A Study of the Reliability and Concurrent Validity of the Chinese Version of the Pain Medication Attitude Questionnaire (ChPMAQ) in a Sample of Chinese Patients with Chronic Pain.

OBJECTIVES: The Pain Medication Attitude Questionnaire (PMAQ) was designed to assess concerns about pain medication among patients with chronic nonmalignant pain. The instrument has been demonstrated to be a reliable measure with good psychometric properties, yet its validity among Chinese has not been evaluated. This study aimed to translate the English-language version of the PMAQ into Chinese (ChPMAQ) and to evaluate its reliability and concurrent validity. METHODS: A total of 201 Chinese patients with chronic pain attending two multidisciplinary pain clinics in Hong Kong completed the ChPMAQ, the Chronic Pain Grade (CPG) questionnaire, the mental health subscale of the SF-12 (QoL-Mental), and questions assessing sociodemographic and pain characteristics. RESULTS: Our results showed that the seven ChPMAQ scales possessed good internal consistency. Except for the correlation between Withdrawal and Mistrust (r = 0.13), all ChPMAQ scales were significantly correlated with each other (all p < 0.01). The scales also correlated with two concurrent criterion measures, QoL-Mental and Pain Disability, in a predictable direction. Results of hierarchical multiple regression analyses showed that the ChPMAQ scales predicted concurrent QoL-Mental (F(7,190) = 2.75, p < 0.05) and pain disability (F(7,188) = 3.00, p < 0.01). Need (std ß = -0.23, p<0.05) and Side effects (std ß = 0.27, p < 0.01) emerged as independent predictors of concurrent QoL-Mental and pain disability, respectively. CONCLUSION: Despite the current preliminary findings for the reliability and concurrent validity of the ChPMAQ, more research is needed to substantiate the reliability, validity and other psychometric properties of the instrument.

The Reliability and Validity of the Cantonese Version of the Pain Treatment Satisfaction Scale (ChPTSS) in a Sample of Chinese Patients with Chronic Pain.

OBJECTIVES: The Pain Treatment Satisfaction Scale (PTSS) was developed in a Western context for evaluating patients' satisfaction with pain treatment. Although the instrument was shown to possess good psychometric properties, its reliability and validity among ethnic Chinese has not been examined. This article reports the translation of the English-language version of the PTSS into Traditional Chinese Cantonese (ChPTSS) and the preliminary examination of the reliability and concurrent predictive validity of the ChPTSS. METHODS: A total of 201 Chinese patients with chronic pain completed the ChPTSS, the Chronic Pain Grade questionnaire, the mental health questions of the 12-item Short Form Health Survey (SF-12), and questions assessing sociodemographic and pain characteristics. RESULTS: All ChPTSS scales demonstrated good internal consistency, with Cronbach's αs ranging from 0.77 to 0.90, and they all correlated with two criterion measures, mental health quality life (QoL) and pain disability, in expected directions. Results of hierarchical multiple regression models showed that the ChPTSS scales predicted concurrent mental health QoL (F(6,191) = 5.20, P < 0.001) and pain disability (F(6,189) = 4.20, P < 0.01). "Side Effects" emerged as the only significant independent predictor in both models (mental health QoL: std ß = -0.31, P < 0.001; pain disability: std ß = 0.25, P < 0.01). CONCLUSION: Our results offer preliminary evidence for the reliability and concurrent predictive validity of the ChPTSS, which can be applied in Cantonese speaking context.

The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors.

OBJECTIVES: Although research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population. METHODS: In a population-based, cross-sectional telephone survey, 5001 adults aged ≥18 years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions. RESULTS: The overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9-6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms. CONCLUSION: This study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.

Factor structure and psychometric properties of the Chinese version of the 20-item Pain Anxiety Symptoms Scale (ChPASS-20).

CONTEXT: The Pain Anxiety Symptoms Scale (PASS) was designed to assess pain-related anxiety and fear. Although the scale is a reliable measure with good psychometric properties, its validity among ethnic Chinese has yet to be evaluated. OBJECTIVES: This study aimed to translate the English-language version of the 20-item PASS into Chinese (ChPASS-20) and evaluate its factor structure, reliability, and validity. METHODS: A total of 223 Chinese patients with chronic musculoskeletal pain attending orthopedic specialist clinics completed the ChPASS-20, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item Tampa Scale of Kinesiophobia, the Hospital Anxiety and Depression Scale, and questions assessing sociodemographic and pain characteristics. RESULTS: Confirmatory factor analyses showed that all the five-factor solutions tested met the minimum acceptable fit criterion. The four ChPASS-20 subscales and the entire scale demonstrated good internal consistency (Cronbach's αs: 0.72-0.92). All ChPASS-20 scales showed significant positive correlations with depression, pain intensity, and disability. Hierarchical multiple regression analyses showed that the ChPASS-20 total score predicted concurrent depression [F(4,159)=11.97, P<0.001], pain intensity [F(4,161)=2.47, P<0.05], and pain disability [F(4,191)=5.47, P<0.001] scores, and the ChPASS-20 Avoidance subscale (standardized beta coefficient=0.21, P<0.05) emerged as a significant independent predictor of concurrent pain disability. CONCLUSION: Our data support the factorial validity, reliability, and construct validity of the ChPASS-20 in a Chinese population.

The effect of optimism on depression: the mediating and moderating role of insomnia.

This article aims to clarify if insomnia exerts a mediating or moderating effect on the optimism-depression association in Chinese college students. 529 Chinese college students completed the Beck Depression Inventory (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), the Revised Life Orientation Test (LOT-R) and the Multidimensional Scale of Social Support (MSPSS). The results failed to show any moderating effect but after adjustment for age, gender and social support, a mediating effect was observed. In conclusion, insomnia qualifies as a mediator, suggesting considerable variance in depressive symptoms of college students could be due to change in their sleep status.

Factorial validity and reliability of the Chinese version of the Pain Vigilance and Awareness Questionnaire (ChPVAQ) in a sample of Chinese patients with chronic pain.

PURPOSE: The Pain Vigilance and Awareness Questionnaire (PVAQ) has been shown to be a reliable measure for assessing attention to pain. Different factor structures have been reported in Western populations; yet, whether the known factor models could be replicated in non-Western populations and the psychometric properties of the scale remain unclear. This study aimed to examine the factorial validity and psychometric properties of the Chinese version of the PVAQ (ChPVAQ). METHODS: A total of 242 Chinese patients with chronic pain completed the ChPVAQ, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item version of the Tampa Scale for Kinesiophobia (ChTSK-11), the Hospital Anxiety and Depression Scale (HADS), and questions assessing socio-demographic characteristics. RESULTS: Results of confirmatory factor analyses showed that of the nine competing models tested, McCracken's two-factor correlated model for the 13-item version of PVAQ (PVAQ-13) demonstrated the best data-model fit (CFI = 0.93). The two subscales and the entire scale of ChPVAQ-13 obtained moderately high internal consistency (Cronbach's αs: 0.75-0.77). The ChPVAQ-13 scales showed significant positive correlations with HADS, ChTSK11, pain intensity, and disability scores. Results of hierarchical multiple regression analyses showed the ChPVAQ-13 scales predicted concurrent depression (F[4,187] = 6.01, P < 0.001) and pain disability (F[4,190] = 3.54, P < 0.05) scores. Passive Awareness emerged as significant independent predictor of concurrent depression (standardized beta coefficient [std ß] = 0.17, P < 0.05) and pain disability (std ß = 0.24, P < 0.01), while Active Vigilance (std ß = 0.19, P < 0.05) predicted concurrent pain disability. CONCLUSIONS: Our results offer preliminary evidence for the factorial validity and reliability the ChPVAQ-13.

Pain-related beliefs among Chinese patients with chronic pain: the construct and concurrent predictive validity of the Chinese version of the Survey of Pain Attitudes-14 (ChSOPA-14).

CONTEXT: Pain beliefs as indexed by the Survey of Pain Attitudes (SOPA) have been consistently shown to predict pain adjustment outcomes in Western populations. However, its utility in non-Western populations is unclear. OBJECTIVES: We evaluated the construct and predictive validity of the Chinese version of the 14-item SOPA (ChSOPA-14) in a sample of Chinese patients with chronic pain. METHODS: A total of 208 Chinese patients with chronic musculoskeletal pain completed the ChSOPA-14, the Chronic Pain Grade questionnaire, the Pain Catastrophizing Scale, the Center for Epidemiological Studies-Depression Scale, and measures of sociodemographic characteristics. RESULTS: Except Medical Cure, all ChSOPA-14 scales were significantly correlated with validity criterion measures (all P<0.05) in expected directions. The present Chinese sample scored the highest on the Medical Cure scale (mean=2.98, standard deviation [SD]=1.05) but the lowest on the Disability scale (mean=1.75, SD=1.67). Results of hierarchical multiple regression analyses showed that the ChSOPA-14 scales predicted concurrent depression (F(7,177)=14.51, P<0.001) and pain disability (F(7,180)=8.77, P<0.001). Pain Control (stdß [standardized beta coefficient]=-0.13; 95% confidence interval [CI]: -3.41, -0.13; P<0.05) and Emotion (stdß=29; 95% CI: 1.76, 5.02; P<0.001) emerged as significant independent predictors of concurrent depression whereas Disability (stdß=0.19; 95% CI: 1.33, 7.88; P<0.01), Emotion (stdß=16; 95% CI: 0.08, 7.59; P<0.05), and Solicitude (stdß=-0.14; 95% CI: -7.05, -0.04; P<0.05) significantly associated with concurrent disability. CONCLUSION: The findings offer preliminary evidence for the construct and concurrent predictive validity of the ChSOPA-14. This makes available a suitable instrument for chronic pain in the Chinese population and will facilitate future cross-cultural research on pain beliefs.

Assessing attitudes toward and beliefs about pain among Chinese patients with chronic pain: validity and reliability of the Chinese version of the Pain Beliefs and Perceptions Inventory (ChPBPI).

CONTEXT: Research consistently has evidenced the reliability and validity of the Pain Beliefs and Perceptions Inventory (PBPI). The instrument, however, has not been tested for its applicability and validity in non-Western populations. OBJECTIVES: To translate the English language version of the PBPI into Chinese (ChPBPI) and to evaluate its reliability, validity, and factor structure. METHODS: A total of 208 Chinese patients with mixed origin chronic pain were recruited from an orthopedic specialist outpatient clinic associated with a public hospital in Hong Kong. In addition to the ChPBPI, patients were administered the Chronic Pain Grade (CPG) questionnaire, the Pain Catastrophizing Scale (PCS), the Center for Epidemiological Studies-Depression Scale (CES-D), and questions assessing sociodemographic characteristics. RESULTS: Using the original factor structure of the PBPI as a model, confirmatory factor analyses revealed that all four ChPBPI scales demonstrated good data-model fit (CFI≥0.92) and adequate internal consistency (Cronbach's αs: 0.60-0.76). The four ChPBPI scales showed significant positive correlations with CES-D, PCS, pain intensity, and disability. Results of hierarchical multiple regression analyses showed that the ChPBPI scales predicted concurrent depression (F(4, 187)=6.01, P<0.001), pain intensity (F(4, 186)=4.61, P<0.01), and pain disability (F(4, 190)=3.54, P<0.05) scores. CONCLUSION: These findings support the factorial validity of the scales of the ChPBPI, and its reliability and construct validity. Now clinically relevant beliefs about pain can be assessed among Chinese patients with chronic pain.

Chronic pain and psychiatric morbidity: a comparison between patients attending specialist orthopedics clinic and multidisciplinary pain clinic.

OBJECTIVE: The objective of this study was to examine the associations between chronic pain and psychiatric morbidity using interview-based assessments of psychiatric symptomatology. We compared the prevalence of common mental disorder (CMD; consistent with neurotic and somatic symptoms, fatigue, and negative affect), depression, and anxiety disorder(s), and associated factors with these psychiatric illnesses among Chinese patients with chronic pain attending specialist orthopedics clinic and multidisciplinary pain clinic. METHODS: A total of 370 patients with chronic pain were recruited from an Orthopedics Clinic (N=185) and a Pain Clinic (N=185) in Hong Kong. Psychiatric morbidity was assessed using the Revised Clinical Interview Schedule. Individual scores for neurotic symptoms and neurotic disorders (including depression and four types of anxiety disorders) were also calculated. RESULTS: The reported lifetime prevalence rates of CMD were 35.3% and 75.3% for the Orthopedics and Pain Clinic samples, respectively. Rates of depression and anxiety disorders in the Pain Clinic (57.1% and 23.2%, respectively) were significantly higher than those in the Orthopedics sample (20.2% and 5.9%, respectively) (all P<0.001). Pain characteristics including number of pain sites, pain duration, pain intensity, and pain interference were all significantly associated with psychiatric morbidity after controlling for sociodemographic factors. Pain duration and litigation/compensation status consistently predicted concurrent pain intensity and disability. CONCLUSIONS: Chronic pain is associated with psychiatric morbidity. The higher rate of depression than anxiety disorder(s) among patients with chronic pain is consistent with previous studies that have found depression to be highly prevalent in chronic pain.

Prevalence and characteristics of chronic pain in the general population of Hong Kong.

UNLABELLED: Western studies document the prevalence of chronic pain in the general adult population to be between 2 and 55%. Knowing the prevalence of chronic pain among Chinese populations provides important comparative perspective: To determine the prevalence of chronic pain in the general population of Hong Kong; evaluate the relationship of chronic pain with sociodemographic and lifestyle factors; and describe the pain characteristics among chronic pain sufferers. A total of 5,001 adults aged ≥ 18 years (response rate 58%) drawn from the general population of Hong Kong completed the Chronic Pain Grade (CPG) questionnaire, providing information on chronic pain and sociodemographic status using telephone interviews. Overall 34.9% reported pain lasting more than 3 months (chronic pain), having an average of 1.5 pain sites; 35.2% experienced multiple pain sites, most commonly of the legs, back, and head with leg and back being rated as the most significant pain areas among those with multiple pain problems. The CPG criteria classified 21.5% of those with chronic pain symptoms as Grade III or above. Fully adjusted stepwise regression analyses identified being female, older age, divorced/separated, having part-time employment, existing long-term health problems, higher HADS Anxiety scores, poor QoL (mental health component), and low self-perceived health to be significantly associated with chronic pain. PERSPECTIVE: Our data evidenced that chronic pain is common in the general population of Hong Kong, and the prevalence is highest among women and middle-aged adults.

The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: an exploratory cross-sectional analysis.

The negative association of insomnia and internet addiction with mental health is widely documented in the literature, yet little is known about their inter-relationships. The primary aim of this study was to examine the inter-relationships between insomnia, internet addiction and depression. A total of 719 Chinese adolescents in Hong Kong participated in this school-based cross-sectional study. Participants completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), the Chinese Internet Addiction Scale (CIAS), the 12-item version of General Health Questionnaire (GHQ-12) and questions assessing internet use pattern and sociodemographic characteristics. The classification of internet addiction and insomnia was based on the CIAS cutoff global score >63 and PSQI cutoff global score >5, respectively. Multiple regression analyses tested the effects of insomnia and internet addiction on depression. Among students with internet addiction (17.2%), 51.7% were also identified as insomniacs. Internet addicts scored significantly poorer on all PSQI components, except sleep duration, than their non-addicted counterparts. After adjustment for gender and internet use time, both internet addiction (ß=0.05; Sobel test Z=6.50, P<0.001) and insomnia (ß=0.59; Sobel test Z=4.49, P<0.001) demonstrated a significant association with depression. Overall, there is high comorbidity between internet addiction and insomnia. Both insomnia and internet addiction emerged as significant explanatory factors, but they exerted differential effects on depression. Future research should be directed at determining the causal relationship between internet addiction and insomnia, and its underlying mechanism with depression.

Prevalence of insomnia among Chinese adults in Hong Kong: a population-based study.

Prevalence estimates of insomnia in western general populations are well documented, but population-based epidemiological data on insomnia in Chinese adults are scarce. The aims of the present study were to determine the prevalence of insomnia in the general population of Hong Kong, compare components of sleep disturbances and lifestyle factors stratified by sex, and identify risk factors for insomnia. Using a population-based cross-sectional design, a total of 5001 Chinese adults aged ≥18 years completed a telephone interview on the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and measures of quality of life (QoL) indexed by Medical Outcomes Study 12-item Short-Form Health Survey (SF12), lifestyle and sociodemographic details. Insomnia was defined by a PSQI global score >5. The resultant weighted prevalence of insomnia was 39.4%, equivalent to 2.2 million affected adults in Hong Kong. Women reported significantly poorer component and global sleep quality (all P < 0.05). Fully adjusted stepwise regression analyses identified non-full-time employment status, existing long-term health problems, alcohol consumption four to seven times per week, higher HADS scores, poor mental health component of QoL and low self-perceived health were associated significantly with insomnia (all P < 0.05). Our results suggest that insomnia is highly prevalent among Hong Kong Chinese adults and is associated with frequent use of alcohol, poor mental health and QoL.

Fear of movement/(re)injury in Chinese patients with chronic pain: Factorial validity of the Chinese version of the Tampa Scale for Kinesiophobia.

OBJECTIVE: To assess the factor structure of the Chinese version of the Tampa Scale for Kinesiophobia (TSK). DESIGN: Chinese patients with chronic pain attending either orthopaedic specialist services (n = 216) or multidisciplinary specialist pain services (n = 109) participated in this study. METHODS: Subjects completed the Chinese version of TSK, The Chronic Pain Grade Questionnaire, Hospital Anxiety and Depression Scale, and questions assessing socio-demographic characteristics. Confirmatory factor analyses were used to compare hierarchical and correlated models of 5 different factor solutions previously reported in patients with chronic pain in the West. RESULTS: Confirmatory factor analyses demonstrated inequality of the TSK factor structure, in that the TSK11 for the orthopaedics sample was best represented by a two-factor correlated model (S-Bchi2 = 49.593; comparative fit index (CFI) = 0.93; normed filt index (NFI) = 0.911; root mean square error of approximation (RMSEA) = 0.025) comprising 2 first-order factors, Somatic Focus (TSK11-SF) and Activity Avoidance (TSK-AA). The pain clinic sample showed a one-factor structure as best representing the TSK4's underlying dimensions (CFI = 0.971; NFI = 0.912; RMSEA = 0.048). There was no evidence to support a single overarching concept of kinesiophobia. CONCLUSION: The TSK appears to have utility in Chinese chronic pain populations. Elucidation of the TSK's psychometrics properties in other Chinese/Asian pain populations with different diagnoses and presentations of pain problems is warranted.

Prevalence of chronic fatigue among Chinese adults in Hong Kong: a population-based study.

BACKGROUND: Epidemiologic data is available on chronic fatigue for Western, but not for Chinese populations. The aims of the present study were to determine the prevalence of chronic fatigue in the general population of Hong Kong, compare health and lifestyle characteristics of non-chronic fatigue and chronic fatigue cases, and identify risk factors for chronic fatigue. METHODS: We performed telephone interviews on 5001 randomly selected Chinese adults aged ≥18 years administering the Chinese version of Chronic Fatigue Scale (ChCFS), the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) indexed by Medical Outcomes Study 12-item Short-Form Health Survey (SF12). Lifestyle, and sociodemographic data were also collected. Chronic fatigue was defined according to Fukuda et al.'s (1994) criteria and case criterion was a ChCFS total scores ≥4. RESULTS: The weighted prevalence of chronic fatigue was 10.7%, which was equivalent to 0.6 million adults in Hong Kong. Higher prevalence rates were found in females, older age groups, and low socioeconomic status. Fully adjusted stepwise regression analyses identified older age, retirees, housewife, existing long-term health problems, higher HADS scores, poor QoL, and low self-perceived health to be significantly associated with increased risk of chronic fatigue, whereas regular exercise was associated with decreased risk of chronic fatigue (all p<0.05). LIMITATIONS: The cross-sectional design did not allow determination of the time course and causal relationship between chronic fatigue and associated factors. CONCLUSIONS: Our data evidenced that chronic fatigue is common in the general population of Hong Kong, and the prevalence increased with age and was higher in the women and lower socioeconomic population.

The differential mediating effects of pain and depression on the physical and mental dimension of quality of life in Hong Kong Chinese adults.

OBJECTIVE: The impact of pain and depression on health-related quality of life (QoL) is widely investigated, yet the pain-depression interactions on QoL remain unclear. This study aims to examine the pain-depression-QoL mediation link. METHODS: Pain severity were assessed in a sample of Chinese professional teachers (n = 385). The subjects were also assessed on depressive symptoms and QoL. Regression models were fitted to evaluate the pain-depression-QoL relationships. RESULTS: About 44% of the sample had 3-5 painful areas in the past 3 months. Shoulder pain (60%) and headache (53%) were common painful areas. The results of regression analyses showed that pain mediated the effects of depression on the mental aspect of QoL (standardized beta = -0.111; Sobel test: z = -3.124, p < 0.005) whereas depression mediated the effects of pain on the physical aspect of QoL (standardized beta = -0.026; Sobel test: z = -4.045, p < 0.001). CONCLUSIONS: Our study offered tentative evidence that pain and depression impacted differently on the mental and physical aspect of QoL. As these findings were based on a Chinese teacher sample, future studies should employ more representative samples across cultures to verify the present data.

Preliminary psychometric properties of the Chinese version of the Chronic Pain Coping Inventory (ChCPCI) in a Hong Kong Chinese population.

UNLABELLED: The Chronic Pain Coping Inventory (CPCI) is a frequently used measure that assesses 8 categories of coping strategies that patients might use to cope with chronic pain. Despite its good psychometric properties and widespread use, the instrument has not been tested for its applicability and validity in non-Western populations, such as among Chinese. This study evaluated the reliability and validity of a Chinese translation of the 42-item CPCI (ChCPCI-42) in a sample of Chinese patients with chronic pain (n = 208). In addition to the ChCPCI-42, the patients were administered the Chronic Pain Grade (CPG) questionnaire, the Pain Catastrophizing Scale (PCS), the Centre for Epidemiological Studies-Depression Scale (CES-D), and questions assessing sociodemographic characteristics. Results of confirmatory factor analyses revealed that of the ChCPCI-42 8 scales, 6 demonstrated acceptable-to-good data-model fit (CFI >or= 0.90) and 2 demonstrated medium fit (CFI >or= 0.85). The 8 scales demonstrated adequate to good internal consistency (Cronbach alpha, 0.69 to 0.79) and correlated with CES-D, PCS, pain intensity, and disability in expected directions. Results of hierarchical multiple regression analyses showed that the ChCPCI-42 scales predicted concurrent depression (F (8,177) = 3.07, P < .01) and pain disability (F (1, 179) = 4.35, P < .001) scores, the Task Persistence scale being the strongest unique predictor among the 8 scales. The findings support the factorial validity and reliability of a 42-item CPCI that can be used among Chinese patients with chronic pain. PERSPECTIVE: The report outlines the first validation of the CPCI for use in Hong Kong Chinese. This makes available a suitable instrument for chronic pain research in the Southern Chinese population and will help to elucidate similarities and differences in pain coping between Chinese and other ethnic groups.

Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample.

OBJECTIVE: This paper aims to evaluate the factorial validity of the Chinese version of the Chalder Fatigue Scale (ChCFS) using a Chinese community sample. METHODS: A total of 201 Chinese adults completed the ChCFS, the 12-item Short-Form Health Survey (SF12), and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analysis was conducted to assess the fit of a one-factor model, a two-factor correlated model, and a three-factor hierarchical model in both the 14-item and 11-item versions of ChCFS to the current data. RESULTS: ChCFS successfully replicated the original two-factor structure in the current Chinese community sample, and the 11-item version demonstrated better data-model fit than the 14-item version. The instrument possessed good internal consistency (Cronbach's alpha=.863). The convergent validity with HADS and divergent validity with SF12 were also evident. CONCLUSIONS: ChCFS is valid and reliable among Chinese adults in the general population.

Study of the transport of thyroid hormone by transporters of the SLC10 family.

Transport of (sulfated) iodothyronines across the plasma membrane is required for their intracellular metabolism. Rat Na(+)/taurocholate cotransporting polypeptide (Ntcp; Slc10a1) has been identified as an important transporter protein. We demonstrate that among the 7 members of the solute carrier family SLC10, only human SLC10A1 mediates sodium-dependent transport of the iodothyronine T4 and iodothyronine sulfates T3S and T4S. In contrast to SLC10A2-7, cells co-expressing SLC10A1 and the deiodinase D1 demonstrate a dramatic increase in T3S and T4S metabolism. The SLC10A1 substrates taurocholate, DHEAS and E3S inhibit T3S and T4S transport. Furthermore, co-transfection of SLC10A1 with CRYM, a well-known intracellular iodothyronine-binding protein, results in an enhanced intracellular accumulation of T3S and T4S, indicating that CRYM binds iodothyronine sulfates. The present findings indicate that the liver-specific transporter SLC10A1 transports (sulfated) iodothyronines, thereby increasing their intracellular availability. Therefore, SLC10A1 may fulfill a critical step in providing liver D1 with iodothyronine sulfates for rapid degradation.

A longitudinal analysis of patient satisfaction and subsequent quality of life in Hong Kong Chinese breast and nasopharyngeal cancer patients.

BACKGROUND: We evaluated the longitudinal course of the relationship between patient satisfaction and quality of life (QoL) in Chinese breast and nasopharyngeal cancer patients. METHODS: A sample of Chinese breast (n = 250) and nasopharyngeal (n = 242) cancer patients were assessed during their first outpatient visit (baseline) and at 2 follow-up interviews (FU1 and FU2). The Chinese version of the Functional Assessment of Cancer Therapy-General Scale (FACT-G (Ch)) was adopted to assess QoL. Patient satisfaction was assessed by the 9-item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) and the cognitive subscale of the Medical Interview Satisfaction Scale (MISS-Cog). Linear mixed effects models were fitted to identify predictors of patient satisfaction and QoL. RESULTS: Recurrence after baseline (std beta = 0.58; 95% CI: 0.17, 0.98; P < 0.05) was the only predictor of MISS-Cog, age (std beta = 0.01; 95% CI: 0.00, 0.02; P < 0.05) and depressed mood (std beta = 0.20; 95% CI: 0.10, 0.30; P < 0.001) of ChPSQ-9. After adjusting for sociodemographic and psychosocial variables, both ChPSQ-9 (std beta = 0.13; 95% CI: 0.07, 0.19; P < 0.001) and MISS-Cog (std beta = 0.07; 95% CI: 0.02, 0.12; P < 0.05) independently predicted FACT-G (Ch) scores. CONCLUSIONS: These findings suggest both general emotional support and informational support are important in predicting QoL among Chinese breast and nasopharyngeal cancer patients.

The association between patient satisfaction and quality of life in Chinese lung and liver cancer patients.

BACKGROUND: Patient satisfaction has been accorded increased importance in evaluating the quality of health care. However, only a few studies have examined factors associated with patient satisfaction in cancer populations, with no data currently available in Chinese oncology populations. OBJECTIVES: We sought to examine the longitudinal course of the relationship between patient satisfaction and quality of life (QoL) in Chinese cancer patients. METHODS: A total of 253 liver cancer patients and 334 lung cancer patients were assessed during their first outpatient visit (baseline) and at 2 follow-up interviews (FU1 and FU2). QoL was measured by the Chinese version of the Functional Assessment of Cancer Therapy-General Scale [FACT-G (Ch)]. Patient satisfaction was assessed by the Nine-Item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) and the cognitive subscale of the Medical Interview Satisfaction Scale (MISS-Cog). Linear mixed effects (LME) models were fitted to identify predictors of patient satisfaction and QoL. RESULTS: Results of LME analyses showed no significant between-group differences in psychosocial, satisfaction, and QoL measures over time (all P > 0.05). Age [beta = -0.001, 95% confidence interval (CI): -0.03 to 0.00, P < 0.05] and optimism (beta = 0.20, 95% CI: 0.10 to 0.30, P < 0.001) predicted MISS-Cog and ChPSQ-9, respectively. After adjusting for sociodemographic and psychosocial variables, only ChPSQ-9 (beta = 0.12, 95% CI: 0.06 to 0.18, P < 0.001) predicted QoL scores. No significant association between MISS-Cog and QoL was found. CONCLUSIONS: General emotional support from health professionals (ChPSQ-9) was a more effective predictor of QoL than was a measure of informational support (MISS-Cog) among these patients. Because expectations of clinical care likely vary by culture, and nature and stage of disease, measures of patient satisfaction that address both informational and care expectations are important.