Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial

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Structural and biophysical properties of the integrin-associated cytoskeletal protein talin

Talin is a large cytoskeletal protein (2541 amino acid residues) which plays a key role in integrin-mediated events that are crucial for cell adhesion, migration, proliferation and survival. This review summarises recent work on the structure of talin and on some of the structurally better defined interactions with other proteins. The N-terminal talin head (approx. 50 kDa) consists of an atypical FERM domain linked to a long flexible rod (approx. 220 kDa) made up of a series of amphipathic helical bundle domains. The F3 FERM subdomain in the head binds the cytoplasmic tail of integrins, but this interaction can be inhibited by an interaction of F3 with a helical bundle in the talin rod, the so-called “autoinhibited form” of the molecule. The talin rod contains a second integrin-binding site, at least two actin-binding sites and a large number of binding sites for vinculin, which is important in reinforcing the initial integrin–actin link mediated by talin. The vinculin binding sites are defined by hydrophobic residues buried within helical bundles, and these must unfold to allow vinculin binding. Recent experiments suggest that this unfolding may be mediated by mechanical force exerted on the talin molecule by actomyosin contraction

Subjective memory deficits without emotional concern predicts decline in cognitive functioning

Hosted by Alzheimer’s Disease Internationa (ADI) and Alzheimer’s Association Japan (AAJ)Poster Presentation - Risk Reduction and Risk Factors - no. PO1-194Introduction: Impaired memory and cognitive performance are known to be correlated with depression. However, when these three factors are present among the elderly population, it becomes complicated. While memory and cognitive performance degradation may be symptoms of depression, it may also be an indication of a clinically significant cognitive decline, which can lead to a very different conceptualization and treatment. Objectives: This study aims to explore the interplay between the factor of memory performance, cognitive performance, and symptoms of depression, and identify predictors to cognitive decline among the elderly population. Methods: Our study followed 1414 healthy community-dwelling older persons aged 65 or above in Hong Kong for a year, measuring their depressive symptoms with Geriatric Depression Scale (GDS), subjective memory deficits with an item from GDS, concern on memory deficits with a stand-alone dichotomous question, and cognitive performance with Cantonese Montreal Cognitive Assessment (MoCA). Results: After a year, 806 participants’ cognitive performance were maintained or slightly improved (t(805) =30.92, p < .001), while 608 participants’ performance declined (t(607) = -35.60, p < .001). Logistic regression revealed that a one point increase in GDS score was associated with an increase in the odds of cognitive decline for 1.05 (95%CI, 1.01 to 1.09), Wald χ2(1) = 5.68, p < .05, after controlling for age, gender, and education. In addition, after controlling for age, gender, education, and baseline GDS score, on a specific twoitem analysis, if participants reported awareness of relative memory deficits yet reported no emotional concern, the odds for this group to experience cognitive decline was 1.69 (95% CI, 1.24 to 2.29) times that of those who reported no relative memory deficits and/or indicated concerns (Wald χ2(1) = 11.20, p < .01). Conclusion: In general, the depressive symptoms captured by the GDS score contributes to the estimation of overall risk of cognitive decline within a 12 months period. Specifically, we have identified a two-item combination that can identify those who are significantly at higher risk of cognitive decline. Those who reported relative memory deficits, as fact, in the GDS, combined with the absence of subjective worry on deficits of memory/cognitive performance are of particular concern, irrespective of the GDS score. Our results add evidence to the clinical use of GDS as a screening tool of cognitive decline, and demonstrate the independent predictive value of cognitive and emotional awareness of memory deficits on cognitive decline

Validating a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for dementia caregivers

Objectives: The present study aimed to develop and validate a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for Hong Kong Chinese dementia caregivers. Methods: The 12-item Zarit Burden Interview (ZBI) was translated into spoken Cantonese and back-translated by two bilingual research assistants and face validated by a panel of experts. Five hundred Chinese dementia caregivers showing signs of stress reported their burden using the translated ZBI and rated their depressive symptoms, overall health, and care recipients' physical functioning and behavioral problems. The factor structure of the translated scale was identified using principal component analysis and confirmatory factor analysis; internal consistency and item-total correlations were assessed; and concurrent validity was tested by correlating the ZBI with depressive symptoms, self-rated health, and care recipients' physical functioning and behavioral problems. Results: The principal component analysis resulted in 11 items loading on a three-factor model comprised role strain, self-criticism, and negative emotion, which accounted for 59% of the variance. The confirmatory factor analysis supported the three-factor model (CZBI-Short) that explained 61% of the total variance. Cronbach's alpha (0.84) and item-total correlations (rho = 0.39–0.71) indicated CZBI-Short had good reliability. CZBI-Short showed correlations with depressive symptoms (r = 0.50), self-rated health (r = −0.26) and care recipients' physical functioning (r = 0.18–0.26) and disruptive behaviors (r = 0.36). Conclusions: The 12-item CZBI-Short is a concise, reliable, and valid instrument to assess burden in Chinese dementia caregivers in clinical and social care settings

Social value of preventing elderly depression with collaborative stepped care and productive ageing

Approximately 10% of older adults living in the community has clinically significant depression in Hong Kong. The associated societal costs (e.g., years of life lost, direct healthcare and long-term care costs, disease complications) are huge. Previous analysis of Medicare and Medicaid claims data has suggested an additional direct healthcare costs for late-life depression ranging from US$5,771 to up to US$17,607 per person per year depending on care setting. Indicated prevention (targeting older persons with high risk factors) and selective prevention (targeting those with high risk factors and mild symptoms) can reduce suffering and societal costs. Funded by the Hong Kong Jockey Club Charities Trust, this study aims to test a best practice model for effective outreach, engagement, and prevention of late-life depression in 3,840 community-dwelling older adults. The 3-year project has three components: (1) collaborative stepped care between elderly and mental health services; (2) productive ageing for active outreach and engagement; and (3) community empowerment for mental health literacy. The overall social value of the model will be assessed using social return on investment (SROI) method, a type of cost-benefit analysis, to provide evidence for further service rollout. Following standard SROI study method, focus groups and interviews will be conducted to identify areas of changes and map outcomes/financial proxies with stakeholders, and quantitative data will be collected for evidencing, establishing impact and calculating SROI. We report here the service model, preliminary findings from focus groups and interviews, and the forecast SROI of the model

Self-administered acupressure for caregivers of older family members : a randomized controlled trial

202311 bckwAccepted ManuscriptOthersHMRFPublishedGreen (AAM

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P &lt; 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients