Browsing by Author "Xu, Hanzhang"
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Item Open Access An Initial Evaluation of the Impact of Pokémon GO on Physical Activity.(Journal of the American Heart Association, 2017-05-16) Xian, Ying; Xu, Hanzhang; Xu, Haolin; Liang, Li; Hernandez, Adrian F; Wang, Tracy Y; Peterson, Eric DPokémon GO is a location-based augmented reality game. Using GPS and the camera on a smartphone, the game requires players to travel in real world to capture animated creatures, called Pokémon. We examined the impact of Pokémon GO on physical activity (PA).A pre-post observational study of 167 Pokémon GO players who were self-enrolled through recruitment flyers or online social media was performed. Participants were instructed to provide screenshots of their step counts recorded by the iPhone Health app between June 15 and July 31, 2016, which was 3 weeks before and 3 weeks after the Pokémon GO release date. Of 167 participants, the median age was 25 years (interquartile range, 21-29 years). The daily average steps of participants at baseline was 5678 (SD, 2833; median, 5718 [interquartile range, 3675-7279]). After initiation of Pokémon GO, daily activity rose to 7654 steps (SD, 3616; median, 7232 [interquartile range, 5041-9744], pre-post change: 1976; 95% CI, 1494-2458, or a 34.8% relative increase [P<0.001]). On average, 10 000 "XP" points (a measure of game progression) was associated with 2134 additional steps per day (95% CI, 1673-2595), suggesting a potential dose-response relationship. The number of participants achieving a goal of 10 000+ steps per day increased from 15.3% before to 27.5% after (odds ratio, 2.06; 95% CI, 1.70-2.50). Increased PA was also observed in subgroups, with the largest increases seen in participants who spent more time playing Pokémon GO, those who were overweight/obese, or those with a lower baseline PA level.Pokémon GO participation was associated with a significant increase in PA among young adults. Incorporating PA into gameplay may provide an alternative way to promote PA in persons who are attracted to the game.URL: http://www.clinicaltrials.gov. Unique identifier: NCT02888314.Item Open Access Association Between Migration and Cognitive Function Among Middle Aged and Older Adults: a Comparison Between China and India(2018) Xu, HanzhangMigration is a fundamental demographic process that has been linked to cognitive function among the immigrant populations in developed countries. However, there is limited understanding of how migration and cognitive function are related among internal migrants in developing countries. The purpose of this dissertation is to provide some of the first evidence of the association between rural-urban migration and cognitive function among middle aged and older adults in China and India. We also examined whether the association between migration and cognitive function can be explained by a variety of factors such as sociodemographic background, health behaviors, and physical health status.
We first conducted a comprehensive review of the literature on the association between migration and cognition among middle-aged and older adults. Based on the current evidence, we developed a general conceptual framework to understand the factors contributing to the association. We identified five potential mechanisms from the literature: 1) socioeconomic status, 2) psychosocial factors, 3) behavioral factors, 4) physical and psychological health status, and 5) environmental factors. We also included several underlying factors in this conceptual framework such as early-life conditions, gender, and genetic factors. Overall, we found that factors linking migration and cognitive function are multidimensional and complex. We encouraged future studies to further test these mechanisms and refine this framework using empirical data.
To examine the association between migration and cognitive function among the internal migrant populations in China and India, we conducted a cross-national comparison study using the 2007-2010 World Health Organization Study on global AGEing and adult health (SAGE) data. We included 12,937 adults aged 50 or over from China and another 6,244 from India. We categorized migration status into six groups: urban residents, rural residents, urban-to-urban migrants, rural-to-urban migrants, rural-to-rural migrants, and urban-to-rural migrants. We generated a global cognitive function score by combing the following five cognitive tests: immediate and delayed recall tests, digit span tests (forward and backward), and verbal fluency test. We also assessed a variety of covariates in the analyses that included sociodemographic characteristics, psychosocial factors, health behaviors, and physical health status.
In the Chinese sample, we found that urban residents and urban-to-urban migrants had the highest level of cognitive function; whereas rural residents and rural-to-rural migrants had the poorest cognitive function. Our findings also showed that people who migrated to/within rural areas before age 20 had poorer cognitive function than those who migrated later in their adulthood. We found similar association in the Indian sample that urban residents and urban-to-urban migrants had the highest levels of cognition; while rural residents and people who migrated to (or within) rural areas had the poorest cognitive function. In both countries, we found that these patterns remain largely unchanged after adjusting for multiple study covariates.
In this dissertation, we also assessed gender differences in the association between migration and cognitive function. While doing a cross-country comparison, we observed a consistent female disadvantage in cognitive function in both countries. We found that female rural residents and female rural-to-rural migrants had the poorest cognitive function in both the Chinese and Indian samples. Among Chinese men, we found that rural residents had poorer cognitive function than urban residents, while urban-to-urban migrants had the highest level of cognition; however, for male counterparts in India, rural-to-rural migrants had the lowest level of cognitive function.
In sum, we found that cognitive function among middle aged and older adults in China and India differ significantly according to their migration status. The association between migration and cognitive function is complex and differs by gender and country.
Item Open Access Association between perceived risk of Alzheimer's disease and related dementias and cognitive function among U.S. older adults.(Archives of gerontology and geriatrics, 2023-07) Wang, Nan; Xu, Hanzhang; West, Jessica S; Østbye, Truls; Wu, Bei; Xian, Ying; Dupre, Matthew EIntroduction
The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer's disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function.Methods
We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7's test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range = 0-35). Perceived risk of developing ADRD was categorized at baseline as "definitely not" (0% probability), "unlikely" (1-49%), "uncertain" (50%), and "more than likely" (>50-100%). Additional baseline measures included participants' sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization.Results
Of 1457 respondents (median age 74 [IQR = 69-80] and 59.8% women), individuals who perceived that they were "more than likely" to develop ADRD had more depressive symptoms and were more likely to be hospitalized in the past two years than individuals who indicated that it was "unlikely" they would develop ADRD. Alternatively, respondnets who perceived that they would "definitely not" develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower income than individuals who indicated it was "unlikely" they would develop ADRD. Respondents who reported their risks of developing ADRD as "more than likely" (β = -2.10, P < 0.001) and "definitely not" (β = -1.50, P < 0.001) had the lowest levels of cognitive function; and the associations were explained in part by their socioeconomic, psychosocial, and health status.Conclusions
Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals' perceived risk of ADRD and their cognitive function has important implications for increasing public awareness and developing interventions to prevent ADRD.Item Open Access Changes in Informed Consent Policy and Treatment Delays in Stroke Thrombolysis.(Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2020-12-18) Xu, Hanzhang; De Silva, Deidre Anne; Woon, Fung Peng; Ong, Marcus Eng Hock; Matchar, David B; Bettger, Janet Prvu; Laskowitz, Daniel T; Xian, YingObjectives
The efficacy of thrombolytic therapy with tissue plasminogen activator (tPA) is highly time dependent. Although clinical guidelines do not recommend written informed consent as it may cause treatment delays, local policy can supersede and require it. From 2014 to 2017, three out of five public hospitals in Singapore changed from written to verbal consent at different time points. We aimed to examine the association of hospital policy changes regarding informed consent on door-to-needle (DTN) times.Materials and methods
Using data from the Singapore Stroke Registry and surveys of local practice, we analyzed data of 915 acute ischemic stroke patients treated with tPA within 3 hours in all public hospitals between July 2014 to Dec 2017. Patient-level DTN times before and after policy changes were examined while adjusting for clinical characteristics, within-hospital clustering, and trends over time.Results
Patient characteristics and stroke severity were similar before and after the policy changes. Overall, the median DTN times decreased from 68 to 53 minutes after the policy changes. After risk adjustment, changing from written to verbal informed consent was associated with a 5.6 minutes reduction (95% CI 1.1-10.0) in DTN times. After the policy changed, the percentage of patients with DTN ≤60 minutes and ≤45 minutes increased from 35.6% to 66.1% (adjusted OR 1.75; 95% CI 1.12-2.74) and 9.3% to 36.0% (adjusted OR 2.42; 95% CI 1.37-4.25), respectively.Conclusion
Changing from written to verbal consent is associated with significant improvement in the timeliness of tPA administration in acute ischemic stroke.Item Open Access Emergency medical services use and its association with acute ischaemic stroke evaluation and treatment in Singapore.(Stroke and vascular neurology, 2020-06) Xu, Hanzhang; Xian, Ying; Woon, Fung Peng; Bettger, Janet Prvu; Laskowitz, Daniel T; Ng, Yih Yng; Ong, Marcus Eng Hock; Matchar, David Bruce; De Silva, Deidre AnneBackground
Emergency medical services (EMS) is a critical link in the chain of stroke survival. We aimed to assess EMS use for stroke in Singapore, identify characteristics associated with EMS use and the association of EMS use with stroke evaluation and treatment.Methods
The Singapore Stroke Registry combines nationwide EMS and public hospital data for stroke cases in Singapore. Multivariate regressions with the generalised estimating equations were performed to examine the association between EMS use and timely stroke evaluation and treatment.Results
Of 3555 acute ischaemic patients with symptom onset within 24 hours admitted to all five public hospitals between 2015 and 2016, 68% arrived via EMS. Patients who used EMS were older, were less likely to be female, had higher stroke severity by National Institute of Health Stroke Scale and had a higher prevalence of atrial fibrillation or peripheral arterial disease. Patients transported by EMS were more likely to receive rapid evaluation (door-to-imaging time ≤25 min 34.3% vs 11.1%, OR=2.74 (95% CI 1.40 to 5.38)) and were more likely to receive intravenous tissue plasminogen activator (tPA, 22.8% vs 4.6%, OR=4.61 (95% CI 3.52 to 6.03)). Among patients treated with tPA, patients who arrived via EMS were more likely to receive timely treatment than self-transported patients (door-to-needle time ≤60 min 52.6% vs 29.4%, OR=2.58 (95% CI 1.35 to 4.92)).Conclusions
EMS use is associated with timely stroke evaluation and treatment in Singapore. Seamless EMS-Hospital stroke pathways and targeted public campaigns to advocate for appropriate EMS use have the potential to improve acute stroke care.Item Open Access The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study.(BMC Geriatr, 2017-05-15) Xu, Hanzhang; Dupre, Matthew E; Gu, Danan; Wu, BeiBACKGROUND: Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. METHODS: We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. RESULTS: After controlling for covariates, significant differences in cognitive function were found across the four groups: rural-to-urban and rural residents had a higher level of cognition than urban residents at baseline. On average, cognitive function decreased over the course of the study period. Rural-to-urban and rural residents demonstrated a faster decline in cognitive function than urban residents. CONCLUSIONS: This study suggests that residential status has an impact on the rate of changes in cognition among older adults in China. Results from this study provide directions for future research that addresses health disparities, particularly in countries that are undergoing significant socioeconomic transitions.