Xuefen Su

Associations between stigmatization toward HIV-related vulnerable groups and similar attitudes toward people living with HIV/AIDS: Branches of the same tree?

Abstract This study tested the hypothesis that stigmatization toward people living with HIV/AIDS (PLWHA) was associated with stigmatization toward different vulnerable groups, including men who have sex with men (MSM), injecting drug users (IDUs), female sex workers (FSW) and their clients (CFSW). A number of scales and indicators were constructed for the purpose: the four Overall Stigmatization Scale for a Vulnerable Group (OSSVG) and the five Dimensional Stigmatization Scale (DSS) each measuring different dimensions of stigmatization toward the four vulnerable groups, together with four indicators measuring stigmatization toward PLWHA. A random sample of 2,008 Hong Kong Chinese adults aged 18–50 years in the general population were interviewed by telephone. Of these respondents, 22.8– 76.8% perceived that FSW, CFSW, MSM and IDU were pathological and 42–82.2% perceived them as immoral; 74.7% believed that PLWHA are promiscuous. Furthermore, the four OSSVG and the five DSS scales were inter-correlated with one another (Spearman coefficient = 0.11–0.67) and most of them were significantly associated with the four PLWHA stigmatization indicators (Odds Ratio = 1.25–4.27). Other factors were associated with the OSSVG and DSS scores (e.g. age, marital status, religion affiliation, education level, income and perceived severity of the HIV problem in Hong Kong). Campaigns for removing stigmatization toward these vulnerable groups are required in order to reduce stigmatization toward PLWHA. Stigmatization toward FSW and their clients might have been over-looked. The removal of the publics blame on these groups for spreading HIV may be useful. The impact of HIV prevalence of a vulnerable group onto the associations between stigmatization toward that particular group and PLWHA warrants investigation.

Role of S-adenosylhomocysteine in cardiovascular disease and its potential epigenetic mechanism.

Transmethylation reactions utilize S-adenosylmethionine (SAM) as a methyl donor and are central to the regulation of many biological processes: more than fifty SAM-dependent methyltransferases methylate a broad spectrum of cellular compounds including DNA, histones, phospholipids and other small molecules. Common to all SAM-dependent transmethylation reactions is the release of the potent inhibitor S-adenosylhomocysteine (SAH) as a by-product. SAH is reversibly hydrolyzed to adenosine and homocysteine by SAH hydrolase. Hyperhomocysteinemia is an independent risk factor for cardiovascular disease. However, a major unanswered question is if homocysteine is causally involved in disease pathogenesis or simply a passive and indirect indicator of a more complex mechanism. A chronic elevation in homocysteine levels results in a parallel increase in intracellular or plasma SAH, which is a more sensitive biomarker of cardiovascular disease than homocysteine and suggests that SAH is a critical pathological factor in homocysteine-associated disorders. Previous reports indicate that supplementation with folate and B vitamins efficiently lowers homocysteine levels but not plasma SAH levels, which possibly explains the failure of homocysteine-lowering vitamins to reduce vascular events in several recent clinical intervention studies. Furthermore, more studies are focusing on the role and mechanisms of SAH in different chronic diseases related to hyperhomocysteinemia, such as cardiovascular disease, kidney disease, diabetes, and obesity. This review summarizes the current role of SAH in cardiovascular disease and its effect on several related risk factors. It also explores possible the mechanisms, such as epigenetics and oxidative stress, of SAH. This article is part of a Directed Issue entitled: Epigenetic dynamics in development and disease.

The association between multimorbidity and poor adherence with cardiovascular medications

Multimorbidity, defined as the presence of two or more chronic conditions, leads to a substantial public health burden. This study evaluated its association with adherence with cardiovascular medications in a Chinese population. A proportional stratified sampling was adopted to draw a representative sample of residents living in Henan Province, China. Interviewer-administered surveys were conducted by trained researchers. The outcomes included the number of chronic medical conditions, adherence with long-term medications (MMAS-8), and depressive symptoms (CESD-20). Binary logistic regression analysis was conducted to evaluate if medication adherence was associated with the presence of multimorbidity. From a total of 3866 completed surveys, the proportion of subjects having 0, 1 and ≥2 chronic conditions was 62.6%, 23.8% and 13.5%, respectively. Among 27.6% who were taking chronic medications, 66.6% had poor medication adherence (MMAS-8 score≤6). From binary logistic regression analysis, subjects with poor medication adherence were significantly associated with multimorbidity (adjusted odds ratio [AOR]: 1.35, 95% C.I. 1.02-1.78, p=0.037). Other associated factors included older age (AOR=1.04, 95% C.I. 1.03-1.05, p<0.001), smoking (AOR=1.63, 95% C.I. 1.16-2.30, p=0.005), family history of hypertension (AOR=1.51, 95% C.I. 1.19-1.93, p=0.001), and fair to poor self-perceived health status (AOR=2.15, 95% C.I. 1.69-2.74, p<0.001). Using medication adherence as the outcome variable, multimorbidity was significantly associated with poor drug adherence (AOR=1.34, 95% C.I. 1.02-1.77, p=0.037). Multimorbidity was associated with poorer medication adherence. This implies the need for closer monitoring of the medication taking behavior among those with multiple chronic conditions.

Inflammatory Markers of CRP, IL6, TNFα, and Soluble TNFR2 and the Risk of Ovarian Cancer: A Meta-analysis of Prospective Studies.

Background: There has been growing evidence showing that inflammatory markers play an important role in the development of ovarian cancer. We conducted a meta-analysis on the associations between circulating levels of C-reactive protein (CRP), interleukin 6 (IL6), tumor necrosis factor α (TNFα), and soluble TNFα receptor 2 (TNFR2), and the risk of ovarian cancer. Methods: A systematic search of PubMed and EMBASE up until January 19, 2016 was conducted to retrieve prospective studies. The summary risk estimates were pooled using random-effects models. The dose–response relationship was assessed using generalized least-squares trend estimation. Results: Seven nested case–control studies and one prospective cohort study were included in the review. For circulating CRP, women in the highest category had a significantly increased risk of ovarian cancer than women in the lowest category, with no significant between-study heterogeneity [pooled relative risk (RR) = 1.91; 95% confidence intervals (CI) 1.51–2.40; P < 0.001; I2 = 0.0%]. Influence analyses further supported this positive association. A positive dose–response relationship was also observed (pooled RR = 1.15; 95% CI, 1.03–1.30 per 5 mg/L of CRP). Publication bias was found. However, the association persisted after correction using the trim-and-fill method. No significant association was observed for circulating IL6, TNFα, and soluble TNFR2. Conclusion: This meta-analysis provides evidence that elevated levels of CRP, but not circulating IL6, TNFα, or soluble TNFR2, are significantly associated with an increased risk of ovarian cancer. Impact: These results suggest that circulating CRP may play a role in the etiology of ovarian cancer. Cancer Epidemiol Biomarkers Prev; 25(8); 1231–9. ©2016 AACR.

Growth charts for Chinese Down syndrome children from birth to 14 years

Objective To establish Down syndrome (DS)-specific growth charts for Hong Kong Chinese children. Design and setting Growth data were collected from (1) members of the Hong Kong Down Syndrome Association (cross-sectional); (2) DS children attending special schools or living in residential homes (cross-sectional); and (3) the paediatric departments of seven public hospitals (retrospective). Patients 425 DS children (57% males and 43% females) born in 1977–2000, yielding 4987 observations. Main outcome measures The LMS method was used to construct reference centile curves of weight, height, body mass index (BMI) from birth until 14 years and head circumference for the first 4 years. Results The median birth length was 49.8 cm and height at age 14 was 146.7 cm for DS boys. Corresponding figures for DS girls were 49.5 and 142.1 cm. The median birth weight was 3.0 kg for DS boys and 2.9 kg for DS girls. At age 14, 26% DS boys (BMI >22.6 kg/m2) and 12% DS girls (BMI >23.3 kg/m2) were overweight. The median head circumference at birth was 32.8 cm for boys and 32.0 cm for girls. Conclusions Chinese DS children had a shorter stature, lower weight and tendency to be overweight than local non-DS children. Their growth patterns differed from those of Chinese DS children in Taiwan, and DS children in the USA and Sweden. Growth retardation was most salient during the first year of life.

Pelvic inflammatory disease and the risk of ovarian cancer: a meta-analysis

PurposePrevious studies on pelvic inflammatory disease (PID) and the risk of ovarian cancer have found inconsistent results. We performed an updated meta-analysis to summarize the evidence of this association.MethodsPubMed, Embase, and ISI web of science databases were searched through October 2016 for studies that investigated the PID and ovarian cancer association. Summary risk estimates were calculated using random-effects meta-analysis.ResultThirteen studies were eligible for analysis, which included six cohort studies and seven case–control studies. PID was associated with an increased risk of ovarian cancer overall [relative risk (RR) 1.24, 95% CI 1.06–1.44; I2 = 58.8%]. In analyses stratified by race, a significant positive association was observed in studies conducted among Asian women (RR 1.69, 95% CI 1.22–2.34; I2 = 0%), but marginally significant among Caucasians (RR 1.18, 95% CI 1.00–1.39; I2 = 60.7%).Risk estimates were elevated in both cohort (RR1.32; 95% CI 1.05–1.66; I2 = 64.7%) and case-control studies (RR 1.17; 95% CI 0.93–1.49; I2 = 57.6%), albeit not statistically significant in case–control studies.ConclusionsOur results suggested that PID might be a potential risk factor of ovarian cancer, with pronounced associations among Asian women. Large and well-designed studies with objective assessment methods, such as hospital records, are needed to confirm the findings of this meta-analysis.

Reference standards for forced expiratory indices in Chinese preschool children

Spirometric testing is traditionally achievable in children of school‐age and beyond. Incorporation of interactive incentives motivates preschool children to facilitate measurement of forced expiratory indices. Validated spirometric reference standards are available for Caucasian preschoolers but lacking in Asians. We established spirometric references in Chinese children aged 2–7 years, who were recruited from 19 randomly selected nurseries and kindergartens in Hong Kong. Parents completed International Study of Asthma and Allergies in Childhood questionnaire, and children concurrently performed incentive spirometry on‐site according to international guideline. Prediction equations for spirometric indices were formulated by linear regression. One thousand four hundred two (72.9%) of 1,922 consented children, with mean (SD) age 4.4 (1.0) years, successfully performed spirometry. Following exclusions due to medical and technical reasons, 895 (63.8%) children contributed spirometric data to our references. Girls had lower FEV0.5, FEV0.75, FEV1, FVC, and PEF but similar FEF25–75 than boys, adjusted for age, weight, and standing height as covariates. Standing height was the most important predictor for FEV0.5, FEV0.75, FEV1, FVC, and PEF in both boys (adjusted R2 0.525–0.734) and girls (adjusted R2 0.583–0.721), whereas the best prediction model for both gender is formed by standing height, weight, and age. At various standing heights, our preschoolers had FEV1 Z‐scores 0.13–1.00 higher than those of collaborative Caucasian reference. This study justifies the need for ethnic‐specific reference equations and presents spirometry references in young Chinese children. Their forced expiratory indices are determined by gender, age, weight and standing height, and standing height is the best anthropometric index to predict all spirometric indices. Pediatr Pulmonol. 2013; 48:1119–1126.

Circulating Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Concentration and Risk of Cardiovascular Events ― Systematic Review and Meta-Analysis of Prospective Studies ―

BACKGROUND Previous studies have not found a consistent association between circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) and the risk of cardiovascular events. The aim of this meta-analysis was to evaluate this association in prospective studies.Methods and Results:A systematic search of prospective studies published through October 2016 was carried out in order to identify studies that met pre-specified inclusion criteria. After independent data extraction, summary relative risks were calculated using random-effects models. On meta-analysis of 6 cohort and 1 nested case-control study, circulating PCSK9 concentration as a continuous variable was not significantly associated with the risk of cardiovascular events (overall RR, 1.12; 95% CI: 0.98-1.29; P=0.09), with significant heterogeneity (I2=55.1%, Pheterogeneity=0.038). The highest but not middle categories of circulating PCSK9 was significantly associated with the risk of cardiovascular events. On subgroup analysis of study design, mean age at baseline, sample size, follow-up time, and pre-existing disease, there was no significant association between PCSK9 and cardiovascular events. Sensitivity analysis with various exclusion and inclusion criteria did not materially change the results. CONCLUSIONS Circulating PCSK9 concentration as a continuous variable was not significantly associated with the risk of cardiovascular events. More well-designed studies are needed to clarify the role of PCSK9 in cardiovascular risk.

Associations between nitric oxide synthase 3 gene polymorphisms and preeclampsia risk: a meta-analysis.

Previous studies have examined the role of three NOS3 gene polymorphisms [G894T, T-786C, and the variable number of tandem repeats 4b/a (VNTR 4b/a)] in the susceptibility to preeclampsia with inconclusive findings. We therefore conducted an updated meta-analysis by including more studies. The most appropriate genetic model was chosen for each polymorphism by using a well-established method. Pooled results indicated that, compared with the GT + GG genotype, the TT genotype of G894T was associated with an increased risk of preeclampsia (odds ratio (OR) = 1.46; 95% confidence interval (CI) = 1.21–1.77, P < 0.001; I2 = 40.2%). The CC genotype of T-786C was also associated with a higher risk of preeclampsia (OR = 1.30; 95% CI = 1.07–1.58, P = 0.034; I2 = 46.9%) than the CT + TT genotype. No association was found for VNTR 4b/a. Stratified analysis indicated that the increased risk was evident for high-quality studies both for G894T and T-786C, and for studies conducted among Caucasians and Africans for T-786C. However, the increased risk for T-786C among Africans needs further confirmation due to the high probability of false-positive reports. Our results suggested that G894T and T-786C polymorphisms, but not VNTR 4b/a, were associated with an increased risk of preeclampsia.

Profiles of discontinuation and switching of thiazide diuretics: a cohort study among 9398 Chinese hypertensive patients.

This study tested the hypothesis that younger, male patients or new clinic visitors, who were prescribed thiazide diuretics were more likely to have drug discontinuation and switching. All adult patients who visited any primary care clinic in one territory of Hong Kong, and who were prescribed a thiazide diuretic from January 2004 to June 2007 were included. The rates of discontinuation and switching, separately, 180 days after thiazide prescriptions were measured. Factors associated with discontinuation and switching were evaluated by multiple regression analyses. Among 9398 patients, 12.5% discontinued and 10.8% switched their prescriptions, whereas prescriptions of other patients remained the same. Younger patients (<50 years (reference value); adjusted odds ratio (AOR) for 50–59 years=0.74, 95% confidence interval (CI) 0.61–0.90, P=0.002; AOR (60–69 years)=0.57, 95% CI 0.46–0.70, P<0.001; AOR (⩾70 years)=0.88, 95% CI 0.73–1.06, P=0.174), male subjects (AOR=1.23, 95% CI 1.07–1.40, P=0.003) and new visitors (AOR (repeat visitors)=0.55, 95% CI 0.47–0.65, P<0.001) were more likely to be discontinuers. These associations between younger age (<50 years (reference value); AOR (50–59) years=0.85, 95% CI 0.70–1.04, P=0.112; AOR (60–69 year)=0.79, 95% CI 0.65–0.98, P=0.028; AOR (⩾70 years)=0.70, 95% CI 0.57–0.85, P<0.001), male gender (AOR=1.29, 95% CI 1.12–1.48, P<0.001) and new visitors (AOR (repeat visitors)=0.57, 95% CI 0.48–0.67, P<0.001) were also significant for medication switching. Clinicians should monitor the medication-taking behavior more closely among patients aged 50–59 years, male subjects and new clinic visitors when thiazide was prescribed.