BACKGROUND:Population-based studies on the prevalence of screen-time based activities and their role in health-related quality of life (HRQoL) remain lacking. OBJECTIVE:This study aimed to examine the associations between screen time and HRQoL as well as the mediation roles of physical activity and loneliness in these relationships in community-dwelling adults. METHODS:A population-based survey was conducted through telephone interviews in Hong Kong. Participants (N = 1070) were asked about their status as internet gamers and social media users, time spent on internet games and social media, moderate-to-vigorous physical activities (MVPA), loneliness, and HRQoL (EQ-5D and EQ-VAS). Descriptive statistics, regression, and path analyses were conducted. RESULTS:The mediation models of status of social media users and internet gamers by age groups (younger adults: 18-65 years vs older adults: >65 years) showed that MVPA significantly fully mediated the effect of social media users on EQ VAS in younger adults, and partially mediated its effect on EQ-5D index in older adults. However, internet gamers were only associated with more loneliness and better EQ VAS in younger adults but not older adults. The mediation model of social media time among social media users by age groups showed that loneliness significantly and completely mediated the effect of social media time on EQ-5D index only in younger adults. CONCLUSIONS:Internet games and social media may have different roles in health-related behaviors and quality of life. The findings highlight the importance of recognizing the multifaceted influences of screen time on adults' well-being across ages.

OBJECTIVES:To examine changes in the male to female ratio in diagnoses of autism spectrum disorder (ASD) over a 35 year period, providing temporal trends in diagnosis (incidence rate), the male to female ratio, and the age-cohort specific cumulative male to female ratio (cMFR). DESIGN:Population based, prospectively collected birth cohort study. PARTICIPANTS:2 756 779 liveborn children recorded in the Swedish medical birth register between 1985 and 2020. SETTING:Sweden. MAIN OUTCOME MEASURE:Age-period cohort analysis investigating associations between ASD and age at diagnosis, calendar period, birth cohort, and sex, quantified by incidence rate ratios and associated two sided 95% confidence intervals. RESULTS:Among 2 756 779 individuals born in Sweden between 1985 and 2020, ASD was diagnosed in 78 522 (2.8%) by the end of follow-up (2022). The incidence rate for ASD increased with each five year age interval throughout childhood, peaking at 645.5 (per 100 000 person years) for the male cohort at age 10-14 years and 602.6 for the female cohort at age 15-19 years in 2020-2022, and then decreased. Age specific incidence of ASD increased for each calendar period and birth cohort between 1985 and 2020. The male to female ratio decreased with increasing age at diagnosis and, for those older than 10 years, by calendar period. For the final year of follow-up in 2022, the cumulative male to female ratio for incidence of ASD was 1.2 by age 20 years. Further projection of these trends suggested that the cumulative male to female ratio would reach parity at age 20 years by 2024. CONCLUSION:Findings indicate that the male to female ratio for ASD has decreased over time and with increasing age at diagnosis. This male to female ratio may therefore be substantially lower than previously thought, to the extent that, in Sweden, it may no longer be distinguishable by adulthood. This finding highlights a need to investigate why girls and women receive diagnoses of ASD later than boys and men.

BACKGROUND:Autism spectrum disorder (ASD) has a complex inheritance pattern and is more common in males. Etiologic models suggest that most ASD risk is transmitted through common and rare de novo genetic variation. It has been hypothesized that rare variation could be inherited and therefore contribute to the overall risk burden in subsequent generations, especially through female lineage in disorders with male-skewed sex ratios. Here, we tested this hypothesis using multigeneration information on paternal age, because burden of de novo mutations has been linked to paternal age, and there is a well-established association between older age of fathers and ASD. METHODS:We analyzed combined data from Sweden's, Denmark's, and Finland's national registers, totaling 12.6 million family members, including information about parental ages at the time of birth of offspring in 2 generations and ASD diagnosis in the third generation. RESULTS:Among the 1,808,892 children in the third generation, 23,397 (1.29%) were diagnosed with ASD. Increased paternal age at the time of birth of a daughter was associated with increased risk of ASD in the daughter's own offspring. Increased paternal age at the time of birth of a son was not associated with increased ASD risk in the son's offspring, nor was older maternal age in the first or second generations. We observed that young maternal age at birth of a son or a daughter was associated with ASD risk in their offspring. CONCLUSIONS:Collectively, our results suggest that etiologic risk factors for ASD could extend over multiple generations through different underlying mechanisms, suggesting new directions for research on genetic and nongenetic risk factors.

AIMS:Exposure to alcohol content on social media has been linked to increased alcohol consumption, but data are scarce regarding the pathway of these associations. This study aims to examine the association between levels of alcohol social media marketing (SMM) exposure with positive drinking expectancies and whether these expectancies mediate recent drinking behaviour and future drinking intentions. METHODS:An anonymous, random telephone survey was conducted between June to August 2021 on Hong Kong Chinese residents between 18 and 34 years old (n = 675). The study used the Chinese Drinking Expectancy Questionnaire (CDEQ-Adult) to measure drinking-related beliefs. The association between alcohol SMM with drinking behaviour outcomes was assessed with multivariable logistic regression. The study assessed the mediation of the mentioned association by drinking expectancy using the PROCESS macro (version 4.0). FINDINGS:Past month exposure to alcohol SMM was significantly associated with all drinking behaviours (ORmv ranged from 1.93 to 7.85). The Total CDEQ-Adult positive expectancies score showed statistically significant mediation effects on all drinking behaviours except for future intention to drink to intoxication (Indirect effect: 0.08-0.19). Mediation analysis performed with subscales showed that Interpersonal Benefits, Increased Confidence, and Tension Reduction expectancies mediated the association between SMM exposure and drinking behaviours while Health Benefits and Negative Consequences did not. CONCLUSIONS:The noted associations between alcohol SMM drinking behaviours may be partly explained by drinking expectancies. The study findings provide information regarding the mechanisms through which SMM influences drinking behaviors. It may be necessary to counter-balance these types of advertising messages targeting young people.

BACKGROUND:Cost-of-illness studies are essential for care planning and policy making. It is increasing recognized that care for people living with neurocognitive disorders (NCDs) is costly. This study estimated the service utilisation and economic cost of mild and major NCDs among older adults in Hong Kong. METHOD:Based on a population-based prevalence survey of NCDs in Hong Kong, a total of 461 community-dwelling older adults aged 60 and over (major NCD: 68, mild NCD: 264, normal cognition: 129) completed the COI survey and were included in analysis. Service utilisation of participants, including medical, social, and informal care, was measured by the adapted version of Resource Utilisation of Dementia questionnaire. Per person cost was estimated from a societal perspective and expressed in 2022 US dollars. Associated factors of service utilisation and economic cost were examined by two-part models fitting for mixed discrete-continuous outcomes. RESULT:Annual cost per community-living adult with major and mild NCD was US$9,542 (95%CI: 7,728-11,356) and US$4,218 (3,670-4,766) in Hong Kong, respectively, significantly higher than that of normal cognition. The territory-wide cost of major and mild NCD in community was estimated at US$2.0 (1.7-2.2) and US$1.5 (1.2-1.8) billion, accordingly. The majority of cost of major NCD (76%) and mild NCD (50%) was attributable to social care and informal care. Costs of major NCDs even doubled from moderate to severe stages, and diagnosed cases incurred half and more costs than hidden cases. CONCLUSION:Economic burden of NCDs in Hong Kong is great, reflecting a striking social and care needs particularly in moderate and severe stages. Care planning should prepare for the blowout needs being revealed by hidden cases of NCDs, as well as the diversified needs by patients in different stages and their caregivers.

BACKGROUND:Psychological distress is common in family carers of persons with neurocognitive disorders (NCDs). This study evaluated suicidal ideation in family caregivers of persons with NCDs, and the roles of positive experience of caregiving in moderating these severe psychological difficulties. METHOD:445 older adults (NCDs: 322, normal cognition: 123) and their family caregivers were recruited from the population-based Hong Kong Mental Morbidity Survey for Older Persons. Carers' suicidal ideation was screened by positive response from Patient Health Questionnaire-9 (PHQ-9): thoughts being better off dead or hurting yourself in the past two weeks. Positive aspects of caregiver (PAC) were measured. A conceptual model was constructed to test the mediation and moderation effects among PAC, carer burden, psychological distress and suicidal ideation. RESULT:Nearly one in eleven (9%) dementia caregivers reported thoughts of death or suicidal ideation in the past two weeks. Higher rates were found in female carers comorbid with mood disorders and carers of high comorbidity or dependence persons. The association between carer burden and suicidal ideation was mediated by psychological distress (80.5%, p = 0.023). Higher levels of PAC were associated with lower rates of suicidal ideation in carers with moderate-to-high caring burden (moderation effects of PAC, p <0.05). CONCLUSION:Suicidal ideation in carers was associated with caring burden and affected by psychological distress. PAC attenuates the impact of burden and distress on suicidal ideation. Carer psychological intervention should focus on strengthening PAC, especially in carers experiencing high psychological distress.

AIMS:To evaluate the Hong Kong Primary Care Office (HKPCO) strategy against international guidelines from China, UK, US, Canada and Australia for identifying high-risk individuals requiring diagnostic testing for diabetes mellitus (DM) and pre-DM. METHODS:A cross-sectional study involved adults aged ≥25 without prior DM diagnoses. Participants underwent HbA1c point-of-care testing, with self-reported risk factors and clinical measurements documented. DM was defined as HbA1c ≥6.5 %, and pre-DM as 5.7-6.4 %. Sensitivity, specificity, number needed to test (NNT), and net benefit of different strategies were assessed. RESULTS:Amongst 1810 individuals (age: 59.3 ± 9.2 years, 39.6 % men), 4.8 % had DM and 53.6 % had pre-DM. The sensitivity, specificity and NNT for various detection strategies ranged from 19.5 % to 100 %, 0.58 % to 92.8 % and 8.3 to 20.7 respectively. Over 95 % fulfilled the HKPCO guideline (sensitivity = 100 %, specificity = 0.58 %, NNT = 20.7) without missing DM cases. NICE criteria (sensitivity = 96.6 %, specificity = 19.2 %, NNT = 17.6) correctly reclassified 18.6 % of high-risk participants, providing greater net benefits compared to HKPCO guideline. CONCLUSIONS:The community-based program detected high proportion of Chinese adults at high-risk for undiagnosed DM and pre-DM. Utilizing strategies developed by NICE, or other international strategies, can enhance net benefits and potentially improve cost-effectiveness when compared to the current HKPCO guideline.

Background: This trial assessed the feasibility of titrating evening dosing of anti-hypertensive medications based on nighttime home blood pressure measurement (HBPM) readings in primary care for hypertensive (HT) patients. Methods: 78 patients with nocturnal HT and stage I daytime HT were randomly assigned in a 1:1 ratio to either nighttime HBPM measurements (intervention group) or daytime HBPM measurements (control group). Nighttime blood pressure (BP) was measured 3x per night for at least two nights over 1 week using an automatic and validated HBPM device. The intervention group and control group aimed to achieve systolic BP <120 mmHg on nocturnal HBPM and systolic BP <135 mmHg on daytime HBPM respectively. All patients were seen every four weeks and followed the same drug titration algorithm. Results: The trial achieved a recruitment rate of 6.5 persons per month and a retention rate of 96.1%. In the intervention group, patients provided >= 6 (considered adequate) and >= 9 nighttime HBPM readings for 77.5% and 63.8% of their follow-ups, respectively. At 6-month, both groups had similar nighttime, 24-hour, and daytime BP on ambulatory BP monitoring, as well as similar numbers of non-dippers and healthcare utilisation. Most patients reported that they learned more from their HBPM nighttime readings and found the intervention well-tolerated. Conclusion: Adjusting evening dosage of anti-HT medications based on nighttime HBPM is a potential and feasible treatment approach for patients with nocturnal HT in primary care. This approach is well-accepted by patients and results in at least non-inferior BP control. Although titrating medications according to nighttime HBPM readings may improve nighttime BP, the small sample size limited statistical significance and the single-centre design restricted generalizability. Additionally, a few patients exhibited fair adherence to nighttime HBPM. Further randomised controlled trials are required to confirm that targeting nocturnal BP should be the primary treatment goal for HT.

AIMS:This study aimed to establish an outcome-derived threshold for central blood pressure (cBP) and evaluate its clinical utility in stratifying cardiovascular (CVD) risk. METHODS AND RESULTS:A retrospective cohort study of 34 289 adults without prior CVD was conducted using the UK Biobank dataset. The primary endpoint was a composite of cardiovascular mortality and non-fatal cardiovascular events. Diagnostic threshold for cBP was developed by bootstrap and approximation methods, based on the current brachial BP. Cox regression models were employed to evaluate the clinical utility of diagnostic thresholds for cBP in predicting in CVD. A diagnostic threshold of 135 mmHg for central systolic blood pressure (SBP) corresponded to the threshold of 140 mmHg for brachial SBP. Simultaneous assessment of brachial and central SBP configurated following categories: brachial and central normotension (49.84%), isolated brachial hypertension (2.23%), isolated central hypertension (3.65%) and concordant brachial and central hypertension (44.28%). Compared with concordant normotension, hazard ratios for cardiovascular events were 0.81 (0.45, 1.44) for isolated brachial hypertension, 1.70 (1.23, 2.35) for isolated central hypertension and 1.51 (1.30, 1.76) for concordant hypertension. The inclusion of cBP improved model fit and discrimination for predicting CVD beyond brachial BP alone. CONCLUSION:This study established a diagnostic threshold of 135 mmHg for central SBP. Individuals with central HT exhibited elevated risks of CVD, regardless of brachial HT status. Incorporating central BP enhanced the prediction of CVD risk beyond traditional BP measurement alone.

Cardiovascular diseases, a leading cause of death globally and in Hong Kong, lead to disability, mood changes, and increased healthcare burden. Lifestyle modifications can prevent these diseases. Health coaching, a client-centered approach, aids in behavior change. Despite its promise, cultural nuances in Hong Kong, like traditional diets and collectivist values, may influence health coaching effectiveness. Understanding these factors is crucial for tailored and effective cardiovascular disease prevention in the local Chinese population. Eighteen participants were recruited from the We WATCH project, a health coaching program for cardiovascular disease prevention in middle-aged adults (35–59 years) at post-program. Purposive sampling was used regarding gender, age and lifestyle domains. Three semi-structured focused-group interviews were conducted. Interviews followed a guide focusing on lifestyle changes and health coaching experiences. Thematic analysis, based on Braun and Clarke’s approach, identified emergent themes. The study revealed challenges faced by middle-aged individuals in Hong Kong in adopting healthy habits due to various barriers. Comfort foods and inactivity hinder behavioral changes. The end of health coaching programs posed a barrier. Participants cited facilitators from health coaching for promoting healthy behaviors. Clients noted health coach characteristics impacting effectiveness. A mix of online and offline channels was preferred for health coaching modality in Hong Kong for a more versatile approach. Psychological, behavioral, and cultural factors impact health decisions. Tailored health coaching in Hong Kong and similar cultures should consider unique cultural and environmental contexts (e.g., family-based health coaching, exploring indoor exercises).

Subthreshold depression is common in primary care and is associated with significant healthcare burden. There is emerging evidence for the benefits of Exercise can reduce depressive symptoms among people with diagnosed depression, but there is limited evidence for subthreshold depression in primary care setting. This study aims to examine the efficacy of a 12-week online instructor-led exercise intervention in reducing depressive symptoms among people with subthreshold depression in primary care, when compared to usual care control. This 1:1 randomised controlled trial will enrol 260 participants with subthreshold depression randomizing into 2 groups (online exercise intervention versus usual care control). The intervention consists of twice-weekly 1-h exercise online classes over 12 weeks, which will be led by certified instructors. Data will be collected at baseline (T0), immediate post intervention (T1), 3-month post intervention (T2) and 9-month post intervention (T3). The primary outcome is depressive symptoms measured by the Chinese version of Beck Depression Inventory-II (BDI-II) at T1. Secondary outcomes include anxiety symptoms, quality of life, physical activity levels, feasibility and acceptability, medication use and health service utilization, and cost assessment. Intention-to-treat analysis will be performed. The proposed study will assess the efficacy of online exercise intervention in improving subthreshold depressive symptoms in primary care. The findings will inform clinicians and policy makers concerning prevention of depression in primary care, and may lead to changes in the respective current guidelines and public policies. This trial has been registered in the Chinese Clinical Trial Registry, with the registration number: ChiCTR2400087923. The date of registration is 2024–08-07.

PURPOSE:There is currently no specific treatment for nocturnal hypertension (HT). By improving sleep quality and drug-specific mechanisms, hypnotics have been suggested as a potential treatment for nocturnal HT, but this has never been investigated by a systematic review and meta-analysis. MATERIALS AND METHODS:Multiple databases were searched since inception till 19 November 2024. Only randomised controlled trials (RCTs) comparing oral hypnotics administration for ≥1 week versus placebo and reporting nocturnal systolic blood pressure (SBP) or diastolic blood pressure (DBP) were included. Study selection, data extraction and quality assessment (by the Cochrane risk-of-bias tool) were conducted by two independent reviewers. Pairwise meta-analysis using a random effect model pooled weighted mean BP difference. RESULTS:Eight studies including 414 participants were included. Hypnotics did not significantly impact on nocturnal SBP (-3.24 mmHg; 95% confidence interval [CI]: -8.55, 2.06; I2: 89.4%), nocturnal DBP (-0.97 mmHg; 95% CI: -2.79, 0.85; I2: 74.6%) and daytime/24-h/office SBP/DBP except for nonbenzodiazepine benzodiazepine receptor agonists (NBZRAs), which may reduce 24-h SBP. Benzodiazepines increase 24-h/daytime/nighttime heart rate. Seven included studies had unclear to high risk of bias. Strength of evidence was ranked very low to low. This is the first meta-analysis to investigate the effects of hypnotics on nocturnal BP, highlighting the lack of adequately powered and low-risk-of-bias studies, especially in patients with HT and insomnia, who may experience preferential nocturnal BP reduction with hypnotics, but this hypothesis is currently supported only by two RCTs involving NBZRAs. CONCLUSIONS:Despite limited data, hypnotics appear to have neutral effects on BP, including nocturnal SBP and DBP, and currently have no role in clinical practice for the treatment of HT (PROSPERO no.: CRD42023490914).

Background This study aims to investigate age- and gender-specific effects of household solid fuels for heating on major depression and buffering effects of outdoor time in a high-income country. Methods Data were obtained from the UK Biobank. Participants with complete information on our studied variables and no prior diagnosis of major depression at baseline were included. Cox proportional hazards regression models were used to examine the effects of household solid fuels for heating on major depression. Subgroup analyses were conducted to investigate the buffering effects of outdoor time in summer and winter. Sensitivity analyses were performed to test the robustness of the main findings. Results Of 255,505 participants (50.2 % women), the 12-year cumulative incidence of major depression was 4.4 %. Household solid fuels for heating increased the risk of major depression only in women aged <45 years (HR (95%CI) = 1.30 (1.04, 1.63)). In this group, the solid fuel effect was moderated by outdoor time spending both in summer (HR (95%CI), ≤2 h/day: 1.61 (1.13, 2.28); >2 h/day: 1.13 (0.84, 1.52)) and winter (≤1 h/day: 1.35 (1.01, 1.08); >1 h/day: 1.24 (0.86, 1.77)). Limitations Self-reported measures might lead to recall bias and some potential confounders, such as ventilation efficiency, were not measured and controlled in data analyses. Conclusions Younger women are more vulnerable to the impact of domestic air pollution on major depression. Promoting outdoor activities is a cost-effective and efficient approach to mitigating the risk of major depression caused by household solid fuels.

BACKGROUND:Undiagnosed diabetes mellitus (UDM) is associated with poorer health outcomes compared to diagnosed DM. We investigated factors associated with UDM in a highly urbanized Chinese setting to facilitate UDM detection. METHODS:We analysed data from the cross-sectional Hong Kong Population Health Survey. We defined UDM by blood glucose and HbA1c levels and a negative history of self-reported doctor-diagnosed DM. We categorized diabetes status into UDM, incident DM (IDM, i.e. recently diagnosed) and individuals without diabetes and used multinomial logistic regression models to investigate the relationship between diabetes status and social and health service-related factors. RESULTS:We included 98 IDM cases, 101 UDM cases, and 2,153 individuals without diabetes. Individuals aged 35-44 years (aOR 12.65, 95% C.I. 2.54-62.97) and those living in subsidized-sale housing (aOR 2.01, 95% C.I. 1.14-3.56) had a higher risk of UDM relative to not having diabetes, but not IDM. Males who were economically active (aOR 4.22, 95% C.I. 1.25-14.30), and males who did not have regular check-ups (aOR 3.05, 95% C.I. 1.16-8.00) had higher risks of UDM relative to not having diabetes, whereas males with a higher household income had a lower risk of UDM (aOR 0.94, 95% C.I. 0.89-0.99). Compared to individuals without diabetes, UDM cases had comparable physical activity levels but most were work- and transport-related rather than recreational. CONCLUSIONS:Compared to individuals without diabetes or IDM cases, economically active males, males without regular check-ups and males with lower household income had a higher risk of UDM. Targeted active DM screening can reduce UDM. However, further research on the benefits of different types of physical activity is needed.

Caring for people with dementia in communities inevitably brings heavy burden for their family caregivers. Senses of positive aspects from caring and proper service support may help shape a healthy care journey for carers. This study aims to evaluate the caregiving burden, positive aspects, and service utilization of informal caregivers for community-living older adults with neurocognitive disorders (NCDs). 448 informal caregivers of older adults aged ≥60 (major NCD/ dementia: 68, mild NCD: 254, normal cognition: 126) were recruited from in a community-based prevalence survey in Hong Kong. Caregivers’ subjective burden was measured by Zarit Burden Interview (ZBI), while their gain was measured by positive aspect of caregiving scale (PACS). Caregivers’ use of medical and social service was also recorded. Differences in measures across three disease groups were examined by analysis of variance and t-test. Correlations between measures were estimated by Pearson coefficient. Nearly 60% of interviewed carers were female, spouses of care recipients, and not in employment. Over 75% of them cohabited with care recipients and take the major responsibility for caring. Compared to normal controls, carers of major and mild NCD had higher scores in caring burden, and over one in ten dementia carers were suffering moderate to severe degree of burden. Regarding positive aspects, carers of major and mild NCDs also have higher scores, mainly in items of “feel needed”, “feel appreciated”, and “feel important”. As for service utilization, dementia carers used more psychological and home help services. Finally, caring burden was positively correlated to positive gain (r = 0.233, P<0.001), psychological (r = 0.186, P<0.001) and social services (r = 0.146, P<0.001). The sense of positive aspects was uncorrelated to psychological services (r = -0.064, P = 0.174) but positively correlated to social services (r = 0.149, P = 0.002). Informal caregivers of major and mild NCD are experiencing heavier caring burden. They also have higher sense of positive aspects from caring and more utilization of psychological and social care. Relationships between positive and negative experience of caregivers and their service utilization need further investigations.

Prenatal maternal rheumatoid arthritis (RA) is postulated to increase the risk of offspring with Autism Spectrum Disorder (ASD), yet findings of the association are inconsistent, potentially owing to small sample sizes and insufficient consideration of the timing of RA onset. This study aimed to examine the association between maternal RA, particularly its timing, and offspring ASD risk. Two Israeli birth cohorts with national coverage and a meta-analysis were analyzed. Two harmonized birth cohorts of individuals born between 2003 and 2014 from Israeli Health Maintenance Organizations were followed up to 2021–05-01. Meta-analysis included all studies published up to 2023–06-07. Two exposures differentiated the timing of RA onset through maternal RA diagnosed before or after delivery. The association between maternal RA and the risk of offspring ASD was quantified by separate and pooled hazard ratios (HRs) from Cox proportional hazards regression with adjusted confounders. In the meta-analysis, the association was quantified using odds ratios (OR) fitted with random effects models with sensitivity analyses testing heterogeneity. Two Israeli birth cohorts included Cohort I (Population = 251,903; ASD = 1,939 [0.77

Objective: This study aimed to establish the diagnostic threshold for central blood pressure (BP) and evaluate its clinical usefulness in risk stratification for cardiovascular diseases (CVD). Design and method: A cohort study of 34,289 adults without prior CVD was conducted using the UK Biobank dataset. The primary endpoint was a composite of cardiovascular mortality and non-fatal cardiovascular events. The diagnostic threshold was determined by using current brachial BP cutoff with bootstrap and approximation methods. Cox regression models were constructed to evaluate the clinical utility of diagnostic thresholds for central BP in CVD prediction. Results: Over a median follow-up of 40 months, 809 composite cardiovascular events occurred. A diagnostic threshold of 135 mmHg for central systolic BP (SBP) corresponded to the threshold of 140 mmHg for brachial SBP. Concurrent assessment of brachial and central BP identified brachial and central normotension (49.84%), isolated brachial hypertension (HT) (2.23%), isolated central HT (3.65%) and concordant brachial and central HT (44.28%). Compared to concordant normotension, hazard ratios for cardiovascular events were 0.81 (0.45, 1.44) for isolated brachial HT, 1.70 (1.23, 2.35) for isolated central HT and 1.51 (1.30, 1.76) for concordant HT. Inclusion of central BP improved model fit and discrimination for predicting CVD beyond brachial BP alone. Conclusions: The study determined a diagnostic threshold of 135 mmHg for central SBP. Individuals with central HT had elevated risks of CVD, regardless of brachial HT status. Incorporating central BP enhanced the prediction of CVD risk beyond traditional BP measurement.

Introduction Emerging evidence supports mindfulness as a potential psychotherapy for post-traumatic stress disorder (PTSD). Individuals with subthreshold PTSD experience significant impairment in their daily life and functioning due to PTSD symptoms, despite not meeting the full diagnostic criteria for PTSD in DSM-5. Mindfulness skills, including non-judgmental acceptance, attentional control and openness to experiences may help alleviate PTSD symptoms by targeting characteristics such as intensified memory processing, dysregulated hyperarousal, avoidance, and thought suppression. This trial aims to test the effects of mindfulness-based cognitive therapy (MBCT) when compared to an active control.Method and analysis This 1:1 randomised controlled trial will enroll 160 participants with PTSD symptoms in 2 arms (MBCT vs. Seeking Safety), with both interventions consisting of 8 weekly sessions lasting 2 h each week and led by certified instructors. Assessments will be conducted at baseline (T0), post-intervention (T1), and 3 months post-intervention (T2), with the primary outcome being PTSD symptoms measured by the PTSD checklist for DSM-5 (PCL-5) at T1. Secondary outcomes include depression, anxiety, attention, experimental avoidance, rumination, mindfulness, and coping skills. Both intention-to-treat and per-protocol analyses will be performed. Mediation analysis will investigate whether attention, experimental avoidance, and rumination mediate the effect of mindfulness on PTSD symptoms.Discussion The proposed study will assess the effectiveness of MBCT in improving PTSD symptoms. The findings are anticipated to have implications for various areas of healthcare and contribute to the enhancement of existing intervention guidelines for PTSD.Trial registration number ChiCTR2200061863.