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Although testing is widely regarded as critical to fighting the COVID-19 pandemic, what measure and level of testing best reflects successful infection control remains unresolved. Our aim was to compare the sensitivity of two testing metrics – population testing number and testing coverage – to population mortality outcomes and identify a benchmark for testing adequacy. We aggregated publicly available data through 12 April on testing and outcomes related to COVID-19 across 36 OECD (Organization for Economic Development) countries and Taiwan. Spearman correlation coefficients were calculated between the aforementioned metrics and following outcome measures: deaths per 1 million people, case fatality rate and case proportion of critical illness. Fractional polynomials were used to generate scatter plots to model the relationship between the testing metrics and outcomes. We found that testing coverage, but not population testing number, was highly correlated with population mortality (rs = −0.79, P = 5.975 × 10−9vs. rs = −0.3, P = 0.05) and case fatality rate (rs = −0.67, P = 9.067 × 10−6vs. rs = −0.21, P = 0.20). A testing coverage threshold of 15–45 signified adequate testing: below 15, testing coverage was associated with exponentially increasing population mortality; above 45, increased testing did not yield significant incremental mortality benefit. Taken together, testing coverage was better than population testing number in explaining country performance and can serve as an early and sensitive indicator of testing adequacy and disease burden.
Extensive environmental contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in hospitals during pandemic coronavirus disease 2019 (COVID-19). We highlighted the practice of directly-observed environmental disinfection (DOED) in the community isolation facility (CIF) and community treatment facility (CTF) in Hong Kong.
CIF (250 single-room bungalows in a holiday camp) was opened on July 24, 2020 to receive step-down patients from hospitals, while CTF (500-bed of open-cubicle inside a conventional hall) was activated on August 1, 2020 to admit newly diagnosed COVID-19 patients from the community. Healthcare workers (HCWs) and cleaning staff received infection control training to reinforce donning and doffing of personal protective equipment and understand the practice of DOED, where the cleaning staff observed patients’ and staff activities and then performed environmental disinfection immediately after their use. Supervisors also observed cleaning staff to ensure the quality of work. In CTF, air and environmental samples were collected on day 7, 14, 21, and 28 for SARS-CoV-2 by RT-PCR, while patients’ compliance of wearing mask was recorded.
Of 291 HCWs and 54 cleaning staff, who managed 243 and 674 patients in CIF and CTF, respectively, from July 24 to August 29, 2020, none of them acquired COVID-19. All 24 air samples and 520 environmental samples collected in the patient area of CTF were negative for SARS-CoV-2. Patients’ compliance of wearing mask was 100%.
With appropriate infection control measures, zero environmental contamination and nosocomial acquisition of COVID-19 among HCWs and cleaning staff could be achieved.
Families facing end-stage nonmalignant chronic diseases (NMCDs) are presented with similar symptom burdens and need for psycho-social–spiritual support as their counterparts with advanced cancers. However, NMCD patients tend to face more variable disease trajectories, and thus may require different anticipatory supports, delivered in familiar environments. The Life Rainbow Programme (LRP) provides holistic, transdisciplinary, community-based end-of-life care for patients with NMCDs and their caregivers. This paper reports on the 3-month outcomes using a single-group, pre–post comparison.
Patients with end-stage NMCDs were screened for eligibility by a medical team before being referred to the LRP. Patients were assessed at baseline (T0), 1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale (IPOS). Their hospital use in the previous month was also measured by presentations at accident and emergency services, admissions to intensive care units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 using the Chinese version of the Modified Caregiver Strain Index, and self-reported health, psychological, spiritual, and overall well-being. Over-time changes in outcomes for patients, and caregivers, were tested using paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests.
Seventy-four patients and 36 caregivers participated in this research study. Patients reported significant improvements in all IPOS domains at both 1 and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and information needs fulfilled)]. Average hospital bed-days in the previous month fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, caregiver strain was significantly reduced (r = 0.332), while spiritual well-being was enhanced (r = 0.333).
After receiving 3 month's LRP services, patients with end-stage NMCDs and their caregivers experienced significant improvements in the quality of life and well-being, and their hospital bed-days were reduced.
To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.
Pilot prospective multicenter surveillance study.
The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.
All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.
In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.
Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).
Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
Multiple sclerosis (MS) is a central nervous system disorder that impacts more than 400,000 people in the U.S. The disease results in multiple functional impairments that are diverse and varied across individuals. Additonally, MS has a profound impact on community participation which, like other rehabilitation outcomes, cannot be explained on the basis of functional limitations alone. The purpose of this study was to develop and evaluate a model of community participation for people living with MS using the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) framework. The model focused on the roles that personal factors have as predictors of community participation, while also serving as mediators and moderators for the relationship between activity limitation and participation. Results from the hierarchical regression analysis indicated that demographic characteristics (i.e. MS type), personal factors (i.e. core self-evaluations (CSE), MS self-management, resilience, and social skills), and activity limitations accounted for 64% of the variance in participation. Further, mediation analysis indicated that CSE mediated the relationship between activity limitation and community participation. Finally, moderation analysis indicated an interaction effect between educational attainment and MS self-management. Implications for future research in rehabilitation and clinical application are discussed.
The coastline of the Korean Peninsula is influenced by three major oceanographic ecoregions, including the estuarine Yellow Sea ecoregion on the west coast, the warmer and saline East China Sea ecoregion on the south coast, and the cold East Sea ecoregion on the east coast. The influence of these marine ecoregions on the distribution of intertidal barnacles has not been extensively studied. The present study examines the biogeography of thoracican barnacles from intertidal and shallow subtidal zones, along the coasts of Korea. Twenty-one species in seven families were identified, including three species of coral-associated barnacles. Species composition varied significantly in the three marine ecoregions. Multivariate analysis showed barnacle assemblages were significant among the three ecoregions, although there are large overlaps of clusters between the Yellow Sea and East China Sea ecoregions. The estuarine species, Fistulobalanus albicostatus, occurred mainly in the Yellow Sea ecoregion; warm-water species, Tetraclita japonica, and sponge inhabiting barnacles Euacasta dofleini were observed in the East China Sea ecoregion; and cold-water species, Balanus rostratus and Perforatus perforatus, were found in the East Sea ecoregion. Four invasive barnacle species were recorded and the European barnacle Perforatus perforatus expanded its range northward from its recorded distribution nine years earlier. The cold-water species, Chthamalus dalli and Semibalanus cariosus, previously recorded in the East Sea ecoregion, were absent in the present survey. A trend of increasing seawater temperatures in Korean waters may have a significant impact on the distribution of cold-water species and enhance the northward invasion of P. perforatus.
Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia.
To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China.
This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan–Meier survival analysis and Cox hazard regressions were conducted.
Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01–1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93–0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide.
Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.
Background: In the United States, carbapenemases are rarely the cause of carbapenem resistance in Pseudomonas aeruginosa. Detection of carbapenemase production (CP) in carbapenem-resistant P. aeruginosa (CRPA) is critical for preventing its spread, but testing of many isolates is required to detect a single CP-CRPA. The CDC evaluates CRPA for CP through (1) the Antibiotic Resistance Laboratory Network (ARLN), in which CRPA are submitted from participating clinical laboratories to public health laboratories for carbapenemase testing and antimicrobial susceptibility testing (AST) and (2) laboratory and population-based surveillance for CRPA in 8 sites through the Emerging Infection Program (EIP). Objective: We used data from ARLN and EIP to identify AST phenotypes that can help detect CP-CRPA. Methods: We defined CRPA as P. aeruginosa resistant to meropenem, imipenem, or doripenem, and we defined CP-CRPA as CRPA with molecular identification of carbapenemase genes (blaKPC, blaIMP, blaNDM, or blaVIM). We applied CLSI break points to 2018 ARLN CRPA AST data to categorize isolates as resistant, intermediate, or susceptible, and we evaluated the sensitivity and specificity of AST phenotypes to detect CP among CRPA; isolates that were intermediate or resistant were called nonsusceptible. Using EIP data, we assessed the proportion of isolates tested for a given drug in clinical laboratories, and we applied definitions to evaluate performance and number needed to test to identify a CP-CRPA. Results: Only 203 of 6,444 of CRPA isolates (3%) tested through AR Lab Network were CP-CRPA harboring blaVIM (n = 123), blaKPC (n = 53), blaIMP (n = 16), or blaNDM (n = 13) genes. Definitions with the best performance were resistant to ≥1 carbapenem AND were (1) nonsusceptible to ceftazidime (sensitivity, 93%; specificity, 61%) (Table 1) or (2) nonsusceptible to cefepime (sensitivity, 83%; specificity, 53%). Most isolates not identified by definition 2 were sequence type 111 from a single-state blaVIM CP-CRPA outbreak. Among 4,209 CRPA isolates identified through EIP, 80% had clinical laboratory AST data for ceftazidime and 96% had clinical laboratory AST data for cefepime. Of 967 CRPA isolates that underwent molecular testing at the CDC, 7 were CP-CRPA; both definitions would have detected all 7. Based on EIP data, the number needed to test to identify 1 CP-CRPA would decrease from 135 to 42 for definition 1 and to 50 using definition 2. Conclusions: AST-based definitions using carbapenem resistance combined with ceftazidime or cefepime nonsusceptibility would rarely miss a CP-CRPA and would reduce the number needed to test to identify CP-CRPA by >60%. These definitions could be considered for use in laboratories to decrease the testing burden to detect CP-CRPA.
Disclosures: In the presentation we will discuss the drug combination aztreonam-avibactam and acknowledge that this drug combination is not currently FDA approved.
Until the shocking results in the 14th General Elections (GE-14) that saw the longruling Barisan Nasional (BN) being defeated in parliament and most states by the opposition coalition, Pakatan Harapan (PH) Johor was always regarded as BN's electoral bastion. Historically, Johor has the highest number of parliamentary seats contested and won by the two largest BN parties, namely the ethnic Malay-Muslimbased United Malays National Organization (UMNO) and its Chinese partner, the Malaysian Chinese Association (MCA). With a mixed racial make-up (60 per cent bumiputra, 33 per cent Chinese, and 7 per cent Indian), clear urban-rural divides, an influential royal house, and a growing and relatively industrialized economy (Hutchinson 2018, p. 2; van Grunsven and Hutchinson 2016), Johor is often deemed to be the bell-wether of BN's support, or rather, its “jewel in the political crown” (Reme Ahmad and Cheong 2017).
UMNO's strength in and dependence on Johor as its point of origin, a forging ground for leaders, and base of support has been convincingly documented (Hutchinson 2015b, 2018; Funston 1980). Yet, the same cannot be said for the MCA. The party's relative resilience in Johor, despite its notable decline from 2008 to 2018, remains unexplored. Its resilience can be seen from the fact that Johor MCA managed to hold onto most of its seats in the 2008 elections despite BN as a whole suffered massive losses nationwide. The importance of Johor can also be intimated from the fact that most MCA presidents are in some way connected to Johor—some for the fact that they are Johor-born (Neo Yee Pan, Chua Soi Lek); some for standing for office in the state (Lee San Choon, Ling Liong Sik); and almost all—with the exception of Tan Siew Sin, Tan Koon Swan, and Liow Tiong Lai, for having at some point of time been appointed chairman of the MCA Johor State Liaison Committee.
This chapter examines the MCA's electoral performance in Johor in relation to its history, Malaysia's national politics in general, the state's changing socio-economic landscape, and most importantly, the unique ethnic-pooling formula that worked in the MCA's favour. It argues that the MCA's fate in Johor, while at first secured by its local Chinese networks and affiliations, was soon undermined by the party's changing membership structure and the party's progressive loss of influence within BN, especially vis-à-vis UMNO.
Little is known about methylphenidate (MPH) use and mortality outcomes.
To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis.
This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 68 096 children and adolescents aged 4–17 years with an ADHD diagnosis and prescribed MPH between 2000 and 2010 were compared with 68 096 without an MPH prescription, matched on age, gender and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme or 31 December 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analysed using a repeated-measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide) and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan.
The MPH group had lower unadjusted all-cause, natural-, unnatural- and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all-cause mortality (adjusted hazard ratio AHR = 0.81, 95% CI 0.67–0.98, P = 0.027), delayed use of MPH was associated with higher mortality (AHR = 1.05, 95% CI 1.01–1.09) and longer MPH use was associated with lower mortality (AHR = 0.83, 95% CI 0.70–0.98).
MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.
While China's Constitution says everyone is treated equally before the law, employment discrimination continues to exist. This paper breaks new ground by analysing a quantitative survey of more than 10,000 lesbian, gay, bisexual, transgender and intersex (LGBTI) people, the largest dataset of its kind to date in China. Only 5.1 per cent of respondents were completely open about their gender and sexuality at work. More than one-fifth reported experiencing negative treatment in the workplace. Transgender and intersex people reported higher rates of negative treatment, as did respondents with lower educational levels and lower incomes and those residing in towns. Employer policies against discrimination were rare, but when in place, they were significantly associated with less negative treatment. These findings highlight an almost completely neglected segment of the workforce and document discriminatory experiences that could be addressed by changes in discrimination law and by employer policies and practices related to diversity and inclusion.
The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms.
This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16–75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up.
The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up.
Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.
Sleep quality in psychosis has been reported to have abnormalities in terms of sleep efficiency, initiation, maintenance and total sleep time (Bromundt et al., 2011; Wulff et al., 2012; Wilson & Argyropoulos, 2012). Some have even argued that such sleep abnormalities may have caused a few cognitive symptoms in psychosis (e.g., Wamsley et al., 2011). In recent years, physical exercise has been reported to have significant effects in reducing cognitive symptoms in patients with psychosis. However, there is no up-to-date study that has investigated the correlation between physical exercise, sleep quality and the cognitive function of patients with psychosis.
The aim of this study is to promote a 12-week physical exercise intervention to the psychotic population, and investigate whether the intervention can improve the sleeping quality as well as procedural memory performance. A randomised control trial has been carried out for this study. Patients with psychosis were recruited and randomly assigned to either a 12-week physical exercise intervention or a 12-week Carrom control intervention. Sleep quality (i.e., Insomnia Sleep Index; Bastien et al., 2001, Pittsburgh Sleep Quality Index; Buysee et al., 1988), cognitive function and clinical scale will be assessed before and after the 12-week intervention.
The present pilot study aimed to evaluate the effectiveness of a 7-week mindfulness-based intervention program (MBI-p), as a part of a RCT of larger scale. The MBI-p was developed by the Early Psychosis Studies and Intervention (EPSI) team in Hong Kong designated for patients with early psychotic disorders. In particular, the objective was to investigate the effects of MBI-p on depressive and anxiety symptoms associated with psychosis.
An uncontrolled design was used. Nine participants with psychotic disorders received MBI-p were assessed at baseline and post-treatment on outcomes of symptom severity (Positive and Negative Syndrome Scale, PANSS), depression and anxiety (Calgary Depression Scale, CDS, and Depression Anxiety Stress Scale-21, DASS), and mindfulness skills (Five Facet Mindfulness Questionnaire, FFMQ).
Significant improvements were found on the PANSS total score (P<.01), PANSS general symptom subscore (P<.01), CDS total score and DASS 21 depression subscore (P=0.05), accompanied by the improvements of mindfulness skills (FFMQ-observing subscore P<.01).
These pilot results indicated initial effectiveness of a group intervention based on mindfulness principles for patients with early psychosis. Significance in various measures despite small sample revealed a potentially robust effect of improving patients’ mood condition. It provides the foundation for future studies of larger scale and implementation of a promising and cost-efficient treatment option.
Adherence problems are an inherent issue with any bio-psycho-social-spiritual prescription for any disease or behvaioural entity. It is all the more important in a patient with severe mental illness like Schizophrenia with limited insight. In several countries various interventions have been studied to address adherence problems in psychosis. Such as compliance therapy, family and psycho educational interventions, telephonic prompting and also legislative measures like Community Treatment Orders (CTO) have to date shown inconsistent and only modest benefits. Incentives based interventions have been tested for both preventive measures and also for adherence problems in chronic diseases. The Institute of Mental Health, Singapore has implemented a Pilot Supervision Programme (PSP) that incentivise patient engagement through quarterly vouchers as well as minimising barriers to accessing service by waiving off certain treatment fees whilst also offering them intensive intervention for one year. Our Pilot Programme, that focused on high risk patients with diagnosis of severe mental illness needing involuntary admission with history of either prolonged or repeated admissions, has begun recruiting patients since October 2012. The comparison was done between pre and post intervention phase. Total of 58 patients (95% suffering from schizophrenia or schizoaffective disorder) accepted into the treatment programme and of that nearly half of them have completed 6 months interventions. The results are promising with more than 50% improvemnt in length of stay, number of admissions and psychiatric emergency room visits, making significant impact on our high risk patients with severe mental illness.
The Community Treatment Order (CTO) Programme has been in place in several countries and encompasses the legislative requirement of a group of psychiatric patients to receive psychiatric treatment.
The Institute of Mental Health (IMH),Singapore has implemented a pilot supervision programme (PSP) that contains elements of the CTO programme (but without the requirement for legislative changes).
The objective of PSP is to engage patients with serious mental disorders, such as schizophrenia, delusional disorder, bipolar disorder (as per the Diagnostic and Statistical Manual of Mental Disorders IV criteria) to continue to receive treatment while living in the community, the least restrictive environment.
This paper focuses on the implementation of Phase 1 of PSP. Phase 1 which cover a period of one year focuses on ‘high-risk‘ patients who suffer from a major psychiatric disorder and had 3 and more inpatient admissions over the past 1 year. They are then divided into 3 groups (70 each):
1) Group 1: Receiving standard community mental health treatment (monthly visit) and service is chargeable.
2) Group 2: Same as Group 1 but service is pro-bono.
3) Group 3: Receiving intensive community mental health treatment (weekly visit) and service is pro-bono.
In addition, patients in Group 2 and 3 will also receive incentives such as welfare voucher.
The results of Phase 1 will provide a better understanding of the patient's motivation and/or compliance for treatment and forms the test bed for Phase 2 which will include psychiatric patients with significant Axis II diagnoses.
Impairments of attention and memory are evident in early psychosis, and often lead to severe, longstanding functional disability. Effective non-pharmacological interventions are needed due to the unsuccessful results of pharmacological interventions.
To determine whether yoga is effective for cognitive impairments, and the neural mechanism underlying these effects.
It was a randomized controlled study of 12-week of yoga and aerobic exercise (walking and cycling) intervention vs wait-list control for female early psychotic patients. Memory was measured with Hong Kong List Learning Test and Digit Span test, and attention was measured with Letter Cancellation test. Cognitive data analysis was based on the Intention-to-Treat method using a mixed-model analysis. Seed based functional connectivity was applied using posterior cingulate cortex (PCC) as seed with AFNI. Cortical thickness analyses were performed using FreeSurfer. Results from yoga and control groups were presented.
A total of 140 women were recruited and randomized into three groups. 95 completed the study, and 115 were included for cognitive data analysis. For imaging data, 42 participants were used for cortical thickness analyses; and 60 were included for neural connectivity analyses. Yoga group demonstrated significant improvements in working memory, verbal acquisition and attention (P=.01). Cortical thickness increased in the postcentral gyrus (P<.01); connectivity between PCC and bilateral inferior parietal gyrus increased after yoga intervention (P<.005).
Yoga has been found to be effective for memory and attention in early psychotic patients. The increases of thickness and neural connectivity indicate the possible neural mechanisms underlying the improvements of cognition.
Maternal and child health are intrinsically linked. With accumulating evidence over the past two decades supporting the developmental origins of health and diseases hypothesis, it is now widely recognised that nutrition in the first 1000 d sets the foundation for long-term health. Maternal diet before, during and after pregnancy can influence the developmental pathways of the fetus and lead to health consequences later in life. While maternal and infant mortality rates have declined significantly in the past two decades, the growing burden of obesity and chronic non-communicable diseases in women of reproductive age and children is on a rapid rise worldwide, in developed and developing countries. A key contributory factor is malnutrition, which is a consequence of consuming poor quality diets. Suboptimal macronutrient balance and micronutrient inadequacies can lead to undesirable maternal body composition and metabolism, in turn influencing the health of the mother and leading to longer-term metabolic and cognitive health consequences in the infant. The GUSTO (Growing Up in Singapore Towards healthy Outcomes) study, a mother–offspring multi-ethnic cohort study in Singapore, has contributed to this body of evidence over the past 10 years. This review will illustrate how nutritional epidemiological research through a birth cohort has illuminated the importance and urgency of maternal and child nutrition and health in a modern, industrialised setting. It underscores the importance of a number of critical nutrients during pregnancy, in combination with healthy dietary patterns and appropriate meal timing, for optimal maternal and child health.
We conducted a survey of 16,914 patients to determine the point prevalence of healthcare-associated catheter-associated urinary tract infection (HA-CAUTI) and urinary catheter care in public hospitals in Hong Kong. Overall HA-CAUTI prevalence was 0.27%. Compliance was generally good, except for documenting the date of planned removal and securing the catheter properly.
Although neurocognitive dysfunction and physical performance are known to be impaired in patients with schizophrenia, evidence regarding the relationship between these two domains remains insufficient. Thus, we aimed to investigate the relationship between various physical performance domains and cognitive domains in individuals with schizophrenia, while considering other disorder-related clinical symptoms.
Sixty patients with schizophrenia participated in the study. Cardiorespiratory fitness and functional mobility were evaluated using the step test and supine-to-standing (STS) test, respectively. Executive function and working memory were assessed using the Stroop task and Sternberg working memory (SWM) task, respectively. Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Multivariate analyses were performed to adjust for relevant covariates and identify predictive factors associated with neurocognition.
Multiple regression analysis revealed that the step test index was most strongly associated with reaction time in the Stroop task (β = 0.434, p = 0.001) and SWM task (β = 0.331, p = 0.026), while STS test time was most strongly associated with accuracy on the Stoop task (β=−0.418, p = 0.001) and SWM task (β=−0.383, p = 0.007). Total cholesterol levels were positively associated with Stroop task accuracy (β=−0.307, p = 0.018) after controlling for other clinical correlates. However, clinical symptoms were not associated with any variables in Stroop or SWM task.
The present findings demonstrate the relationship between physical performance and neurocognition in patients with schizophrenia. Considering that these factors are modifiable, exercise intervention may help to improve cognitive symptoms in patients with schizophrenia, thereby leading to improvements in function and prognosis.