Hypomanic symptoms in early pregnancy: prevalence and associated factors.

Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.

Course, risk factors, and adverse outcomes of disordered eating in pregnancy.

OBJECTIVE: Although eating disorders in pregnancy have been studied extensively, little research attention has been given to disordered eating. The objectives of the present study were to determine the prevalence and levels of disordered eating in the perinatal period, and to identify risk factors and adverse outcomes of disordered eating during pregnancy. METHOD: A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,470 Chinese pregnant women from hospitals in Hong Kong was assessed using standardized instruments at five time points from the first trimester to 6 months postpartum. RESULTS: The levels of disordered eating changed significantly across trimesters. Higher levels of disordered eating in pregnancy were significantly associated with higher levels of disordered eating at 6 weeks and 6 months postpartum, greater anxiety and depressive symptoms, lower 1-min Apgar scores, and abnormal birth weight. DISCUSSION: The present study pointed to the need for more research and clinical attention to antenatal disordered eating given that it is associated with anxiety, depression, postpartum disordered eating and obstetric outcomes.

A Study of Violence Among Hong Kong Young Adults and Associated Substance Use, Risky Sexual Behaviors, and Pregnancy.

This study aimed to estimate the self-reported prevalence of violence perpetration and victimization among Hong Kong youths and the associated health risk behaviors using a representative sample of 1,126 young adults aged 18-27 years. Perpetrating physical and emotional violence was common in Hong Kong, with prevalences ranging from 20.8% to 38.3% in males and from 6.4% to 21.3% in females. Victimization of physical and emotional violence was also common for both sexes, with prevalences ranging from 16.4% to 36.3% in males and from 6.6% to 19.2% in females. Perpetration of sexual harassment and sexual violence was less prevalent, whereas victimization of sexual harassment and sexual violence ranged from 0.6% to 3.6% in males and from 2.3% to 13.2% in females. Both violence perpetration and victimization among youths were significantly associated with substance use, risky sexual behaviors, and pregnancy. The implications of this study for violence prevention programs are discussed.

Latent Heterogeneity of Online Sexual Experiences and Associations With Sexual Risk Behaviors and Behavioral Health Outcomes in Chinese Young Adults: Cross-Sectional Study.

BACKGROUND: Online sexual experiences (OSEs) are becoming increasingly common in young adults, but existing papers have reported only on specific types of OSEs and have not shown the heterogeneous nature of the repertoire of OSEs. The use patterns of OSEs remain unclear, and the relationships of OSEs with sexual risk behaviors and behavioral health outcomes have not been evaluated. OBJECTIVE: This study aimed to examine the latent heterogeneity of OSEs in young adults and the associations with sexual risk behaviors and behavioral health outcomes. METHODS: The 2021 Youth Sexuality Study of the Hong Kong Family Planning Association phone interviewed a random sample of 1205 young adults in Hong Kong in 2022 (male sex: 613/1205, 50.9%; mean age 23.0 years, SD 2.86 years) on lifetime OSEs, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4) scores, sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections [STIs], drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSEs was analyzed via latent class analysis with substantive checking of the class profiles. Structural equation modeling was used to examine the direct and indirect associations between the OSE class and behavioral health outcomes via sexual risk behaviors and PHQ-4 scores. RESULTS: The data supported 3 latent classes of OSEs with measurement invariance by sex. In this study, 33.1% (398/1205), 56.0% (675/1205), and 10.9% (132/1205) of the sample were in the abstinent class (minimal OSEs), normative class (occasional OSEs), and active class (substantive OSEs), respectively. Male participants showed a lower prevalence of the abstinent class (131/613, 21.4% versus 263/592, 44.4%) and a higher prevalence of the active class (104/613, 17.0% versus 28/592, 4.7%) than female participants. The normative class showed significantly higher sex knowledge than the other 2 classes. The active class was associated with male sex, nonheterosexual status, higher sex desire and PHQ-4 scores, and more sexual risk behaviors than the other 2 classes. Compared with the nonactive (abstinent and normative) classes, the active class was indirectly associated with higher rates of STIs (absolute difference in percentage points [Δ]=4.8%; P=.03) and drug use (Δ=7.6%; P=.001) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ=2.5%; P=.007) via PHQ-4 scores. CONCLUSIONS: This study provided the first results on the 3 (abstinent, normative, and active) latent classes of OSEs with distinct profiles in OSEs, demographic and family characteristics, PHQ-4 scores, sex-related factors, and behavioral health outcomes. The active class showed indirect associations with higher rates of STIs and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 scores than the other 2 classes. These results have implications for the formulation and evaluation of targeted interventions to help young adults.

Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong.

BACKGROUND: Little is known about sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. It is of public health importance to investigate this topic to inform sex education, policymaking, and prevention and intervention programs. METHODS: Based on the Youth Sexuality Survey conducted by Hong Kong Family Planning Association (FPAHK) in 2011, this study explored the characteristics of sexual knowledge, attitudes, and high-risk sexual behaviors among 1,126 unmarried youth aged 18 to 27 years. Multiple logistic regressions were performed to examine factors associated with unmarried youth's premarital sex, casual relationships, multiple sex partners, and premarital pregnancy. RESULTS: Unmarried youth in Hong Kong had adequate sex knowledge, but contraceptive knowledge was deficient. The majority of unmarried youth (63.8%) held liberal attitudes toward premarital sex and about half held liberal attitudes toward any form of sexual activity and premarital pregnancy. Around 60% held conservative attitudes toward causal sex relationships and multiple sex partners. Males tended to hold more liberal attitudes toward high-risk sex behaviors than female youth. Approximately 41.5% of unmarried youth reported having engaged in premarital sex, whereas less than 10% engaged in high-risk sexual behaviors. Males also reported higher amounts of premarital sex, casual sex relationships, and multiple sex partners. Females reported higher levels of sexual coercion. Logistic regressions indicated that being older, coming from a divorced family, out of school status and liberal attitudes toward risky sex behavior were more likely to engage in premarital sex or high-risk sex behaviors, and being female, being better educated and being immigrants were less likely to engage in premarital sex. However, being immigrants was more likely to engage in casual relationship and to have multiple partners. CONCLUSIONS: Premarital sex is becoming more prevalent among unmarried youth in Hong Kong, and a small proportion of young adults are engaging in high-risk sexual behaviors. Sex education and HIV prevention programs should equip them with adequate knowledge on contraception and condom use. Intervention programs can start with their attitudes toward sex.

Study protocol for "Moving Bright, Eating Smart"- A phase 2 clinical trial on the acceptability and feasibility of a diet and physical activity intervention to prevent recurrence in colorectal cancer survivors.

BACKGROUND: Colorectal cancer is the second most common cancer and cancer-killer in Hong Kong with an alarming increasing incidence in recent years. The latest World Cancer Research Fund report concluded that foods low in fibre, and high in red and processed meat cause colorectal cancer whereas physical activity protects against colon cancer. Yet, the influence of these lifestyle factors on cancer outcome is largely unknown even though cancer survivors are eager for lifestyle modifications. Observational studies suggested that low intake of a Western-pattern diet and high physical activity level reduced colorectal cancer mortality. The Theory of Planned Behaviour and the Health Action Process Approach have guided the design of intervention models targeting a wide range of health-related behaviours. METHODS/DESIGN: We aim to demonstrate the feasibility of two behavioural interventions intended to improve colorectal cancer outcome and which are designed to increase physical activity level and reduce consumption of a Western-pattern diet. This three year study will be a multicentre, randomised controlled trial in a 2x2 factorial design comparing the "Moving Bright, Eating Smart" (physical activity and diet) programme against usual care. Subjects will be recruited over a 12-month period, undertake intervention for 12 months and followed up for a further 12 months. Baseline, interim and three post-intervention assessments will be conducted.Two hundred and twenty-two colorectal cancer patients who completed curative treatment without evidence of recurrence will be recruited into the study. Primary outcome measure will be whether physical activity and dietary targets are met at the end of the 12-month intervention. Secondary outcome measures include the magnitude and mechanism of behavioural change, the degree and determinants of compliance, and the additional health benefits and side effects of the intervention. DISCUSSION: The results of this study will establish the feasibility of targeting the two behaviours (diet and physical activity) and demonstrate the magnitude of behaviour change. The information will facilitate the design of a further larger phase III randomised controlled trial with colorectal cancer outcome as the study endpoint to determine whether this intervention model would reduce colorectal cancer recurrence and mortality. TRIAL REGISTRATION: ClinicalTrials.gov No: NCT01708824.

Non-suicidal self-injury and suicidal behavior: prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong.

BACKGROUND: Despite increasing concern over the prevalence of non-suicidal self-injury (NSSI) among adolescents, there is debate about its classification as a stand-alone psychiatric diagnosis. This study investigated the patterns, co-occurrence, and correlates of NSSI and other suicidal behaviors among a representative community sample of in-school adolescents. METHODS: A cross-sectional survey of 2,317 adolescents was conducted. Participants were asked to self-report NSSI, suicidal ideation, suicide attempt, and psychosocial conditions over the past 12 months. Logistic regression and cumulative logit modeling analyses were conducted to investigate the different and similar correlates among these self-harm behaviors. RESULTS: The age-standardized prevalence rates of NSSI among male and female adolescents were estimated to be 13.4 and 19.7 %, respectively, compared with 11.1 and 10.1 % for male and female suicide attempt. Only a small proportion engaged in NSSI exclusively in the past year. NSSI by burning or reckless and risky behaviors, frequent drinking, and sexual experience were associated with increasing severity level of suicidal behaviors among individuals with NSSI. CONCLUSIONS: NSSI is prevalent among in-school adolescents in Hong Kong. However, it co-occurs with suicidal ideation and suicide attempt. High lethality of NSSI, frequent drinking habit, and lifetime sexual experience are suggested to be indicators for screening potential suicide attempters among those having NSSI.

Culturally sensitive, preventive antenatal group cognitive-behavioural therapy for Chinese women with depression.

Postnatal depression (PND) affects 10-15% of postnatal women worldwide, yet it is poorly recognized and managed. Among the psychological interventions, which are used to manage PND, cognitive-behavioural therapy was found to be effective and promising. In the past decade, research efforts have focused on developing effective antenatal interventions to prevent PND. Strong antenatal predictors such as antenatal depressive symptoms have been identified for targeted early intervention or prevention to help reduce the risk of developing depression after childbirth. However, the findings regarding effectiveness of antenatal preventive interventions have been inconsistent. Based on the reports of previous studies, a brief group antenatal intervention using cognitive-behavioural approach is necessary, particularly one with sensitivity for Chinese woman. This paper reports the details of a nurse-led cognitive-behavioural programme developed and tested in, and for use with a sample of Hong Kong pregnant women. The trial run showed that the programme was feasible to be implemented and well received by the participants.

Case report: Therapeutic potential of Flourishing-Life-Of-Wish Virtual Reality Therapy on Relaxation (FLOW-VRT-Relaxation)-a novel personalized relaxation in palliative care.

In view of the global aging population and growing need of palliative care, innovative intervention for effective symptom management is of urgent need. Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT) is a brief, structured, manualized, and personalized psychological intervention with theoretical foundations based on stress coping theory, self-determination theory, flow theory, and attention restoration theory. With a specific focus on relaxation, FLOW-VRT-Relaxation intends to facilitate adaptive end-of-life coping through delivering personalized relaxation. This paper reports a case study of the application of FLOW-VRT-Relaxation, and discusses its therapeutic potential as a cost-effective method for reducing palliative symptoms by addressing patient's unmet needs. The case study is a 51-year-old Chinese female, diagnosed with advanced cervix cancer, and presented with unmet psychological (i.e., unfulfilled wishes) and physical needs (i.e., pain and fatigue) before FLOW-VRT-Relaxation. To address her unmet needs, FLOW-VRT-Relaxation was delivered by a registered clinical psychologist specialized in palliative care. Need assessment was first conducted, followed by a 10-min VR travel of Japan as her own choice. Relaxation was verbally coached during VR. Right after VR, consolidation with psychological components including psychoeducation, cognitive and emotional processing, and reminiscence intervention were delivered. The patient showed improvement in physical and psychological symptoms, lower sense of loneliness and engulfment, as well as enhanced peace after FLOW-VRT-Relaxation. The current findings provide encouraging initial support for the feasibility, acceptability, and therapeutic potential of using FLOW-VRT-Relaxation as a cost-effective, scalable and personalized VR relaxation for patients under palliative care. It is hoped that with its optimal use, FLOW-VRT-Relaxation can serve as an alternative therapeutic tool that effectively improves the end-on-life care.

Who wants a slimmer body? The relationship between body weight status, education level and body shape dissatisfaction among young adults in Hong Kong.

BACKGROUND: Body shape dissatisfaction has been thought to have an indispensable impact on weight control behaviors. We investigated the prevalence of body shape dissatisfaction (BSD) and explored its association with weight status, education level and other determinants among young adults in Hong Kong. METHODS: Information on anthropometry, BSD, and socio-demographics was collected from a random sample of 1205 young adults (611 men and 594 women) aged 18-27 in a community-based household survey. BSD was defined as a discrepancy between current and ideal body shape based on a figure rating scale. Cross-tabulations, homogeneity tests and logistic regression models were applied. RESULTS: The percentages of underweight men and women were 16.5% and 34.9% respectively, and the corresponding percentages of being overweight or obese were 26.7% and 13.2% for men and women respectively. Three-quarters of young adults had BSD. Among women, 30.9% of those underweight and 75.5% of those with normal weight desired a slimmer body shape. Overweight men and underweight women with lower education level were more likely to have a mismatch between weight status and BSD than those with higher education level. After controlling for other determinants, underweight women were found to have a higher likelihood to maintain their current body shapes than other women. Men were found to be less likely to have a mismatch between weight status and BSD than women. CONCLUSIONS: Overweight and obesity in men and underweight in women were prevalent among Hong Kong young adults. Inappropriate body shape desire might predispose individuals to unhealthy weight loss or gain behaviors. Careful consideration of actual weight status in body shape desire is needed in health promotion and education, especially for underweight and normal weight women and those with a low education level.

Lived experience of dietary change among Chinese colorectal cancer survivors in Hong Kong: A qualitative study.

OBJECTIVES: This is a qualitative study which aims to understand the lived experience of dietary changes among Chinese survivors of colorectal cancer who participated in a dietary intervention. SETTING: The surgical and oncological departments of four public hospitals in Hong Kong. PARTICIPANTS: Fifty-five Chinese colorectal cancer survivors who were aged 18 years or above and had received potentially curative treatment in the surgical and oncological departments in Hong Kong were examined. Participants' mean age was 64 years, with 29 (53%) males. INTERVENTION: A 12-month dietary intervention delivered via face-to-face motivational interviews, fortnightly motivational phone calls, monthly electronic pamphlets, quarterly newsletters and quarterly group meeting. OUTCOME MEASURE: We adopted the qualitative approach to capture participants' perspectives and to apply the understanding pragmatically in everyday life. Content analysis was conducted. RESULTS: We identified themes of motives to changes of dietary practices including (1) individual commitment to dietary change; (2) adaptive strategies in interpersonal contexts and (3) working with healthcare professionals during the journey. CONCLUSIONS: The findings demonstrated how Chinese custom and culture posing unique challenges to colorectal cancer survivors and the need of having dietary advice from healthcare professionals. Participants were motivated to change their eating habits by support from family, friends and healthcare professionals. Our findings could help healthcare professionals provide specific dietary advice and guidance to Chinese colorectal cancer survivors. TRIAL REGISTRATION NUMBER: NCT01708824.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) is widely used in adult populations; however, its usefulness with adolescents has been explored less. This study sought to evaluate the reliability, validity, and factor structure of the Chinese version of HADS in a community sample of adolescents residing in Hong Kong. METHODS: A prospective cohort of 5,857 students recruited from 17 secondary schools completed the HADS. Internal consistency and concurrent validity were examined. Confirmatory factor analysis was applied to test the relative fits of six factor structures of the HADS. The best fitting model was further cross-validated by male, female, split-half samples, and age subgroups. RESULTS: The HADS possessed adequate internal consistency, especially for the anxiety subscale. Significant concurrent intercorrelations with self-reported suicidal thoughts and the Youth Self Report Anxious/Depressed subscale were discovered and found to be stronger for females. The cross-validation supported a two-factor model, where anxiety item 7, "I can sit at ease and feel relaxed", was placed in the depression subscale. CONCLUSIONS: The HADS showed satisfactory psychometric properties as a screening instrument in assessing anxious and depressive states as two correlated but distinct factors in adolescents. Study implications and recommendations for future research were discussed.

Validation of the Chinese version of the Pregnancy-related Anxiety Questionnaire-Revised (PRAQ-R) and its distinction from general anxiety and depression in pregnant women.

Objective: This study aims to evaluate the reliability and validity of the translated Chinese-Cantonese version of the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) in a sample of pregnant women in Hong Kong, China. It also aims to determine whether pregnancy-related anxiety changes significantly across trimesters and if it is differentiated from general anxiety and depression.Method: This study adopts a prospective longitudinal design with a quantitative approach. A consecutive sample of 186 Chinese pregnant women from hospitals in Hong Kong are assessed using the translated Chinese-Cantonese version of the PRAQ-R and other standardized instruments at three time points during the first to third trimester.Results: A confirmatory factor analysis revealed a three-factor structure of the Chinese-Cantonese version of the PRAQ-R, including fear of giving birth, fear of bearing a physically or mentally handicapped child, and concern about one's appearance. The internal consistency was excellent (α = 0.88 to 0.91) for all of the items in the PRAQ-R across the three trimesters. The average variance extract (AVE) and composite reliability (CR) for each factor were greater than the recommended level of CR > 0.70 and AVE > 0.50. Multiple regression analyses showed that a combination of general anxiety and depression explained a small proportion of the variance (10-29%) in the PRAQ-R subscales during the three trimesters.Conclusions: The Chinese-Cantonese version of the PRAQ-R has good validity and reliability, and the results provide evidence of its relevance for Chinese pregnant women with pregnancy-related anxiety in Hong Kong. The finding also shows that pregnancy-related anxiety is a relatively distinctive form of anxiety that is different from general anxiety and depression.

Associations of body dissatisfaction with anxiety and depression in the pregnancy and postpartum periods: A longitudinal study.

BACKGROUND: Pregnancy is a time of increasing vulnerability to the development of body dissatisfaction, anxiety, and depression. The present study aims to examine associations of body dissatisfaction with anxiety and depression at the following points: 6 months before pregnancy (retrospective report); in the first, second, and third trimesters of pregnancy; and up to 6 weeks postpartum. METHODS: A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,371 Chinese pregnant women in Hong Kong was assessed using standardized instruments at four time points. RESULTS: A mixed-effects model with repeated measures revealed that body dissatisfaction and depression symptoms changed across different stages of pregnancy. Hierarchical multiple regressions showed that, after adjusting for the identified risk factors, body dissatisfaction before and during pregnancy were positively associated with antenatal anxiety and depression symptoms. Concurrent body dissatisfaction was positively associated with postpartum depression symptoms. LIMITATIONS: There was a high attrition rate in the follow-up assessments. Antenatal anxiety symptoms were assessed using the scale for general anxiety, which may not adequately capture the experience of anxiety among pregnant women. CONCLUSIONS: Primary healthcare practitioners should be made aware of body dissatisfaction among pregnant women in order to facilitate early intervention for anxiety and depression, because untreated psychological disturbance during pregnancy may persist into the postpartum period.

Effects of dietary and physical activity interventions on generic and cancer-specific health-related quality of life, anxiety, and depression in colorectal cancer survivors: a randomized controlled trial.

PURPOSE: To assess the effects of dietary and physical activity (PA) interventions on generic and cancer-specific quality of life (QoL), anxiety, and depression levels among adult Chinese colorectal cancer (CRC) survivors. METHODS: Two-hundred twenty-three adult CRC survivors within 1 year of completion of primary cancer treatment were randomized to receive dietary, PA or combined intervention, or usual care for a 12 monthduration, under a 2 (diet vs usual care) × 2 (PA vs usual care) factorial design. Generic and cancer-specific QoL was assessed using a Chinese version 12-Item Short Form Health Survey (SF-12) and the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, respectively. Anxiety and depression was assessed using the Hospital Anxiety and Depression Scale at baseline, 6, 12, 18, and 24 months. Linear mixed models were used for examining the intervention effects. RESULTS: Participants receiving dietary intervention experienced a significant improvement in the generic measure of QoL (SF-6D utility scores, mean difference 0.042, 95%CI 0.03 to 0.081) at 12 months, the cancer-specific QoL scores (mean difference 3.09, 95%CI 0.13 to 6.04), and levels of depression (P = 0.015) at both 12 and 24 months follow-up. Participants receiving PA intervention only demonstrated a significant improvement in SF-6D utility index (mean difference 0.039, 95%CI 0.002 to 0.077) and physical functioning (mean difference 2.85, 95%CI 1.00 to 4.70) at 6 months. CONCLUSIONS: Dietary intervention improved the generic and cancer-specific QoL and depression in CRC survivors. TRIAL REGISTRATION: The study was prospectively registered on 17 October 2012 at ClinicalTrials.gov (NCT01708824). IMPLICATIONS FOR CANCER SURVIVORS: CRC survivors can benefit from dietary interventions in alleviating depression and improving overall health-related QoL.

A short version of the ADAM Questionnaire for androgen deficiency in Chinese men.

BACKGROUND: A 10-question screening questionnaire for androgen deficiency in aging men (ADAM) was reported in previous white but not Chinese populations. We therefore investigated the validity of a Chinese version of the Saint Louis University ADAM questionnaire to screen for androgen deficiency in Chinese men. METHODS: This was a cross-sectional study. Seven hundred ninety-six ambulatory community-based Chinese men, 18-89 years old, were recruited from October 2003 through June 2006. Self-administered Chinese ADAM questionnaire and morning blood samples for serum total testosterone (TT) and bioavailable testosterone (BT) levels were collected from all participants. Low serum BT levels (androgen deficiency) were defined as <5th percentile of serum BT levels in young healthy Chinese men (18-29 years). RESULTS: The Chinese ADAM questionnaire had good internal consistency (Cronbach alpha = 0.74) and test-retest reliability (Pearson correlation coefficient, r = 0.86; p <.001, two-tailed). As a screening test for low serum BT levels, the Chinese ADAM questionnaire has a high sensitivity of 88% but low specificity of 32%. In 6 of the 10 questions, the mean serum BT levels were significantly lower in those who answered positively than in those who answered negatively. Using a cut-off score of > or =2, a six-question short Chinese ADAM questionnaire demonstrated sensitivity, specificity, and positive and negative predictive values of 86%, 40%, 46%, and 82%, respectively. CONCLUSION: We have validated a full Chinese version and developed a shortened version of the ADAM questionnaire, and demonstrated that they are sensitive but not specific screening tests for androgen deficiency in Chinese men.

Associations of paternal postpartum depressive symptoms and infant development in a Chinese longitudinal study.

Although fathers actively provide infant care and support to their partners in modern societies, data on fathers' difficulties and mental health problems is still limited. This study examined paternal postpartum depression and its adverse impact on infants, and the possible mediating role of father-infant attachment in the link between fathers' depressive symptoms and infants' outcomes. Pregnant women and their partners were recruited from the antenatal clinics of two public hospitals in Hong Kong. Information about paternal and maternal depression, paternal-infant attachment, and infant development were collected at antenatal period, 6 weeks and 6 months postpartum. Linear regression was employed to examine risk factors for paternal depression symptoms, and mediation analysis was conducted to examine the mediating mechanisms. 121 couples joined the longitudinal study and completed all the assessments. Paternal postpartum depression symptoms were associated with fathers' prenatal depression symptoms, and mothers' postpartum depression symptoms. Fathers with postpartum depression symptoms experienced reduced paternal-infant attachment, which also acted as mediators between postpartum depression in fathers and adverse infants' social development. Effective assessment and interventions targeted at preventing or identifying and reducing paternal postpartum depression and improving father-infant relationship would help to lower the risk of infant disorders and poor development. Strategies improving the fathers' mental health during antenatal period and their partner's psychosocial well-being may also reduce paternal postpartum depression.

Dietary and Physical Activity Interventions for Colorectal Cancer Survivors: A Randomized Controlled Trial.

There has been evidence on the protective effects of diets high in fiber and low in red and processed meat (RPM), and physical activity (PA) against colorectal cancer (CRC) development, but that against CRC recurrence has been limited. This study evaluated the efficacy of a behavioral program comprising dietary and PA interventions in improving Chinese CRC survivors' lifestyle. A 2 × 2 factorial randomized controlled trial of 223 CRC patients (82 females, mean age 65), randomly assigned to receive dietary, PA or both interventions, or usual care for 12 months, and assessed every 6 months for 24 months. Primary outcomes included two dietary and two PA targets. Secondary outcomes included changes in dietary consumptions and PA levels. Dietary interventions significantly increased the odds of achieving the targets of consuming less RPM at all time-points (OR 3.22-4.57, all p < 0.01) and refined grain (RG) at months 6 (OR 3.13, p = 0.002) and 24 (OR 2.19, p = 0.039), and reduced RPM (2.49-3.48 servings/week, all p < 0.01) and RG (0.31-0.5 servings/day, all p < 0.01) consumptions. Patients receiving PA interventions potentially spent more time on moderate-to-vigorous PA. This study demonstrated the efficacy of a behavioral program in improving dietary habits of Chinese CRC survivors.

Prevalence, course, and risk factors for antenatal anxiety and depression.

OBJECTIVE: To estimate the prevalence and course of antenatal anxiety and depression across different stages of pregnancy, risk factors at each stage, and the relationship between antenatal anxiety and depression and postpartum depression. METHODS: A consecutive sample of 357 pregnant women in an antenatal clinic in a regional hospital was assessed longitudinally at four stages of pregnancy: first trimester, second trimester, third trimester, and 6 weeks postpartum. The antenatal questionnaire assessed anxiety and depression (using the Hospital Anxiety and Depression Scale) and demographic and psychosocial risk factors. The postpartum questionnaire assessed postpartum depression with the Edinburgh Postnatal Depression Scale. RESULTS: More than one half (54%) and more than one third (37.1%) of the women had antenatal anxiety and depressive symptoms, respectively, in at least one antenatal assessment. Anxiety was more prevalent than depression at all stages. A mixed-effects model showed that both conditions had a nonlinear changing course (P<.05 for both), with both being more prevalent and severe in the first and third trimesters. Risk factors were slightly different at different stages. Both antenatal anxiety (adjusted odds ratio [OR] 2.66, P=.004 in the first trimester; adjusted OR 3.65, P<.001 in the second trimester; adjusted OR 3.84, P<.001 in the third trimester) and depression (adjusted OR 4.16, P<.001 in the first trimester; adjusted OR 3.35, P=.001 in the second trimester; adjusted OR 2.67, P=.009 in the third trimester) increased the risk of postpartum depression. CONCLUSION: Antenatal anxiety and depression are prevalent and serious problems with changing courses. Continuous assessment over the course of pregnancy is warranted. Identifying and treating these problems is important in preventing postpartum depression. LEVEL OF EVIDENCE: II.

Validity of the Cantonese Chinese Montreal Cognitive Assessment in Southern Chinese.

AIM: The objective of the present study was to investigate the reliability and the validity of the Cantonese Chinese Montreal Cognitive Assessment (MoCA) as a brief screening tool of amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) in Southern Chinese older adults. METHODS: Cognitively normal, aMCI and AD Cantonese-speaking Chinese older adults were recruited from a memory clinic and the community. The English MoCA was translated into Cantonese Chinese and then back-translated. We then evaluated the content validity, reliability, sensitivity and specificity of the Chinese Cantonese MoCA. RESULTS: We recruited 115 cognitively normal controls, 87 aMCI and 64 AD patients. Only education was positively correlated with the Cantonese MoCA score (r = 0.46, P < 0.001). The Chinese Cantonese MoCA had a high internal consistency with a Cronbach's alpha of 0.85. In the test-retest reliability assessment, the intraclass correlation coefficient (ICC) was 0.95 (P < 0.001). The ICC for the interrater reliability was 0.96 (P < 0.001). Receiving operating characteristic curve analyses showed an area under the curve of 0.85 and 0.99 for aMCI and AD, respectively (both P < 0.001). The optimal cut-off score for detection of aMCI was 22/23, which yielded a sensitivity and specificity of 78% and 73%, respectively. The optimal cut-off score for detection of AD was 19/20, which gave sensitivity and specificity of 94% and 92%, respectively. CONCLUSION: The Cantonese Chinese MoCA is a consistent and reliable instrument. In terms of its validity, the MoCA is better in the detection of AD than aMCI in Cantonese-speaking Chinese persons. It is only fair for the screening of aMCI.