Cross-Border Medical Services for Hong Kong's Older Adults in Mainland China: The Implications of COVID-19 for the Future of Telemedicine.

Cross-border services and support are becoming an increasingly important part of Hong Kong's social policy because an increasing number of its older citizens are choosing to live in mainland China. Unfortunately, with the recent outbreak of COVID-19, medical services for cross-border older adults have been blocked due to strict immigration controls. This article examines the effects of COVID-19 on these older adults, with a specific focus on the interruption of medical services and the remedial measures taken by the government and non-governmental organizations. It also discusses the prospect of delivering care for cross-border older people using telemedicine, which is considered one of the most important methods for overcoming space-distance and reducing the risk of cross-contamination caused by close contact.

Phonological Production in Young Speakers of Cantonese as a Heritage Language.

This study investigates the phonological production of 50 heritage speakers of Cantonese aged 5-11 in the USA. They were compared to 12 majority language speaker peers in Hong Kong via ratings from first language adult speakers. Overall, the heritage speakers were rated as less native-like and less comprehensible than the children in Hong Kong, although they received higher scores from raters speaking the same variety of Cantonese (i.e., Guangzhou Cantonese, vs. Hong Kong Cantonese). None of the tested language background factors, including age of testing, had a predictive effect on the heritage speakers' scores. The results illustrate the divergence and heterogeneity of heritage phonology compared to homeland varieties.

Will there be a silver lining in the end? Lessons from and reflections on the COVID-19 pandemic in Hong Kong and beyond.

This article provides an analysis of the psychological and moral transformations as people confront the risk of infection, using Hong Kong as a case example. In the face of an unfamiliar threat, the need for uncertainty reduction gives rise to hasty, uncritical, and oversimplified assumptions about risk reduction, while prejudice against people and nations who do not share similar practices, as well as those symptomatic or at risk of catching the virus, ensue. The pandemic is eroding basic human decency and our compassion for one another while the human race battles a common threat to our destiny. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Modeling competitive evolution of multiple languages.

Increasing evidence demonstrates that in many places language coexistence has become ubiquitous and essential for supporting language and cultural diversity and associated with its financial and economic benefits. The competitive evolution among multiple languages determines the evolution outcome, either coexistence, or decline, or extinction. Here, we extend the Abrams-Strogatz model of language competition to multiple languages and then validate it by analyzing the behavioral transitions of language usage over the recent several decades in Singapore and Hong Kong. In each case, we estimate from data the model parameters that measure each language utility for its speakers and the strength of two biases, the majority preference for their language, and the minority aversion to it. The values of these two biases decide which language is the fastest growing in the competition and what would be the stable state of the system. We also study the system convergence time to stable states and discover the existence of tipping points with multiple attractors. Moreover, the critical slowdown of convergence to the stable fractions of language users appears near and peaks at the tipping points, signaling when the system approaches them. Our analysis furthers our understanding of evolution of various languages and the role of tipping points in behavioral transitions. These insights may help to protect languages from extinction and retain the language and cultural diversity.

The experience of first-time Hong Kong Chinese fatherhood: A qualitative exploratory study.

The father's involvement in childrearing can positively influence health outcomes not only for the man himself but also for his partner and their children. However, the experience of first-time fatherhood is limited in Chinese communities. The aim of this study is to explore men's experience of first-time fatherhood and coping in Hong Kong. An exploratory qualitative design was used. A purposive sample of 44 first-time Chinese fathers who had participated in a couple-based cognitive-behavioral intervention for postnatal depression were recruited for telephone interviews at 1-3 months postpartum. Data were collected by a semistructured interview guide and analyzed using thematic analysis. The process involved in men's transition to first-time fatherhood reveals four major themes: changes in daily life, new paternal roles and responsibilities, availability of resources to enhance adaptation, and coping strategies. The findings have implications for health care professionals and policy-makers in the provision of comprehensive perinatal care and family-friendly policies to aid men's transition to first-time fatherhood in Chinese communities.

A longitudinal study on the relationship among childhood emotional abuse, gratitude, and suicidal ideation of Chinese adolescents.

BACKGROUND AND OBJECTIVE: Suicidal ideation is a significant predictor of suicidal attempt. Based on the developmental psychopathology perspective and the resilience theory, this study examines whether trait gratitude mediates the relationship between childhood emotional abuse and adolescent suicidal ideation. PARTICIPANTS AND SETTING: A sample of 909 Grade 8 to Grade 9 adolescents aged 12-18 years in Hong Kong, a Special Administrative Region in China, was recruited from six secondary schools. METHOD: A two-wave longitudinal study was conducted. Participants completed the same measures on Gratitude Quesitonnaire-6, Suicidal Ideation Scale, emotional subscale of Child Abuse and Trauma Scale at two time points 12 months apart. RESULTS: Results of cross-lagged analyses showed that adolescents' suicidal ideation was positively associated with childhood emotional abuse and negatively associated with gratitude; further, the association between childhood emotional abuse and suicidal ideation was mediated by gratitude. CONCLUSIONS: Findings of this study implied that while exposure to parental emotional abuse might have an adverse impact on the development of gratitude, adolescents' current level of gratitude still exerts its protective effect by directly reducing their suicidal ideation. Gratitude or other resilience factors that might comprise additional mediating mechanisms from childhood emotional abuse to mental health problems in later life is worthy of further investigation.

Translation, cross-cultural adaptation and validation of the traditional Chinese intermittent and constant osteoarthritis pain (ICOAP) questionnaire for knee osteoarthritis.

OBJECTIVES: To translate and culturally adapt the Intermittent and Constant Osteoarthritis and Pain (ICOAP) measure to a traditional Chinese version, and to study its psychometric properties in patients with knee osteoarthritis (KOA). METHOD: The ICOAP was translated and cross-culturally adapted into traditional Chinese according to the recommended international guidelines. A total of 110 participants with KOA in Hong Kong were invited to complete the traditional Chinese ICOAP (tChICOAP), the Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and the Chinese Short form of Health Survey (SF-12v2). Psychometric evaluations included content validity, construct validity, internal consistency and test and retest reliability. RESULTS: All participants completed the tChICOAP questionnaire without missing items. The content validity index of all items ranged from 80% to 100%. The tChICOAP total pain and subscale scores had excellent internal consistency with Cronbach's alpha value (0.902-0.948) and good corrected item-total subscale correlations. It had high test and retest reliability (intra-class correlations 0.924-0.960). The tChICOAP constant, intermittent and total pain scores correlate strongly with the WOMAC pain subscale (r=0.671, 0.678 and 0.707, respectively, p<0.001). The tChICOAP intermittent and total scores correlate strongly with SF-12v2 physical component score (r=-0.590 and -0.558, respectively, p<0.001). CONCLUSIONS: The tChICOAP is a reliable and valid instrument to measure the pain experience of Chinese patients with KOA.

Cultural variation in social judgments of smiles: The role of ideal affect.

While significant research has demonstrated that people's beliefs about a group shape how they judge members of that group, few studies have examined whether people's beliefs and values regarding emotion (their "ideal affect") shape how they socially judge people's emotional facial expressions. We predicted that the more people valued and ideally wanted to feel excitement and other high arousal positive states (HAP), the more affiliative (extraverted, agreeable) they would judge excited (vs. calm) faces. Moreover, because European Americans typically value HAP more than Hong Kong Chinese do, we predicted that European Americans would rate excited (vs. calm) targets as more affiliative than would Hong Kong Chinese. We found consistent support for these hypotheses in four studies. In Studies 1a and 1b, these effects held regardless of target race (White, Asian) and target sex (male, female); emerged for human as well as computer-generated faces; and did not consistently emerge for nonaffiliative social judgments (i.e., dominance, competence). In Studies 2 and 3, we replicated these findings in more realistic contexts. In Study 2, culture and ideal affect predicted participants' extraversion judgments of excited Facebook profiles. In Study 3, culture and ideal affect predicted participants' extraversion and agreeableness judgments of an excited job applicant, which increased their likelihood of hiring that applicant. Together, these findings suggest that people's culture and ideal affect shape how affiliative they judge excited (vs. calm) smiles. We discuss the role these processes may play in perpetuating biases in multicultural settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development and validation of Attitudes towards Recovery Questionnaire across Chinese people in recovery, their family carers, and service providers in Hong Kong.

Considering the lack of existing measures on attitudes toward personal recovery and the need to acknowledge the cultural milieu in recovery attitude assessment, the present study developed and validated the Attitudes towards Recovery Questionnaire (ARQ) in a sample of people in recovery of mental illness, family carers, and mental health service providers in Hong Kong. The ARQ was developed based on existing literature and measures of recovery, and focus group discussions with various stakeholders. Findings of the multi-sample confirmatory factor analyses supported a five-factor structure: (1) resilience as a person in recovery, (2) self-appreciation and development, (3) self-direction, (4) family involvement, and (5) social ties and integration. The ARQ was positively correlated with recovery outcomes, empowerment, recovery knowledge, and recovery orientation of mental health services. As a tool for examining recovery attitudes, the ARQ informs us of the mindset across stakeholders and areas that need enhancement to facilitate the recovery process.

Learning and Socializing Preferences in Hong Kong Chinese Children.

The impact of social group information on the learning and socializing preferences of Hong Kong Chinese children were examined. Specifically, the degree to which variability in racial out-group exposure affects children's use of race to make decisions about unfamiliar individuals (Chinese, White, Southeast Asian) was investigated. Participants (N = 212; Mage  = 60.51 months) chose functions for novel objects after informants demonstrated their use; indicated with which peer group member to socialize; and were measured on racial group recognition, preference, and identification. Overall, children preferred in-group members, though out-group exposure and the relative social status of out-groups mattered as well. At a young age, children's specific experiences with different races influence how they learn and befriend others across racial group lines.

Socioeconomic status and quality of life among Chinese American breast cancer survivors: The mediating roles of social support and social constraints.

OBJECTIVE: Literature has well noted ethnic/racial disparities in cancer survival and cancer care. However, socioeconomic disparities in psychosocial adjustment to breast cancer have garnered little attention. This study addresses the research gap by investigating the associations between socioeconomic indicators (ie, education, annual personal, and household income) and quality of life (QOL) and the mediating roles of social support and social constraints (objective and subjective conditions that constrain individuals from disclosing cancer concerns) in these associations among Chinese American breast cancer survivors (CABCS). METHODS: Ninety-six CABCS completed questionnaires assessing these variables. RESULTS: After controlling for stage of cancer, annual personal and household income had indirect effects on QOL through social support, and education showed indirect effect on QOL through social support and social constraints. Subscale analyses indicated that controlling for years of immigration, annual personal and household income showed indirect effect on functional well-being through social support. When controlling for stage of cancer and income, education showed indirect effects on physical well-being through social support and social constraints and showed both direct and indirect effects on breast cancer concerns through social constraints. CONCLUSION: This study suggested that socioeconomic indicators, education, and income could be associated with different aspects of QOL through unique interpersonal mechanisms among CABCS. Our findings implied that increasing social support and reducing social constraints when implementing psychosocial interventions for CABCS may help to address the SES-related health disparities.

A longitudinal comparison of age patterns and rates of suicide in Hong Kong, Taiwan and Japan and two Western countries.

Suicide data relating to 1979-2014 were obtained from three East Asian jurisdictions (Taiwan, Hong Kong, Japan) and two 'Western' countries (Australia, New Zealand). Rates and age patterns of suicide have changed markedly since 1979. Graphs of these patterns largely remained either upward-sloping, bimodal or flat (uniform) over the 36 years, male commonly differing from female, and East Asian patterns more like each other than those of the Western countries. Japan's male middle-aged suicide rate reached a peak in 1999-2003, which, like increased rates among working age males in Hong Kong and Taiwan, has been attributed largely to consequences of Asian financial crises. Male to female ratios of suicide rates have remained higher in the Western countries, but late life suicide rates have decreased to varying extents in all five jurisdictions. Identifying reasons for differences between jurisdictions in their suicide rates and patterns at particular times, and over time, is likely to point to factors (period, cohort, psychosocial or cultural) that protect against or foster suicidal ideation. This avenue of research may assist in identifying ways of preventing suicide.

"The deceased has left; the alive has to move on": Experiences of Chinese Widows in the UK.

Relatively little is known about the experiences of Chinese widows, especially those living outside China. This qualitative study examines the experiences of eight Chinese or Hong Kong-born widows living in the UK. Using a semistructured approach to interviewing, participants were asked about their lives before, during, and after their spousal bereavement. Five major themes emerged: (1) complexity of marital lives; (2) experiences around the time of the death including fate; (3) loneliness and isolation; (4) the challenges of practical tasks; and finally, (5) current life. The implications of the findings for social policy and practice are briefly discussed.

Low relational mobility leads to greater motivation to understand enemies but not friends and acquaintances.

Enemyship occurs across societies, but it has not received as much attention as other types of relationships such as friendship in previous research. This research examined the influence of relational mobility on people's motivation to understand their personal enemies by measuring different dependent variables across three studies. First, a cross-cultural comparison study found that Hong Kong Chinese, from a low-relational-mobility society, reported a stronger desire to seek proximity to enemies relative to European Canadians, from a high-relational-mobility society (Study 1). To test causality, two manipulation studies were conducted. Participants were presented with images of co-workers, including enemies, friends, and acquaintances, in a hypothetical company. The results showed that the participants who perceived lower relational mobility paid more attention to their enemies in an eye-tracking task (Study 2) and had a higher accuracy rate for recognizing the faces of the enemies in an incidental memory test (Study 3). In contrast, the influence of relational mobility on motivation to understand friends and acquaintances was minimal. Implications for research on interpersonal relationships and relational mobility are discussed.

Barriers and facilitators for psychiatrists in managing mental health patients in Hong Kong-Impact of Chinese culture and health system.

INTRODUCTION: This study investigated the barriers and facilitators for psychiatrists in managing mental health patients under a Chinese context and a mixed private-public health system. METHODS: Two focus group interviews were conducted to explore the in-depth opinions of psychiatrists in Hong Kong. The themes identified from the focus groups were investigated in a questionnaire survey with data from 83 psychiatrists working in public and private sectors. RESULTS: No insurance coverage of mental health problems, patients' poor compliance of medication, and stigma of seeing psychiatrists were rated as the top barriers in the survey. Some psychiatrists mentioned in focus groups that they might write down the associated physical symptoms of the patients rather than the mental disorder diagnoses on the medical certificate. They observed some patients suspecting that psychiatric drugs were prescribed to control their behavior and make them more muddleheaded. The survey also found that consultation time constraint, long patient waiting list, and difficulty in discharging patients to primary care mostly affected public psychiatrists rather than private ones. However, they perceived similar facilitators, including public campaign to promote positive results of help-seeking, adequate explanation by other health professionals to the patients before referrals, handling severe cases by casework approach, and having a regular primary care physician. DISCUSSION: The top barriers are related to insufficient public awareness and negative attitudes towards mental illness and its treatment. Major solutions include promoting positive results of help seeking, enhancing collaboration with primary care physicians, and follow-up of severe cases by a casework approach.

Does Parental Mind-Mindedness Account for Cross-Cultural Differences in Preschoolers' Theory of Mind?

This study of 241 parent-child dyads from the United Kingdom (N = 120, Mage  = 3.92, SD = 0.53) and Hong Kong (N = 121, Mage  = 3.99, SD = 0.50) breaks new ground by adopting a cross-cultural approach to investigate children's theory of mind and parental mind-mindedness. Relative to the Hong Kong sample, U.K. children showed superior theory-of-mind performance and U.K. parents showed greater levels of mind-mindedness. Within both cultures parental mind-mindedness was correlated with theory of mind. Mind-mindedness also accounted for cultural differences in preschoolers' theory of mind. We argue that children's family environments might shed light on how culture shapes children's theory of mind.

Prevalence, Incidence, and Persistence of Postpartum Depression, Anxiety, and Comorbidity among Chinese Immigrant and Nonimmigrant Women: A Longitudinal Cohort Study.

OBJECTIVE: Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status. METHOD: We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated. RESULTS: Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants. CONCLUSION: Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women.

Couple Relationship Standards and Migration: Comparing Hong Kong Chinese with Australian Chinese.

Rates of international migration are increasing, which raises the question of how migration might influence couple relationship standards and impact on the standards of migrants forming intercultural relationships. We compared relationship standards in n = 286 Chinese living in Hong Kong, China, with standards in n = 401 Chinese migrants to a Western country (Australia) by administering the Chinese-Western Intercultural Couple Standards Scale (CWICSS). We also compared these two groups to n = 312 Westerners living in Australia. We first tested the structural invariance of the CWICSS across the three samples with a multigroup confirmatory factor analysis. There was marginal but acceptable fit of a model of two positively correlated latent factors: Couple Bond (with four indicators, such as demonstration of love and caring) and Family Responsibility (also with four indicators, such as extended family relations and preserving face). Within the limitations of the study, results suggest migration is associated predominantly with differences in women's, but not men's, relationship standards. Migrant Chinese women show alignment of Couple Bond standards with Western standards, and divergence of Family Responsibility standards from Western standards. Discussion focused on how migration and intercultural relationship experiences might differentially influence various domains of relationship standards, gender differences in migration effects on standards, and the implications for working with culturally diverse couples.

Experiences of Chinese immigrant women following "Zuo Yue Zi" in British Columbia.

AIMS AND OBJECTIVES: To describe Chinese women's experiences with "zuo yue zi" in British Columbia, Canada. BACKGROUND: Women born in China and Taiwan are increasingly immigrating to westernised countries. Many women choose to follow traditional Chinese postpartum practices, also called "zuo yue zi." Few studies have examined women's use of traditional practices in western countries. DESIGN: The study used a qualitative descriptive design. METHODS: We recruited 13 mothers who were: aged 19 or older, immigrants from mainland China, Hong Kong or Taiwan in the last 5 years, and caring for infants born in the previous 6 weeks. Semistructured interviews were conducted in Mandarin, translated into English, transcribed and analysed using inductive content analysis. RESULTS: The core theme was Chinese women's novel encounters with "zuo yue zi." The women's expectations of "zuo yue zi" were acquired through birth experiences or interactions with family and friends. The participants struggled with implementing traditional practices because social support and formal institutional structures were lacking. They modified their expectations about "zuo yue zi." Factors affecting their practices were catalysts and deterrents. Catalysts included help from Chinese family members, friends and informed healthcare providers. Deterrents included unregulated paid helpers, uninformed care providers, financial constraints and structural limitations in their new environments. CONCLUSIONS: Chinese immigrant women struggled to modify and implement traditional practices in their adopted country when they encountered financial constraints, unregulated paid helpers and varying support from health care providers. RELEVANCE TO CLINICAL PRACTICE: Some postpartum women following "zuo yue zi" believed that the practice would prevent chronic illness and strengthen their intrafamily relationships. Immigrant mothers require nursing support to follow traditional postpartum practices. Nurses can advocate on patients' behalf to increase care providers' knowledge about "zuo yue zi" and public awareness for necessary regulated institutional structures.

Facilitators and barriers to the acceptance of human papillomavirus (HPV) vaccination among adolescent girls: a comparison between mothers and their adolescent daughters in Hong Kong.

BACKGROUND: The aim of this study is to examine knowledge and attitude as facilitators and barriers to the acceptance of HPV vaccination for adolescent girls by mothers and adolescent girls. METHODS: A cross-sectional survey conducted in Hong Kong in January 2010. Adolescent girls aged 12-18, together with their mothers, were recruited to complete two separate questionnaires with similar questions. RESULTS: A total of 170 mother-adolescent girl dyads were recruited. When the daughters and mothers were compared, the mothers were found to be more aware of "the risk of becoming infected with HPV through early sexual intercourse," while more daughters than mothers knew that "the HPV virus cannot be cured with antibiotics." Significantly more daughters perceived that they had a "chance of being infected with HPV and getting cervical cancer without the vaccine," while more mothers were concerned that "vaccinating for HPV will cause a girl to be stigmatized as promiscuous" and thought that their "adolescent daughters are too young to receive the HPV vaccine." The major predictive factor for the acceptance of the HPV vaccine among mothers was "The HPV vaccine is safe" (OR = 10.126, 95% CI 2.47-41.54). Among daughters who accepted the vaccine, the predictive factor was "The HPV vaccine can prevent most HPV infections" (OR = 6.274, 95% CI 1.93-20.42). CONCLUSIONS: The findings provide healthcare professionals with a better understanding of the differences between mothers and adolescent girls in knowledge, attitude, and potential factors associated with acceptance of the HPV vaccine. Health professionals should promote the early prevention of HPV infection and eliminate the stigma surrounding HPV vaccination to increase its acceptance. The government should provide financial support for adolescent girls to receive the vaccination in school.