Timothy Kwok - Academia.edu (original) (raw)

Zee B by Timothy Kwok

Pharmacological research : the official journal of the Italian Pharmacological Society, 2007

Studies in animals and a short-term human study have suggested that curcumin, a polyphenolic comp... more Studies in animals and a short-term human study have suggested that curcumin, a polyphenolic compound concentrated in the curry spice turmeric, decreases serum cholesterol concentration. However, no controlled human trials have examined the effect of curcumin on cholesterol. This study investigated the effects of consuming curcumin on the serum lipid profile in men and women. Elderly subjects (n=36) consumed 4 g/d curcumin, 1g/d curcumin, or placebo in a 6-month, randomized, double-blind trial. Plasma curcumin and its metabolites were measured at 1 month, and the serum lipid profile was measured at baseline, 1 month, and 6 months. The plasma curcumin concentration reached a mean of 490 nmol/L. The curcumin concentration was greater after capsule than powder administration. Consumption of either dose of curcumin did not significantly affect triacylglycerols, or total, LDL, and HDL cholesterol over 1 month or 6 months. However, the concentrations of plasma curcumin and serum cholester...

Papers by Timothy Kwok

BMC Geriatrics

Background Although the majority of existing literature has suggested positive effects of housewo... more Background Although the majority of existing literature has suggested positive effects of housework on older adults’ health and survival rate, the underlying mechanisms of such effects remain unclear. To address potential mechanisms, the present study examined the association between older adults’ housework engagement and days of survival across 14 years and tested three potential mediation pathways in this association. Methods Four thousand Hong Kong older adults (50% female; aged between 65 and 98 years) participated in a longitudinal study in which they reported initial housework engagement and health status across three domains (cognitive functioning, physical health, and mental health) at the baseline, and the numbers of days they survived over the subsequent 14-year period were recorded. Linear regression, Cox proportional hazard, and parallel mediation analyses were performed to examine the relationship between housework engagement and days survived, and the mediating effects...

The Journals of Gerontology: Series B, 2019

Objectives To examine the longer-term effects of benefit-finding on caregivers’ depressive sympto... more Objectives To examine the longer-term effects of benefit-finding on caregivers’ depressive symptoms (primary outcome), and global burden, role overload, psychological well-being, and positive aspects of caregiving (secondary outcomes). Method Ninety-six Hong Kong Chinese caregivers of relatives with Alzheimer’s disease were randomly assigned to receive the benefit-finding intervention (BFT) or one of the two control conditions, namely, simplified psychoeducation (lectures only; SIM-PE) or standard psychoeducation (STD-PE). Caregivers received four biweekly one-to-one interventions of 3 hours each at their own homes. We focused on outcomes measured at 4- and 10-month follow-ups. The trajectories of intervention effects were modeled by BFT × time and BFT × time2 interaction terms. Results Mixed-effects regression showed significant BFT × time2 interaction effects on depressive symptoms against both control conditions, suggesting diminishing BFT effects over time. Z tests showed that, ...

Journal of Cardiovascular Medicine and Cardiology, 2021

Background and Objective: To perform an integrated Cross-Biostatical analysis of four randomized ... more Background and Objective: To perform an integrated Cross-Biostatical analysis of four randomized controlled trials (RCTs) to assess the efficacy and safety of oral administration of D&G capsule (D&G) for the maintenance of cardiovascular health.

JAMA Network Open

ImportanceOlder patients living in nursing homes are at very high risk of mortality after getting... more ImportanceOlder patients living in nursing homes are at very high risk of mortality after getting COVID-19.ObjectiveTo evaluate outcomes following oral antiviral treatment for COVID-19 among nonhospitalized older patients living in nursing homes.Design, Setting, and ParticipantsThis is a territory-wide, retrospective cohort study conducted between February 16 and March 31, 2022, with the last follow-up date on April 25, 2022. Participants were patients with COVID-19 living in nursing homes in Hong Kong. Data analysis was performed from May to June 2022.ExposuresMolnupiravir, nirmatrelvir/ritonavir, or no oral antiviral treatment.Main Outcomes and MeasuresThe primary outcome was hospitalization for COVID-19, and the secondary outcome was risk of inpatient disease progression (ie, admission to intensive care unit, use of invasive mechanical ventilation, and/or death).ResultsOf 14 617 patients (mean [SD] age, 84.8 [10.2] years; 8222 women [56.2%]), 8939 (61.2%) did not use oral antivir...

Atmosphere

To evaluate the impact of PM2.5 air pollution on atherogenic processes in modernizing Southern ve... more To evaluate the impact of PM2.5 air pollution on atherogenic processes in modernizing Southern versus Northern China, we studied 1323 asymptomatic Chinese in Southern and Northern China in 1996–2007. PM2.5 exposure and metabolic syndrome (MS) were noted. Brachial flow-mediated dilation (endothelial function FMD) and carotid intima-media thickness (IMT) were measured by ultrasound. Although age and gender were similar, PM2.5 was higher in Northern China than in Southern China. The Northern Chinese were characterized by lower lipids, folate and vitamin B12, but higher age, blood pressures, MS and homocysteine (HC) (p = 0.0015). Brachial FMD was significantly lower and carotid IMT was significantly greater (0.68 ± 0.13) in Northern Chinese, compared with FMD and IMT (0.57 ± 0.13, p < 0.0001) in Southern Chinese. On multivariate regression, for the overall cohort, carotid IMT was significantly related to PM2.5, independent of location and traditional risk factors (Model R2 = 0.352, F...

Atmosphere

Air pollution (PM2.5) has been associated with cardiovascular disease (CVD) globally and with ear... more Air pollution (PM2.5) has been associated with cardiovascular disease (CVD) globally and with early atherosclerosis surrogate markers in modernized China. A sizeable number of Chinese have migrated overseas, with an increase in their vulnerability to CVD. To evaluate the impact of PM2.5 air pollution on atherogenesis in native vs. overseas Chinese, we recruited 756 asymptomatic native Chinese and 507 age- and gender-matched overseas Chinese from Sydney and San Francisco. Their cardiovascular profiles were evaluated. PM2.5 was derived from remote sensing technology; atherosclerosis surrogate markers, flow-mediated dilation (FMD) and carotid intima-media thickness (IMT) were measured by ultrasound. The native Chinese had a higher proportion of smokers as well as higher blood pressure, glucose, metabolic syndrome and PM2.5 exposure (p < 0.001), but lower lipids and folate than the overseas Chinese (p < 0.0001). Carotid IMT was lower in the native Chinese (p < 0.0001), but the ...

Nature Aging

Changes in the levels of circulating proteins are associated with Alzheimer’s disease (AD), where... more Changes in the levels of circulating proteins are associated with Alzheimer’s disease (AD), whereas their pathogenic roles in AD are unclear. Here, we identified soluble ST2 (sST2), a decoy receptor of interleukin-33–ST2 signaling, as a new disease-causing factor in AD. Increased circulating sST2 level is associated with more severe pathological changes in female individuals with AD. Genome-wide association analysis and CRISPR–Cas9 genome editing identified rs1921622, a genetic variant in an enhancer element of IL1RL1, which downregulates gene and protein levels of sST2. Mendelian randomization analysis using genetic variants, including rs1921622, demonstrated that decreased sST2 levels lower AD risk and related endophenotypes in females carrying the Apolipoprotein E (APOE)-ε4 genotype; the association is stronger in Chinese than in European-descent populations. Human and mouse transcriptome and immunohistochemical studies showed that rs1921622/sST2 regulates amyloid-beta (Aβ) patho...

Journal of Medical Internet Research, 2021

BMC Geriatrics, 2020

Background The prevalence of dementia is surging that results in huge service demand in the commu... more Background The prevalence of dementia is surging that results in huge service demand in the community care services. Dementia care competence of staff working in these settings is fundamental of the care quality. This project aims to examine the effects of staff training on their competence for the anticipated challenges in dementia care and explore how the training influence their care practices. Methods This study adopted a mixed methods triangulation design, including a prospective multi-center study with pre-test post-test evaluations and a narrative analysis of the participants’ reflective essays. Seventeen experienced health and social care professionals were trained as trainers at the Dementia Services Development Centre of the University of Stirling, UK. The trainers provided local facilitator training to staff members by using training materials that were culturally adapted to the local context. The facilitators were required to deliver 12 two-hour in-service training sessi...

Health Services Insights, 2010

Purpose To compare health related quality of life (HRQOL) and handicap of stroke survivors in Hon... more Purpose To compare health related quality of life (HRQOL) and handicap of stroke survivors in Hong Kong (HK) and Chengdu (CD) in Mainland China. Method Fifty-four pairs of first ever stroke patients in CD and in HK matched by age, sex and Modified Barthel Index (MBI) were interviewed using a structured questionnaire at 16–36 months after stroke. HRQOL and handicap outcomes were evaluated by the Chinese version of the Short-Form Health Survey (SF-36) and London Handicap Scale (LHS) respectively. Results Compared to stroke patients in CD, HK subjects reported significantly greater handicap, especially in the occupation domain. HK subjects also had significantly lower HRQOL Z scores in domains of role limitations due to emotional or physical problems, and bodily pain. CD subjects had more social support, but had more difficulties in meeting medical costs, and were less likely to have regular medical follow-up and dysphagia symptom. After adjusting for social and health related factors,...

Journal of the American Medical Directors Association, Jan 25, 2017

Mild cognitive impairment (MCI) is a prevalent symptom associated with the increased risk of deme... more Mild cognitive impairment (MCI) is a prevalent symptom associated with the increased risk of dementia. There are many cognitive tests available for detection of MCI, and investigation of the diagnostic performance of the tests is deemed necessary. This study aims to evaluate the diagnostic performance of different cognitive tests used for MCI detection. A list of cognitive tests was identified in previous reviews and from online search engines. Literature searches were performed on each of the cognitive tests in MEDLINE, Embase, and PsycINFO from the earliest available dates of individual databases to December 31, 2016. Google Scholar was used as a supplementary search tool. Studies that were used to assess the diagnostic performance of the cognitive tests were extracted with inclusion and exclusion criteria. Each test's performance was compared with the standard diagnostic criteria. Bivariate random effects models were used to summarize the test performance as a point estimate ...

Pediatric Rheumatology, 2016

Background Evolving data link juvenile idiopathic arthritis (JIA) to environmental factors and gu... more Background Evolving data link juvenile idiopathic arthritis (JIA) to environmental factors and gut microbes, which may trigger the innate immune system through bacterial lipopolysaccharides. We hypothesized that children with new onset JIA have increased intestinal bacterial translocation and endotoxinemia. Methods 65 new onset, systemic treatment naive JIA patients (polyarticular JIA, n = 21, oligoarticular JIA, n = 29 and spondylarthropathies, n = 15) and 14 healthy controls participated in the study. We determined the plasma immunoglobulin reactivity against Escherichia coli lipopolysaccharide (LPS). We measured the levels of lipopolysaccharide binding protein (LBP), and alpha-1-acid glycoprotein (A1AGP), which are acute phase proteins related to intestinal bacterial translocation, and C-reactive protein (CRP). Assays were performed using commercial EIA kits (Hycult, R&D systems) or laboratory-prepared LPS. Results Children with polyarticular JIA have statistically significant increased concentrations of circulating anti-LPS antibodies, LBP, CRP, and A1AGP compared to healthy controls (p < 0.05). The concentration of LBP, CRP and A1AGP in patients with polyarticular JIA significantly differs from the oligoarticular JIA group (p < 0.05), but not spondylarthropathies. Spondylarthropathy patients have increased circulating anti-LPS antibodies compared to healthy controls (p < 0.05). There are no statistically significant differences between oligoarticular JIA patients and healthy controls. LBP and A1AGP levels correlate with CRP levels (r = 0.787 and r = 0.635 respectively). Conclusions Children with polyarticular JIA and spondylarthropathies have evidence of increased exposure to gut bacteria, as reflected by anti-LPS antibodies and LBP. The degree of exposure is proportional to the degree of systemic inflammation. These data imply that the intestine maybe the source of stimulation for the immune system in JIA. P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis

Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2012

1. Case management was not effective in improving quality of life of mildly demented people or re... more 1. Case management was not effective in improving quality of life of mildly demented people or reducing family caregiver burden. 2. Case management reduced depressive symptoms in mildly demented people in the short term. 3. Case management encouraged family caregivers to seek outside help.

Health Psychology and Behavioral Medicine, 2014

In both acute care and residential care settings, physical restraints are frequently used in the ... more In both acute care and residential care settings, physical restraints are frequently used in the management of patients, older people in particular. Recently, the negative outcomes of physical restraint use have often been reported, but very limited research effort has been made to examine whether such nursing practice have any adverse effects on patients' length of stay (LOS) in hospitals. The aim of this study was to examine the association between physical restraint use on older patients during hospitalization and their LOS. Medical records of 910 older patients aged 60 years and above admitted to one of the Hong Kong public hospitals in 2007 were randomly selected and recorded during July to September 2011. The recorded items included patients' general health status, physical and cognitive function, the use of physical restraints, and patients' LOS. Hierarchical regression analysis was conducted to analyze the data. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. Independent of these factors, the physical restraint use was still significantly predictive of longer LOS, and these two blocks of variables together served as an effective model in predicting older patients' LOS in the hospital. Since physical restraint use has been found to be predictive of longer hospital stay, physical restraints should be used with more caution and the use of it should be reduced on older patients in the hospital caring setting. All relevant health care staff should be aware of the negative effects of physical restraint use and should reduce the use of it in hospital caring and nursing home settings.

The Journal of rheumatology, 2004

To measure the impact of osteoarthritis (OA) on quality of life in the Hong Kong Chinese populati... more To measure the impact of osteoarthritis (OA) on quality of life in the Hong Kong Chinese population. This was a cross sectional, retrospective, non-random, cohort design stratifying disease severity and presence or absence of joint prostheses. Patients with OA (n = 574; 136 men and 438 women) were recruited from rheumatology, family medicine, orthopedics, and geriatric medicine clinics. They were divided into 2 equal groups based upon disease severity (either American College of Rheumatology functional classes I and II, or III and IV). The 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) and Western Ontario and McMaster Universities (WOMAC) OA Index were used. Patients with severe disease had lower mean scores in all SF-36 domains and higher mean scores in all WOMAC domains, indicating poorer quality of life. Scores in patients who had had arthroplasty were better than those with severe disease only in certain domains: role physical, general health, vitality, and ment...

Community nurse specialists and prevention of readmissions in older patients with chronic lung di... more Community nurse specialists and prevention of readmissions in older patients with chronic lung disease and cardiac failure Key Messages 1. A post-discharge follow-up by community nurses significantly reduced length of stay in acute hospital and accident and emergency attendances in older cardiac failure patients. 2. Community nursing intervention also resulted in minor improvements in dyspnoea and handicap levels in older cardiac failure patients. 3. Total public health care costs tended to be reduced by community nursing for older cardiac failure patients. 4. Post-discharge follow-up by community nurses for older patients with chronic lung disease patients had no measurable benefit in terms of hospital readmission rates, length of hospital stay, or any functional and psychological outcomes. 5. The effectiveness of community nursing may vary according to the client groups. It is necessary for community nursing to define its target group, the intervention protocols and the expected outcomes, so that its effectiveness can be evaluated.

Journal of Clinical Nursing, 2010

Aims. The primary aim was to examine the prevalence of post-stroke depression in Chinese stroke s... more Aims. The primary aim was to examine the prevalence of post-stroke depression in Chinese stroke survivors six months after discharge from a rehabilitation hospital. A second aim was to determine if six-month post-stroke depression was associated with psychological, social and physical outcomes and demographic variables. Background. There has been increasing recognition of the influence of depression on post-stroke recovery. While some previous studies report associations between depression and social, psychological, physical and clinical outcomes, few studies had sufficient sample sizes for regression analysis thereby limiting the clinical applicability of their findings. Design. A cross-sectional design was used. Methods. Data were collected from 124 male and 86 female stroke survivors (mean age 71.7, SD 10.2 years). The Geriatric Depression Scale was used to measure depression, the State Self-esteem Scale to measure state self-esteem, the London Handicap Scale to measure participation restriction, the Social Support Questionnaire to measure satisfaction with social support and the Modified Barthel Index to measure functional ability. Results. Forty-two survivors (20.5%) reported mild and 33 (16.1%) reported severe, depression. The presence of depression was associated with low levels of state self-esteem, social support satisfaction and functional ability. Logistic regression analysis revealed that Post-stroke depression 3 these variables were statistically significant in predicting the probability of having depression (p < 0.05). Conclusions. Analyses in the present study revealed distinct patterns of correlates of depression and the results were in agreement with prior studies that depression has a consistent positive association with physical disability, living arrangements and social support and no significant association with the different types of brain lesion. Relevance to clinical practice There is a need, routinely, to assess stroke survivors for depression and, where necessary, to intervene with the aim of enhancing psychological and social well-being.

Journal of Clinical Neuroscience, 2003

The interaction between genetic and environmental factors for PD was examined in a Chinese popula... more The interaction between genetic and environmental factors for PD was examined in a Chinese population. It was found that although the intron 2 MAOB ðGTÞ n repeat polymorphism was not associated with PD in the population, a relationship might have been masked by the "protective effect" of tea drinking. In individuals who did not drink tea (<1 cup/day), the possession of short length O178 bp ðGTÞ n alleles conferred a borderline significant increased risk for PD (adjusted OR ¼ 1:47; C:I: ¼ 1:03-2.1). As the extent of tea consumption increased, the association between the O178 bp allele and PD disappeared. This result suggests that the MAOB gene may be associated with PD in Chinese if the putative protective effect of tea drinking is taken into account. The significance of this finding is unclear as the study may be limited because of its marginal significance and limited numbers. However, it does demonstrate the importance of considering putative positive and negative environmental risk factors in any examination of genetic risk factors for PD.

Journal of Aging and Health, 2002

Objectives:This study aims to examine the cognitive and emotional reactions of Chinese elderly pe... more Objectives:This study aims to examine the cognitive and emotional reactions of Chinese elderly people toward death, to extend the use of aWestern scale on death anxiety to a Chinese sample, and to explore the correlates of death anxiety. Methods:A community sample of 237 Chinese elderly people (62 men and 175women) in HongKong between the ages of 60 and 91 years old was individually interviewed. Results:Among this elderly cohort, a high level of death anxiety was associated with younger age, a high level of psychological distress, and the presence of recent stressors butwas unrelated to number of physical disorders, gender, personal income, marital and employment status, and religious affiliations. Discussion:Reactions of Chinese elderly people toward specific death-related issues were discussed with regard to Chinese cultural beliefs. Limitations and implications of the present study were also discussed.

Pharmacological research : the official journal of the Italian Pharmacological Society, 2007

BMC Geriatrics

The Journals of Gerontology: Series B, 2019

Journal of Cardiovascular Medicine and Cardiology, 2021

JAMA Network Open

Atmosphere

Nature Aging

Journal of Medical Internet Research, 2021

BMC Geriatrics, 2020

Health Services Insights, 2010

Journal of the American Medical Directors Association, Jan 25, 2017

Pediatric Rheumatology, 2016

Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2012

Health Psychology and Behavioral Medicine, 2014

The Journal of rheumatology, 2004

Journal of Clinical Nursing, 2010

Journal of Clinical Neuroscience, 2003

Journal of Aging and Health, 2002

The Gerontologist, 2013

To examine the social networks of family caregivers of persons with Alzheimer's disease and the d... more To examine the social networks of family caregivers of persons with Alzheimer's disease and the degree to which network characteristics were associated with satisfaction with social support, burden, and positive gains. Design and Methods: A total of 142 Chinese caregivers responded to measures of structural support, positive exchanges, and negative exchanges using the social convoy questionnaire, as well as to measures of social support satisfaction, burden, role overload, positive gains, self-rated health, and behavioral and psychological symptoms of dementia (BPSD) of the care recipient. Data were analyzed using multiple regression. Results: The caregivers had small networks (mean = 4.4 persons). They reported few negative exchanges with network members and higher emotional than instrumental support, while being rather satisfied with the social support obtained. Surprisingly, both spouse/sibling and adult child caregivers excluded many close kin, in particular ~40% of their children, from their networks. A larger network was associated with higher social support satisfaction and positive gains, and lower role overload. Controlling for network size and social support satisfaction, positive exchanges were associated with higher positive gains, whereas negative exchanges were associated with higher burden and overload. Caregivers who experienced more BPSD and poorer self-rated health also reported lower support satisfaction and positive gains, as well as higher burden and overload. Implications: Under the influence of collectivism, individuals may shoulder the responsibilities of caregiving for the collective well-being of the family and end up being isolated and disappointed when expectations of family support were not forthcoming, to the extent that even ties with close kin may be severed.