mill wastewater, and slaughterhouse wastewaters. These constituents have contributed to various operational problems faced by the high-rate anaerobic bioreactor (HRAB). During the hydrolysis stage of anaerobic digestion (AD), these constituents can be hydrolyzed. Since hydrolysis is known to be the rate-limiting step of AD, the overall AD can be enhanced by improving the hydrolysis stage. This can be done by introducing pretreatment that targets the degradation of these constituents. This review mainly focuses on the biological pretreatment on various high-strength wastewaters by using different types of enzymes namely lipase, amylase, protease, and ligninolytic enzymes which are responsible for catalyzing the degradation of oil and grease, carbohydrate, protein, and lignin respectively. This review provides a summary of enzymatic systems involved in enhancing the hydrolysis stage and consequently improve biogas production. The results show that the use of enzymes improves the biogas production in the range of 7 to 76%. Though these improvements are highly dependent on the operating conditions of pretreatment and the types of substrates. Therefore, the critical parameters that would affect the effectiveness of pretreatment are also discussed. This review paper will serve as a useful piece of information to those industries that face difficulties in treating their high-strength wastewaters for the appropriate process, equipment selection, and design of an anaerobic enzymatic system. However, more intensive studies on the optimum operating conditions of pretreatment in a larger-scale and synergistic effects between enzymes are necessary to make the enzymatic pretreatment economically feasible.
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http://dx.doi.org/10.1016/j.scitotenv.2019.136373DOI Listing
April 2020

Associations of lifestyle activities and a heathy diet with frailty in old age: a community-based study in Singapore.

Aging (Albany NY) 2020 01 2;12(1):288-308. Epub 2020 Jan 2.

Department of Psychological Medicine, National University of Singapore, Singapore.

Frailty is an age-related state characterized by a reduced physiological reserve, and is associated with adverse health outcomes in the elderly. We analyzed the data from 895 adults aged 60 years and above, and investigated the relationships between midlife and late-life social activities, intellectual activities, working hours, and dietary habits and frailty status. Participation in social or intellectual activities in late life was less prevalent among those who were frail than among those who were robust. A greater proportion of those who were frail had worked long hours in midlife. After adjustment for confounders, participating in social activities or intellectual activities in late life was associated with a reduced risk for prefrailty and frailty, while working long hours in midlife was associated with a higher risk for frailty. The risk of frailty decreased with increasing healthy diet scores in midlife and late life. When the results were stratified by gender, late-life participation in social activities and midlife or late-life participation in intellectual activities correlated negatively with prefrailty/frailty only in women. Our study suggests that social and intellectual activities are inversely associated with frailty status, but the association seems to differ based on gender.
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http://dx.doi.org/10.18632/aging.102615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977658PMC
January 2020

Factors influencing professional values among Indonesian undergraduate nursing students.

Nurse Educ Pract 2019 Nov 31;41:102648. Epub 2019 Oct 31.

Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Wilayah Persekutuan, Malaysia. Electronic address:

Background: Undergraduate nursing students are required to acquire professional values during professional nurse education to provide safe and high quality patient care. However, there was no documentation in professional values among Indonesian undergraduate nursing students and the factors influencing its development.

Purpose: The purpose of this study was to determine professional values among Indonesian undergraduate nursing students and examine the relationship between students' demographic factors and professional values.

Design: A cross-sectional study using convenience sampling was applied to recruit 391 Indonesian undergraduate nursing students. The 26 items of Nurses Professional Values Scale Revision (NPVS-R) with five dimensions was employed to collect data. Descriptive and inferential statistics, independent samples t-test were applied to analyse and interpret data.

Results: The result showed that the total score of nurse professional values was high (95.80 ± 12.93). The most important professional value dimension was caring, while activism was the least important values. The NPVS-R total score had a significant association with length of professional clinical practice of the students (p < .05).

Conclusion: Nurse educators need to consider the integration of professional values when developing nursing curriculum, in order to ensure that the students develop their own understanding of these values and their importance in practice.
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http://dx.doi.org/10.1016/j.nepr.2019.102648DOI Listing
November 2019

Association between ideal cardiovascular health score trajectories and arterial stiffness: the Kailuan Study.

Hypertens Res 2020 02 30;43(2):140-147. Epub 2019 Oct 30.

Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Some studies have shown that a higher ideal cardiovascular health score (CVHS) predicts a lower incidence of arterial stiffness. Few studies have used multiple measurements of CVHS to examine the impact of CVHS on arterial stiffness. The current study aimed to identify the long-term patterns in CVHS trajectory and to explore the association between CVHS trajectory and arterial stiffness. The study cohort consisted of 18,854 participants from the Kailuan Study who were followed up for five physical examinations over 8.10 years. Five discrete CVHS trajectories were identified among the participants: low-stable (8.10%), low-moderate (6.84%), moderate-low (23.46%), moderate-stable (39.83%), and elevated-stable (21.77%). After adjustment for confounding factors, generalized linear model analysis showed that CVHS trajectory group correlated negatively with brachial-ankle pulse wave velocity (baPWV). Compared with the low-stable group, the low-moderate group, moderate-low group, moderate-stable group, and elevated-stable group had B values of -41.81, -24.11, -86.79, and -169.54, respectively. We also used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for CVHS trajectory groups and arterial stiffness. In fully adjusted models, ORs were 0.76 (95% CI: 0.62-0.94) for the low-moderate group, 0.80 (95% CI: 0.67-0.97) for the moderate-low group, 0.51 (95% CI: 0.42-0.62) for the moderate-stable group, and 0.23 (95% CI: 0.18-0.29) for the elevated-stable group compared with the low-stable group. The results were consistent across a number of sensitivity analyses. In conclusion, the higher long-term attainment and the improvement of CVHS were negatively associated with baPWV and could reduce the risk of arterial stiffness. Our study emphasizes the importance of optimizing CVH throughout life to prevent the incidence of arterial stiffness.
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http://dx.doi.org/10.1038/s41440-019-0341-4DOI Listing
February 2020

Loss to follow-up: A significant barrier in the treatment cascade with direct-acting therapies.

J Viral Hepat 2020 03 2;27(3):243-260. Epub 2019 Dec 2.

BC Centre for Disease Control, Vancouver, BC, Canada.

Effectiveness of direct-acting antiviral (DAA) therapies could be influenced by patient characteristics such as comorbid conditions, which could lead to premature treatment discontinuation and/or irregular medical follow-ups. Here, we evaluate loss to follow-up and treatment effectiveness of sofosbuvir/ledipasvir ± ribavirin (SOF/LDV ± RBV), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (OBV/PTV/r + DSV ± RBV) for hepatitis C virus (HCV) genotype 1 (GT1) and sofosbuvir + ribavirin (SOF + RBV) for genotype 3 (GT3) in British Columbia Canada: The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV since 1992, integrated with medical visit, hospitalization and prescription drug data. HCV-positive individuals who initiated DAA regimens, irrespective of treatment completion, for GT1 and GT3 until 31 December, 2017 were included. Factors associated with sustained virological response (SVR) and loss to follow-up were assessed by using multivariable logistic regression models. In total 4477 individuals initiated DAAs. The most common prescribed DAA was SOF/LDV ± RBV with SVR of 95%. The highest SVR of 99.5% was observed among OBV/PTV/r + DSV-treated patients. Overall, 453 (10.1%) individuals were lost to follow-up. Higher loss to follow-up was observed among GT1 patients treated with OBV (17.8%) and GT3 patients (15.7%). The loss to follow-up rate was significantly higher among individuals aged <60 years, those with a history of injection drug use (IDU), on opioid substitution therapy and with cirrhosis. Our findings indicate that loss to follow-up exceeds viral failure in HCV DAA therapy and its rate varies significantly by genotype and treatment regimen. Depending on the aetiology of lost to follow-up, personalized case management for those with medical complications and supporting services among IDU are needed to achieve the full benefits of effective treatments.
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http://dx.doi.org/10.1111/jvh.13228DOI Listing
March 2020

A study to determine the educational objectives and outcomes for pre-registration Diploma nursing program: A modified Delphi.

Nurse Educ Pract 2019 Aug 6;39:80-89. Epub 2019 Aug 6.

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. Electronic address:

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http://dx.doi.org/10.1016/j.nepr.2019.08.002DOI Listing
August 2019

RNA Secondary Structure-Based Design of Antisense Peptide Nucleic Acids for Modulating Disease-Associated Aberrant Tau Pre-mRNA Alternative Splicing.

Molecules 2019 Aug 20;24(16). Epub 2019 Aug 20.

Division of Chemistry and Biological Chemistry, School of Physical and Mathematical Sciences, Nanyang Technological University, 21 Nanyang Link, Singapore 637371, Singapore.

Alternative splicing of tau pre-mRNA is regulated by a 5' splice site (5'ss) hairpin present at the exon 10-intron 10 junction. Single mutations within the hairpin sequence alter hairpin structural stability and/or the binding of splicing factors, resulting in disease-causing aberrant splicing of exon 10. The hairpin structure contains about seven stably formed base pairs and thus may be suitable for targeting through antisense strands. Here, we used antisense peptide nucleic acids (asPNAs) to probe and target the tau pre-mRNA exon 10 5'ss hairpin structure through strand invasion. We characterized by electrophoretic mobility shift assay the binding of the designed asPNAs to model tau splice site hairpins. The relatively short (10-15 mer) asPNAs showed nanomolar binding to wild-type hairpins as well as a disease-causing mutant hairpin C+19G, albeit with reduced binding strength. Thus, the structural stabilizing effect of C+19G mutation could be revealed by asPNA binding. In addition, our cell culture minigene splicing assay data revealed that application of an asPNA targeting the 3' arm of the hairpin resulted in an increased exon 10 inclusion level for the disease-associated mutant C+19G, probably by exposing the 5'ss as well as inhibiting the binding of protein factors to the intronic spicing silencer. On the contrary, the application of asPNAs targeting the 5' arm of the hairpin caused an increased exon 10 exclusion for a disease-associated mutant C+14U, mainly by blocking the 5'ss. PNAs could enter cells through conjugation with amino sugar neamine or by cotransfection with minigene plasmids using a commercially available transfection reagent.
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http://dx.doi.org/10.3390/molecules24163020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720520PMC
August 2019

The Relationship Between Psychological Distress and Religious Practices and Coping in Malaysian Parents of Children with Thalassemia.

J Pediatr Nurs 2019 Sep - Oct;48:e15-e20. Epub 2019 Jun 15.

School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Australia.

Study Purpose: This study was conducted to examine the relationship between religious practice, religious coping methods and psychological distress among parents caring for children with transfusion-dependent thalassemia.

Design And Methods: This is a cross-sectional survey. Data were collected on 162 parents of children diagnosed with thalassemia aged 12 years and younger in thalassemia day care centers of three public hospitals in Sabah, Malaysia. Data were collected using questionnaires, including General Health Questionaire-12 (GHQ-12), Duke University Religion Index (DUREL) and Brief RCOPE.

Results: Forty-two percent of parents had psychological distress with GHQ score ≥ 3 (mean score of 2.85 ± 3.17). Ninety-five percent of parents used positive religious coping methods (mean P-COPE score 22.35 ± 2.33) more than negative religious coping methods (mean N-COPE score was 12.19 ± 5.23). They used Organized Religious Activities (mean ORA score of 4.20 ± 1.27), and Non-Organized Religious Activities (NORA, the mean was 4.17 ± 1.37). Positive and negative religious coping methods were significantly related to parents' psychological distress (P-COPE and GHQ-12 scores (r (df) = 0.19, p < .05; N-COPE and GHQ-12 scores r (df) = 0.38, p < .001)).

Conclusion: The study findings showed the parents experienced psychological distress. They used positive religious coping methods more than negative religious coping methods. Psychological distress was significantly related to organized religious activities, non-organized religious activities and positive and negative religious coping methods.

Practice Implication: The study findings facilitate understanding of psychological distress and how parents use religious coping strategies to deal with the stress caring for their child.
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http://dx.doi.org/10.1016/j.pedn.2019.05.016DOI Listing
May 2020

Effects of the new prescribing standards in British Columbia on consumption of opioids and benzodiazepines and drugs.

Can Fam Physician 2019 05;65(5):e231-e237

Adjunct Professor in the School of Population and Public Health at UBC and the Director of the BC Observatory for Population and Public Health at the BC Centre for Disease Control.

Objective: To evaluate the effects of the 2016 College of Physicians and Surgeons of British Columbia's (CPSBC's) opioid and benzodiazepine and drug prescribing standards on the use of these medications in British Columbia.

Design: Interrupted time-series analysis of community-prescribing records over a 30-month period: January 2015 to June 2017.

Setting: British Columbia.

Participants: Random sample of British Columbia residents with filled prescriptions during the study period.

Intervention: Introduction of CPSBC's opioid and benzodiazepine and drug prescribing standards on June 1, 2016.

Main Outcome Measures: Total weekly consumption of opioids (measured in morphine equivalents) and benzodiazepines and drugs (measured in diazepam equivalents); and total monthly users of each class of medication.

Results: Total consumption of both medication classes began to decline in late 2015, and the rate of decrease did not statistically significantly change following the implementation of the CPSBC standards in June 2016. In contrast, introduction of the standards was associated with an immediate 2% decrease in the number of monthly users of opioids for pain ( < .001), culminating in a 9% decrease over the course of the following year ( < .001). This trend was driven largely by a decrease in the number of continuing users; minimal change was seen in the number of new users during the study period. Trends in monthly users of benzodiazepines and drugs mirrored those seen for opioids for pain.

Conclusion: Implementation of the 2016 CPSBC standards did not change a pre-existing downward trend in consumption of opioids or benzodiazepines and drugs that began 6 months earlier. However, the standards did have a small effect on the number of monthly users of these medications, with a decrease in opioid prescribing among continuing users. Given the risk of destabilization of patients who are discontinued from opioid therapy, future research should assess how patient health outcomes are related to changing prescribing practices.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516682PMC
May 2019

Effectiveness of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in People Who Inject Drugs and/or Those in Opioid Agonist Therapy.

Hepatol Commun 2019 Apr 10;3(4):478-492. Epub 2019 Jan 10.

British Columbia Centre for Disease Control Vancouver Canada.

We evaluated the effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treating hepatitis C virus (HCV) genotype 1 and SOF/velpatasvir (SOF/VEL) for all genotypes among people who inject drugs (PWID) and those not injecting drugs and who were on or off opioid agonist therapy (OAT). Study participants comprised a population-based cohort in British Columbia, Canada. The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV from 1990 to 2016 that are integrated with medical visits, hospitalization, and prescription drug data. We classified study participants as off OAT/recent injection drug use (off-OAT/RIDU), off OAT/past IDU (off-OAT/PIDU), off OAT/no IDU (off-OAT/NIDU), on OAT/IDU (on-OAT/IDU), and on OAT/no IDU (on-OAT/NIDU). We assessed sustained virologic response (SVR) 10 weeks after HCV treatment among study groups treated with LDV/SOF or SOF/VEL until January 13, 2018. Analysis included 5,283 eligible participants: 390 off-OAT/RIDU, 598 off-OAT/PIDU, 3,515 off-OAT/NIDU, 609 on-OAT/IDU, and 171 on-OAT/NIDU. The majority were male patients (64%-74%) and aged ≥50 years (58%-85%). The SVRs for off-OAT/RIDU, off-OAT/PIDU, off-OAT/NIDU, on-OAT/IDU, and on-OAT/NIDU were 91% (355/390), 95% (570/598), 96% (3,360/3,515), 93% (567/609), and 95% (163/171), respectively. Among those with no SVR, 14 individuals died while on treatment or before SVR assessment, including 4 from illicit drug overdose. In the overall multivariable model, off-OAT/RIDU, on-OAT/IDU, male sex, cirrhosis, treatment duration <8 weeks, treatment duration 8 weeks, and treatment with SOF/VEL were associated with not achieving SVR. In this large real-world cohort, PWID and/or those on OAT achieved high SVRs, although slightly lower than people not injecting drugs. This finding also highlights the need for additional measures to prevent loss to follow-up and overdose-related deaths among PWID.
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http://dx.doi.org/10.1002/hep4.1307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442698PMC
April 2019

Development and characteristics of the Provincial Overdose Cohort in British Columbia, Canada.

PLoS One 2019 10;14(1):e0210129. Epub 2019 Jan 10.

Office of the Provincial Health Officer, British Columbia Ministry of Health, Victoria, BC, Canada.

Introduction: British Columbia (BC), Canada declared a public health emergency in April 2016 for opioid overdose. Comprehensive data was needed to identify risk factors, inform interventions, and evaluate response actions. We describe the development of an overdose cohort, including linkage strategy, case definitions, and data governance model, and present the resulting characteristics, including data linkage yields and case overlap among data sources.

Methods: Overdose events from hospital admissions, physician visits, poison centre and ambulance calls, emergency department visits, and coroner's data were grouped into episodes if records were present in multiple sources. A minimum of five years of universal health care records (all prescription dispensations, fee-for-service physician billings, emergency department visits and hospitalizations) were appended for each individual. A 20% random sample of BC residents and a 1:5 matched case-control set were generated. Consultation and prioritization ensured analysts worked to address questions to directly inform public health actions.

Results: 10,456 individuals suffered 14,292 overdoses from January 1, 2015 to Nov 30, 2016. Only 28% of overdose events were found in more than one dataset with the unique contribution of cases highest from ambulance records (32%). Compared with fatal overdoses, non-fatal events more often involved females, younger individuals (20 to 29 years) and those 60 or older. In 78% of illegal drug deaths, there was no associated ambulance response. In the year prior to first recorded overdose, 60% of individuals had at least one ED visit, 31% at least one hospital admission, 80% at least one physician visit, and 87% had filled at least one prescription in a community pharmacy.

Conclusion: While resource-intensive to establish, a linked cohort is useful for characterizing the full extent of the epidemic, defining sub-populations at risk, and patterns of contact with the health system. Overdose studies in other jurisdictions should consider the inclusion of multiple data sources.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210129PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328267PMC
September 2019

Inter-muscular adipose tissue is associated with adipose tissue inflammation and poorer functional performance in central adiposity.

Arch Gerontol Geriatr 2019 Mar - Apr;81:1-7. Epub 2018 Nov 13.

Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.

Background: The presence of concomitant sarcopenia and obesity in sarcopenic obesity (SO) confers worse functional, morbidity and mortality outcomes compared to either alone. Excess adiposity and central redistribution of fats are associated with systemic inflammation and ectopic tissue fat infiltration in forms of Intermuscular adipose tissue (IMAT). Our study examines the profile of IMAT across a spectrum of body compositions and associations with physical performance and inflammatory biomarkers including Monocyte Chemoattractant Protein-1 (MCP-1), a novel biomarker of adipose tissue inflammation.

Methods: 187 community dwelling elderly participants were recruited and classified into 4 subgroups: normal, obese, sarcopenia and SO, using validated criteria for sarcopenia and waist circumference to define central obesity. We performed magnetic resonance imaging of mid-thigh sections to segment IMAT and muscle. Participants were assessed for muscle strength, physical performance and blood inflammatory biomarkers of interleukin-6, C-Reactive Protein and MCP-1. We examined correlation of IMAT(ratio) with muscle function measures and blood biomarkers. Multiple regression analyses were used to examine the association of body composition types and IMAT(ratio) with muscle function.

Results: IMAT(ratio) was highest in SO and obese groups. Overall, higher IMAT(ratio) is significantly associated with raised MCP-1, lower gait speed and muscle strength. SO had lowest scores in Short Physical Performance Battery (SPPB), gait speed, hand-grip and knee extension strength. IMAT(ratio) is independently associated with SPPB and handgrip strength, whilst SO is independently associated with muscle strength.

Conclusion: Our results suggest the possible role of IMAT as a candidate imaging biomarker for adipose tissue inflammation and associated poorer functional outcomes in SO.
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http://dx.doi.org/10.1016/j.archger.2018.11.006DOI Listing
January 2020

Applying core theory and spatial analysis to identify hepatitis C virus infection "core areas" in British Columbia, Canada.

J Viral Hepat 2019 03 11;26(3):373-383. Epub 2018 Dec 11.

School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.

"Core areas" of transmission for bacterial sexually transmitted infections have been identified. However, it is unclear whether core areas apply to viral infections, such as hepatitis C virus (HCV). We used geographic mapping and spatial analysis to identify distinct core areas of HCV infection in British Columbia (BC) using the BC Hepatitis Testers Cohort (BC-HTC), 1990-2013. The BC-HTC includes all BC residents tested for HCV (~1.5 million; 1990-2013). Core HCV infection areas were identified spatially and temporally for five time periods (1990-1993, 1994-1998, 1999-2003, 2004-2008 and 2009-2013) through thematic mapping, Kernel Density Estimation, Hotspot analysis and cluster analysis at the Census dissemination area level in ArcGIS and SatScan. HCV infection core areas were consistently identified. HCV core areas expanded from the downtown of major cities in different regions of BC (Metro Vancouver, Vancouver Island, and Northern BC; 1990-1998), to smaller cities in Metro Vancouver and Interior BC (2000 onwards). Statistically significant clusters, or hotspots, were also observed for downtown Vancouver, Northern BC (Prince George) and Vancouver Island from 1990 to 2008 with expansion to other urban areas in Metro Vancouver from 1990-2013. Statistically significant clusters persisted after adjustment for injection drug use, number of HCV tests, age, sex, material and social deprivation. Persistence of areas with high HCV diagnoses rates in Vancouver and Prince George supports the theory of core areas of HCV transmission. Identification of core areas can inform prevention, care and treatment programme interventions and evaluate their impact over time.
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http://dx.doi.org/10.1111/jvh.13043DOI Listing
March 2019

Patterns and history of prescription drug use among opioid-related drug overdose cases in British Columbia, Canada, 2015-2016.

Drug Alcohol Depend 2019 01 25;194:151-158. Epub 2018 Oct 25.

Institute of Mental Health, Department of Psychiatry, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada; The Burnaby Centre for Mental Health & Addiction, 3405 Willingdon Avenue, Burnaby, BC, V5G 3H4, Canada.

Background: British Columbia is the epicenter of the current fentanyl-related overdose crisis in Canada. Our study characterizes prescribing histories of people who had an opioid-related overdose compared to matched controls.

Methods: We examined linked administrative data for individuals who overdosed between January 1, 2015 and November 30, 2016. Past prescriptions over five years were assessed for opioids for pain, opioid agonist therapy, benzodiazepines/z-drugs, antidepressants, antipsychotics, gabapentinoids, mood stabilizers and anti-epileptics, muscle relaxants, and other sedating medications. Prescribing history of 9964 cases was compared with that of 49,820 matched controls.

Results: Overdose cases were more likely to be prescribed opioids for pain and to have used prescription opioids on a long-term basis in the previous five years compared to controls. However, at the time of overdose, 92% of men and 86% of women did not have an active opioid for pain prescription, and approximately half had not filled one in the past five years. Those who overdosed tended to have more prescriptions for psychotropic substances than controls. Fewer than 10% of cases had an active prescription for opioid agonist therapy and most were not on treatment in the past.

Conclusions: Low prevalence of active prescriptions for opioids for pain at the time of overdose suggests that opioid prescribing plays a limited short-term impact in the current fentanyl-related crisis of overdoses. While liberal opioid prescribing practices may have contributed to the development of the current overdose crisis, regulation and enforcement of clinicians' prescribing practices will likely have limited impact in reducing overdoses.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.09.019DOI Listing
January 2019

Effectiveness of a Personalized Brain-Computer Interface System for Cognitive Training in Healthy Elderly: A Randomized Controlled Trial.

J Alzheimers Dis 2018 ;66(1):127-138

School of Computer Science and Engineering, Nanyang Technological University (NTU), Singapore.

Background: Cognitive training has been demonstrated to improve cognitive performance in older adults. To date, no study has explored personalized training that targets the brain activity of each individual.

Objective: This is the first large-scale trial that examines the usefulness of personalized neurofeedback cognitive training.

Methods: We conducted a randomized-controlled trial with participants who were 60-80 years old, with Clinical Dementia Rating (CDR) score of 0-0.5, Mini-Mental State Examination (MMSE) score of 24 and above, and with no neuropsychiatric diagnosis. Participants were randomly assigned to the Intervention or Waitlist-Control group. The training system, BRAINMEM, has attention, working memory, and delayed recall game components. The intervention schedule comprised 24 sessions over eight weeks and three monthly booster sessions. The primary outcome was the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total score after the 24-session training.

Results: There were no significant between-subjects differences in overall cognitive performance post-intervention. However, a sex moderation effect (p = 0.014) was present. Men in the intervention group performed better than those in the waitlist group (mean difference, +4.03 (95% CI 0.1 to 8.0), p = 0.046. Among females, however, both waitlist-control and intervention participants improved from baseline, although the between-group difference in improvement did not reach significance. BRAINMEM also received positive appraisal and intervention adherence from the participants.

Conclusion: A personalized neurofeedback intervention is potentially feasible for use in cognitive training for older males. The sex moderation effect warrants further investigation and highlights the importance of taking sex into account during cognitive training.
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http://dx.doi.org/10.3233/JAD-180450DOI Listing
September 2019