Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: protocol for a randomised controlled trial.

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.

Associations of combined lifestyle index with migraine prevalence and headache frequency: a cross-sectional study from the MECH-HK study.

BACKGROUND: Prior research has shown that individual lifestyles were associated with migraine. Yet, few studies focused on combined lifestyles, particularly in Chinese populations. This cross-sectional study aimed to investigate the relationships of a combined lifestyle index with migraine in Hong Kong Chinese women. METHODS: Baseline data from a cohort study named Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK) were used for analysis. In total 3510 women aged 55.2 ± 9.1 years were included. The combined lifestyle index comprised eight lifestyle factors: smoking, physical activity, sleep, stress, fatigue, diet, body mass index, and alcohol. Each component was attributed a point of 0 (unhealthy) or 1 (healthy). The overall index was the sum of these points, ranging from 0 (the least healthy) to 8 points (the healthiest). Migraine was diagnosed by the International Classification of Headache Disorders 3rd edition. Additionally, for women with migraine, the data on migraine attack frequency (attacks/month) was collected. RESULTS: A total of 357 women with migraine (10.2%) were identified. The prevalence of migraine for the 0-3-point, 4-point, 5-point, 6-point, and 7-8-point groups were 18.0% (162/899), 10.9% (86/788), 6.6% (51/776), 6.0% (38/636), and 4.9% (20/411), respectively. In the most-adjusted model, compared to the 0-3-point group, the odds ratios and 95% confidence intervals for the 4-point, 5-point, 6-point, and 7-8-point groups were 0.57 (0.43-0.75), 0.33 (0.24-0.46), 0.30 (0.21-0.44), and 0.25 (0.15-0.41), respectively (all p < 0.001). For each component, migraine was significantly associated with sleep, stress, fatigue, and diet; but was unrelated to smoking, physical activity, body mass index, and alcohol. Among women with migraine, per point increase in the combined lifestyle index was associated with a reduced migraine attack frequency (ß = - 0.55; 95% confidence interval = - 0.82, - 0.28; p < 0.001). CONCLUSIONS: A combined lifestyle index was inversely associated with migraine and migraine attack frequency in Hong Kong Chinese women. Adhering to a healthy lifestyle pattern might be beneficial to the prevention of migraine attacks. Conversely, it is also plausible that women with migraine might have a less healthy lifestyle pattern compared to those without headaches.

The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial.

INTRODUCTION: There is a lack of studies evaluating mindfulness-based interventions for children with attention-deficit hyperactivity disorder (ADHD) compared with an evidence-based control. This randomized controlled trial (RCT) evaluated the effects of mindfulness for youth (MYmind) in improving children's attention, behavior, and parent-related outcomes versus cognitive behavioral therapy (CBT). METHODS: A total of 138 families of children with ADHD aged 8-12 years were recruited from the community with 69 randomized to MYmind and 69 to CBT. Participants were assessed at baseline, immediately after intervention, at 3 months and 6 months. The primary outcome was the attention score of the Sky Search subtest of the Test of Everyday Attention for Children (TEA-Ch). Secondary outcomes were child behavior and parent-related assessments. Linear mixed models were used to assess the efficacy of MYmind compared with CBT. RESULTS: Both MYmind and CBT significantly improved children's attention score at 6 months (MYmind: ß = 1.48, p = 0.013, Cohen's d = 0.32; CBT: ß = 1.46, p = 0.008, d = 0.27). There were significant within-group improvements in most secondary outcomes. No significant difference was shown for both primary or secondary outcomes between the two arms at any time point. CONCLUSIONS: Both MYmind and CBT appeared to improve children's attention and behavior outcomes, although no difference was found between these two interventions. This is the largest RCT so far comparing MYmind and CBT although there was loss of follow-up assessments during the pandemic. Further RCTs adopting a non-inferiority design are needed to validate the results.

The Effect of Social Isolation on Sarcopenia: A Longitudinal Study among the Middle-Aged and Older Population in China.

INTRODUCTION: Although social isolation is associated with premature death and somatic and mental diseases, evidence of its long-term effect on sarcopenia is scarce. This study aimed to examine the longitudinal association between social isolation and possible sarcopenia. METHODS: We extracted baseline and 4-year follow-up data from the China Health and Retirement Longitudinal Study and included participants aged 45 years or above. Social isolation was measured by factors including living alone, marital status, frequency of contact with adult children and friends, and participation in social activity. The change in social isolation from baseline to follow-up was classified into stable, progressive, and regressive groups. Possible sarcopenia was detected using the handgrip strength and five-time chair-stand test. Using mixed-effects logistic regression, we studied the effect of baseline isolation and the change in isolation status on possible sarcopenia at a 4-year follow-up. RESULTS: A total of 5,289 participants aged 45-90 years and without possible sarcopenia at baseline were included. After 4 years, possible sarcopenia was detected in 21.7% (1,146/5,289) of the participants. Compared with the low social isolation group, the middle (OR = 1.53, 95% confidence interval [CI] = 1.16-2.04, p = 0.003) and high social isolation groups (OR = 1.65, 95% CI = 1.26-2.18, p < 0.001) were associated with a higher risk of possible sarcopenia. Being not married/cohabiting (OR = 1.58, 95% CI = 1.19-2.10, p = 0.002), lack of contact with children (OR = 1.86, 95% CI = 1.21-2.85, p = 0.004), and lack of social activities (OR = 1.26, 95% CI = 1.04-1.53, p = 0.019) were associated with an increased risk of possible sarcopenia. Compared with the stable social isolation group, the progressive group was associated with a greater risk of possible sarcopenia (OR = 1.51, 95% CI = 1.17-1.95, p = 0.001). CONCLUSIONS: Social isolation is associated with an increased risk of possible sarcopenia. Progressive social isolation further elevates the risk. The most vulnerable groups are middle-aged and older people who live alone, are not socially active, and lack contact with their children.

Use, satisfaction, and preference of online health services among older adults with multimorbidity in Hong Kong primary care during COVID-19.

BACKGROUND: The use of online and mobile internet and social media has been increasing in healthcare service delivery. However, there is limited literature on the acceptance and use of online health services for older adults with multimorbidity who require more medical care and assistance. This study aims to explore the use of social media in older adults with multimorbidity in Hong Kong primary care and to assess the feasibility and usage of online health services in this population, including satisfaction, preference, and problems encountered. METHODS: This is a cross-sectional study among older adults with multimorbidity conducted between November 2020 and March 2021 in a Hong Kong primary care programme. Online and face-to-face services were offered based on the needs of the participants. Demographic characteristics and health conditions were assessed at baseline. Participants using online services were invited to complete a feedback questionnaire. RESULTS: The study included 752 participants, of which 66.1% use social media every day. Participants who declined to use online services were found to be significantly older, live alone, have lower income, have social security assistance, have greater cognitive decline, and be less depressed (p < 0.05). Non-responders to the online questionnaire had fewer years of education and greater cognitive decline (p < 0.05). The median satisfaction with the online services was 8 (interquartile range: 7, 9), and 14.6% of the participants preferred online more than face-to-face services. Lower education levels, fewer internet connection issues, and more self-efficacy on mobile apps were associated with a higher level of online satisfaction after adjustment (p < 0.05). Fewer internet connection issues and more self-efficacy on mobile apps were associated with participants' preference for online services (p < 0.05). CONCLUSIONS: More than half of Hong Kong older adults with multimorbidity in primary care use social media daily. Internet connection issues can be a significant barrier to the usage of online services in this population. Prior use and training can be beneficial to enhance use and satisfaction in older adults.

Handgrip strength but not SARC-F score predicts cognitive impairment in older adults with multimorbidity in primary care: a cohort study.

BACKGROUND: Assessing motor function is a simple way to track cognitive impairment. We analysed the associations between cognitive and motor function and assessed the predictive value of two motor function measuring tools for cognitive impairment in older adults with multimorbidity in primary care settings. METHODS: We conducted a prospective cohort study with a 1 year follow-up. Patients aged ≥60 years with ≥2 morbidities were recruited from four primary care clinics. Motor function was assessed using handgrip strength and a sarcopenia screening scale (SARC-F). Cognitive function was measured using the Hong Kong Montreal Cognitive Assessment (HK-MoCA). We defined cognitive impairment as an HK-MoCA score < 22. The associations between cognitive and motor functions were examined from a bidirectional perspective. RESULTS: We included 477 participants (mean age 69.4, 68.6% female) with a mean (SD) HK-MoCA score of 25.5 (3.38), SARC-F score of 1.1 (1.36), and handgrip strength of 21.2 (6.99) kg at baseline. Multivariable linear regression models showed bidirectional cross-sectional associations of the HK-MoCA score and cognitive impairment with SARC-F score and handgrip strength at baseline and 1 year. Cox regression revealed a longitudinal association between baseline handgrip strength and cognitive impairment at 1 year (hazard ratio: 0.48, 95% CI 0.33-0.69) but no longitudinal association between SARC-F and cognitive impairment. Variation in the SARC-F score increased with decreasing HK-MoCA score (Brown-Forsythe test F statistic = 17.9, p < 0.001), while variability in the handgrip strength remained small (modified signed-likelihood ratio test, p < 0.001). CONCLUSIONS: Primary healthcare providers may use handgrip strength to track cognitive function decline in older adults with multimorbidity. However, the SARC-F scale may not have the same predictive value. Further research is needed to evaluate the performance and variability of the SARC-F score in individuals with poor cognitive function.

Association of meaning in life with preventive healthcare use among Chinese adults: are there age and gender differences?

BACKGROUND: Meaning in life could be of clinical importance in stimulating healthy and preventive behaviors. The study aimed to investigate the association between meaning in life and preventive healthcare use among Chinese adults, and to assess their age and gender differences in the association. METHODS: A cross-sectional online survey was conducted among 1444 adults aged 18-64 years in February 2020 in China. Logistic regression models were employed to examine the association of meaning in life with preventive health checkups and assess their age and gender differences. RESULTS: The mean score of meaning in life was 5.801 (Standard Deviation = 1.349) out of 7. Each unit increase on the level of meaning in life was associated with 12.2% higher likelihood of using preventive health checkups (any type) (adjusted odds ratio 1.122, 95% confidence interval 1.015-1.241) after adjustment for sociodemographic factors, comorbidity and other psychological health factors. Meaning in life was significantly associated with the uses of X-ray (1.125, 1.010-1.253), B-ultrasound (1.176, 1.058-1.306), and blood testing (1.152, 1.042-1.274). The associations between meaning in life and these types of preventive healthcare increased with age, but there were no gender differences in these associations. CONCLUSION: Higher meaning in life was independently related to more preventive health checkups. Strategies to strengthen health education and interventions to improve experience of meaning in life might be an important component to increase preventive healthcare use in China.

Comparative effectiveness of non-pharmacological interventions for depressive symptoms in mild cognitive impairment: systematic review with network meta-analysis.

OBJECTIVES: Depressive symptoms are common among mild cognitive impairment (MCI) patients. It is unknown how different the effects on depressive symptoms are among various pharmacological MCI interventions. This systematic review aimed to evaluate the comparative effectiveness of non-pharmacological MCI interventions on depressive symptoms among MCI patients. METHODS: A systematic review and network meta-analysis was conducted on randomized controlled trials (RCT) comparing the effect of different non-pharmacological MCI interventions on changes in depressive symptoms among MCI patients. RCTs were identified from MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and PsycARTICLES. Results were summarized as standardized mean differences (SMD) and 95% confidence intervals (CI). The surface under the cumulative ranking (SUCRA) was used to rank the effect of different interventions. RESULTS: Twenty-two RCTs were included in the network meta-analysis. Compared with non-active control, cognition-based intervention (SMD=-0.25, 95% CI: -0.46, -0.04) and physical exercise (SMD=-0.33, 95% CI: -0.56, -0.10) had significant positive effects to reduce depressive symptoms. Health education, psychosocial intervention, and the combination of physical exercise and cognition-based intervention had non-significant overall effects. The SUCRA demonstrated that physical exercise had the highest SUCRA for the reduction in depression symptoms (0.815). In subgroup analysis, health education, cognition-based intervention, physical exercise, and the combination of physical exercise and cognition-based intervention showed significant longer-term effects (6-12 months). CONCLUSION: Physical exercise and cognition-based intervention were effective interventions for depressive symptoms in MCI patients. This study can provide additional evidence for healthcare providers to make decisions for selecting available and appropriate interventions for MCI patients.

[In vitro screening of natural compounds with antitumor activity by trypsin].

In order to investigate the feasibility of in vitro screening the antitumor activity of natural compounds by trypsin, porcine trypsin was used to for screening test, which is marked by inhibition of enzyme activity. Four compounds, namely daidzin, genistin, matrine and oxymatrine, were selected as test subjects. The natural antitumor drug camptothecin was used as the control. The inhibitory effect was detected by two experimental methods: direct detection of trypsin activity inhibition and hydrolysis of bovine serum albumin by trypsin. The results showed the inhibitory effects of the four natural compounds on trypsin, and the inhibition rates of the four natural compounds were significantly different. The enzyme activity assay showed that the inhibitory effect of matrine was better than that of oxymatrine, indicating that trypsin had a good screening resolution. The inhibitory effect was significantly increased with the increased ratio of sample to trypsin, suggesting the structure-activity correlation and dose-effect correlation of the screening methods. Altogether, the experimental method of screening antitumor activity of natural compounds by trypsin has good application values. Since porcine trypsin is similar to human trypsin in terms of molecular structure and performance, it is more applicable for screening of antitumor efficacy of natural pharmacodynamic compounds.

Mindfulness-based interventions: an overall review.

INTRODUCTION: This is an overall review on mindfulness-based interventions (MBIs). SOURCES OF DATA: We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations. AREAS OF AGREEMENT: MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions. AREAS OF CONTROVERSY: Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations. GROWING POINTS: Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed. AREAS TIMELY FOR DEVELOPING RESEARCH: More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.

The relationship between social support and suicidal ideation among newly diagnosed people living with HIV: the mediating role of HIV-related stress.

Evidence have consistently shown social support to be protective against suicidal ideation among people living with HIV (PLWH), but little is known how social support protects PLHW from suicidal ideation. We aimed to explore whether social support could reduce suicidal ideation by reducing HIV-related stress levels or depression among PLWH during the early post-diagnosis phase. A cross-sectional study of 557 newly diagnosed PLWH was conducted. Information on suicidal ideation, social support, HIV-related stress and depression was collected using a self-administered questionnaire. Generalized structural equation modeling (GSEM) analyses were performed to determine the mediating effect of HIV-related stress and depression on the relationship between social support and suicidal ideation. One-fourth of participants reported considering suicide after HIV diagnosis. Higher social support could prevent PLWH from suicidal ideation directly or indirectly via reducing the HIV-related stress levels. The mediating effect of depression, as well as the chain mediating effect of HIV-related stress and depression were not found. Enhancing social support and reducing HIV-related stress are important to prevent suicide among PLWH.

Recruitment and adherence of randomized controlled trials for mild cognitive impairment: A systematic review and meta-analysis.

OBJECTIVES: The recruitment and adherence status of randomized controlled trials (RCTs) for population with mild cognitive impairment (MCI) are little known. We aimed to explore the RCT recruitment and adherence status and factors associated with these among MCI patients. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and PsycARTICLES from inception to 8th July 2019. Included studies were RCTs conducted among MCI patients with available data of invitation rate, eligibility rate, randomization rate, recruitment rate, adherence rate, satisfaction rate, or potential barrier for recruitment and compliance. Two authors screened the studies and extracted the data independently. We calculated pooled proportions of each rate and their 95% confidence intervals (CIs) using random-effects meta-analysis. Meta-regression and subgroup analysis was conducted. RESULTS: Hundred and ten articles were judged to meet the study inclusion criteria from 10 387 articles. The invitation rates ranged from 9% to96% but were not pooled together due to high heterogeneity. The pooled overall eligibility, randomization, recruitment, intervention adherence, and follow-up adherence rates were 55% (95% CI: 48%-62%), 86% (95% CI: 81%-91%), 44% (95% CI: 37%-50%), 88% (95% CI: 86%-90%), and 85% (95% CI: 83%-87%), respectively. Non-MCI (47.5%), disease or medical problems (13.8%), and loss of interest (8.5%) were the most frequent reasons for screen failure. Refusal without reason (36.6%), adverse events (30.9%), and health issues (7.7%) were the most frequent reasons for drop-out. CONCLUSIONS: This study provided important information for future RCTs targeting at MCI patients. Strategies designed to improve participant recruitment and RCT adherence should be developed among this population.

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong.

BACKGROUND: The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. METHODS: This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. RESULTS: A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51-4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47-8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22-3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01-0.73). CONCLUSIONS: While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Blue-Light Therapy for Acne Vulgaris: A Systematic Review and Meta-Analysis.

PURPOSE: Antibiotic use in acne treatment raises concerns about increased resistance, necessitating alternatives. We assessed the effectiveness of blue-light therapy for acne. METHODS: We analyzed randomized controlled trials comparing blue light with nonlight interventions. Studies included people of any age, sex, and acne severity, in any setting, and reported on investigator-assessed change in acne severity, patients' assessment of improvement, change in inflammatory or noninflammatory lesions, and adverse events. Where data were sufficient, mean differences were calculated. RESULTS: Eighteen references (14 trials) including 698 participants were included. Most of the trials were small and short (<12 weeks) and had high risk of bias. Investigator-assessed improvement was quantitatively reported in 5 trials, of which 3 reported significantly greater improvement in blue light than comparator, and 2 reported improvement. Patients' assessments of improvement were quantitatively reported by 2 trials, favoring blue light. Mean difference in the mean number of noninflammatory lesions was nonsignificant between groups at weeks 4, 8, and 10-12 and overall (mean difference [MD] = 3.47; 95% CI, -0.76 to 7.71; P = 0.11). Mean difference in the mean number of inflammatory lesions was likewise nonsignificant between groups at any of the time points and overall (MD = 0.16; 95% CI, -0.99 to 1.31; P = 0.78). Adverse events were generally mild and favored blue light or did not significantly differ between groups. CONCLUSION: Methodological and reporting limitations of existing evidence limit conclusions about the effectiveness of blue light for acne. Clinicians and patients should therefore consider the balance between its benefits and adverse events, as well as costs.

Changes and determinants of health-related quality of life among people newly diagnosed with HIV in China: a 1-year follow-up study.

PURPOSE: This study aimed to investigate changes in health-related quality of life (HRQoL) among people newly diagnosed with HIV and to identify factors associated with HRQoL. METHODS: Newly diagnosed HIV-positive individuals were consecutively recruited and assessed at baseline and 1-year follow-up after diagnosis. HRQoL was measured through the physical health summary score (PHS) and mental health summary score (MHS) derived from the Medical Outcomes Study HIV Health Survey. Socio-demographic, clinical, and psychological information was also collected at both times. Generalized estimating equations were applied to explore factors associated with HRQoL in 1 year. RESULTS: A total of 410 participants were included. After 1 year, significant increases were observed for both the mean PHS score (53.5-55.0; p = 0.009) and the mean MHS score (44.2-49.0; p < 0.001). Older age (p = 0.024), rural household registration (p = 0.031), HIV-related symptoms (p < 0.001), and depression (p = 0.014) were negatively associated with PHS. Additionally, the negative association between stress and PHS increased over time (ß = - 0.07 for the baseline; ß = - 0.18 for the 12-month follow-up; p < 0.001). HIV-related symptoms, depression, lower social support, and higher levels of stress (all p < 0.001) were negatively associated with MHS. Additionally, the negative relationship between stress and MHS was stronger among participants who were asymptomatic (p = 0.015). CONCLUSION: A relatively lower HRQoL among HIV-infected people shortly after HIV diagnosis and an increase in HRQoL among people 1 year after HIV diagnosis were observed. Additional attention should be paid to individuals of older age, from rural areas, with HIV-related symptoms, with depression, with high levels of stress, and with a lack of social support.

Comparing the Effects of Mindfulness-Based Cognitive Therapy and Sleep Psycho-Education with Exercise on Chronic Insomnia: A Randomised Controlled Trial.

BACKGROUND: Mindfulness-based cognitive therapy (MBCT) is a potential treatment for chronic insomnia. We evaluated the efficacy of MBCT for insomnia (MBCT-I) by comparing it with a sleep psycho-education with exercise control (PEEC) group. METHODS: Adults with chronic primary insomnia (n = 216) were randomly allocated to the MBCT-I or PEEC group. The MBCT-I included mindfulness and psycho-education with cognitive and behavioural components under cognitive behavioural therapy for insomnia. PEEC included psycho-education of sleep hygiene and stimulus control, and exercises. Any change in insomnia severity was measured by the Insomnia Severity Index (ISI). Secondary outcomes included sleep parameters measured by a sleep diary, health service utilisation, absence from work and mindfulness measured by the Five Facet Mindfulness Questionnaire. RESULTS: The ISI score significantly decreased in the MBCT-I group compared with the PEEC group at 2 months (i.e., post-intervention) (p = 0.023, effect size [95% CI] -0.360 [-0.675, -0.046]) but not at 5 or 8 months. Treatment response rates and remission rates based on the ISI cut-off scores were not significantly different between groups. Wake time after sleep onset (WASO) was less in the MBCT-I group at 2 and 5 months. At 8 months, both groups showed a reduced ISI score, sleep onset latency and WASO, and increased sleep efficiency and total sleep time; however, no group differences were seen. Other outcome measures did not significantly improve in either group. CONCLUSIONS: Long-term benefits were not seen in MBCT-I when compared with PEEC, although short-term benefits were seen.

Systematic Review of Guidelines on Managing Patients with Harmful Use of Alcohol in Primary Healthcare Settings.

AIM: To appraise existing alcohol guidelines for identifying and managing harmful alcohol use in primary healthcare settings. METHODS: Seven databases and 18 health organization or medical society websites were systematically searched from inception to 31 October 2016. Guidelines in English language, developed by a national or international medical specialty society, government or health organization, and containing recommendations for identifying and managing harmful use of alcohol in primary healthcare settings, were included. The Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument was used to appraise the guidelines. RESULTS: Of the 970 literature identified, 17 were included for review, with 13 guidelines developed for use in Western countries and 4 for international use. The AGREE II scores ranged from 2.0 to 5.3, out of 7. Variations in terminology of harmful alcohol use were seen, with 'harmful drinking' and 'problem drinking' being mostly used. All guidelines were in favor of screening and brief interventions due to their effectiveness and cost-effectiveness. Potential benefits and costs of applying screening and brief interventions were found, but there was a lack of evidence for long-term effects or specific populations. CONCLUSIONS: All 17 guidelines recommended screening and brief interventions due to its associated health and financial benefits. Policy makers are highly encouraged to integrate these practices into primary healthcare settings taking the drinking status, culture and resources into account. SHORT SUMMARY: Screening and brief interventions were recommended by all 17 guidelines on managing patients with harmful use of alcohol in primary healthcare settings. Policy makers and healthcare practitioners are highly encouraged to implement these recommendations.

Happy@Work: protocol for a web-based randomized controlled trial to improve mental well-being among an Asian working population.

BACKGROUND: Mental health issues pose a serious concern in the workplace for the huge productivity loss and financial burden associated with it. Unlike the traditional 'fixing-what-is-wrong' approach, positive psychology offers a less-stigmatized way to promote mental health. Psychological capital, a concept originated from positive psychology, has been proven effective in improving mental well-being and work performance. However, little evidence exists for its implementation among Asian working population or its cost-benefit for organizations adopting such promotion strategy. The current study is designed to assess the protective effects of a web-based psychology capital intervention among Hong Kong working population on individuals' mental health and work performance, as well as organizations' return-on-investment. METHODS/DESIGN: A two-arm randomized controlled trial design will be adopted. Eligible working adults will be randomly allocated to either the intervention group or the waiting-list control group, with 177 participants in each arm. The intervention, which consists of four web-based training sessions, each targeting one of the psychological capital components (hope, efficacy, optimism and resilience), will be implemented over a 4-week period. On-line surveys will assess the participants in each group at baseline, intervention completion, 1 and 3 months after the completion. The primary outcome is individuals' psychological capital level; secondary outcomes include individuals' well-being, depressive symptoms, work engagement and productivity. Return-on-investment will be calculated from the employers' perspective based on productivity gain, savings in medical expenditure, as well as operation and time costs. Analysis will follow the intention-to-treat principle. DISCUSSION: This is the first experimental study that explores the applicability of psychological capital development among Asian population. Through investigating changes in individuals' work productivity from absenteeism and presenteeism, this will be one of the few studies that quantify productivity gains from any type of mental health promotion. By demonstrating effectiveness in improving mental well-being and a positive return-on-investment rate, the study may help convince more uptake of similar positive psychology interventions at workplace in Asia and elsewhere. TRAIL REGISTRATION: Number (assigned by Centre for Clinical Trials, Clinical Trials Registry, The Chinese University of Hong Kong): CUHK_CCT00396. Registration Date: 2014/02/13.

Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis.

BACKGROUND: Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. OBJECTIVE: This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. METHODS: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. RESULTS: A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children's immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that "health service support" demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by "health education and discussion" (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), "follow-up and reminder" (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and "social marketing campaigns and community mobilization" (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001). CONCLUSIONS: The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a "fit-for-purpose" approach rather than a "one-size-fits-all" approach to maximize the effectiveness of vaccine promotion. TRIAL REGISTRATION: PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081.

Influence of Nurses' Perceptions of Government Policies and COVID-19 Risks on Their Mental Health Status: A Web-Based Cross-Sectional Study.

This study aimed to understand nurses' perceptions of COVID-19-related policies and risks during the outbreak of COVID-19 in Hong Kong and to determine how their perceptions influenced their mental health status. A web-based online survey among Hong Kong nurses was conducted. The questionnaire included a self-designed 5-point Likert scale with 17 items to assess the nurses' perceptions of COVID-19-related policies and risks, as well as the Davidson Trauma Scale (DTS), the Perceived Stress Scale (PSS), the Patient Health Questionnaire-2 (PHQ-2) and the Generalised Anxiety Disorder scale (GAD) for measurement of posttraumatic stress disorder (PTSD), stress, depression and anxiety, respectively. Of 592 nurses enrolled, 30.6% had PTSD (DTS total score ≥40), and 80.4%, 19.9% and 16.4% had moderate-to-high levels of stress (PSS-10 score ≥14), depression (PHQ-2 score ≥3) and anxiety (GAD score ≥3), respectively. The top three concerned aspects were 'worried about themselves and friends to suffer this disease' (84.5%), 'insufficient number of isolation wards' (81.8%) and 'insufficient number of personal protective equipment' (74.3%). Logistic regression analyses showed that more negative perception on 'personal protective equipment in the healthcare institutions', 'the confidence in HK's control of COVID-19', 'worried about themselves and friends to suffer this disease' and 'self-perceived risk of infection' indicated higher severity of the four mental health problems (all p < 0.01). The perception on 'public gathering ban', 'the number of isolation wards' and 'expected time to control COVID-19' were significantly associated with PTSD and stress (all p < 0.05). Nurses' perception on government policies and COVID-19 risks played an important role in predicting their mental health status. Policy makers should be aware of nurses' psychological responses and provide timely and targeted emotional support to nurses amid and after the COVID-19 pandemic.