Return to work, work productivity loss and activity impairment in Chinese breast cancer survivors 12-month post-surgery: a longitudinal study.

Introduction: Existing evidence of returning-to-work (RTW) after cancer comes predominately from Western settings, with none prospectively examined since the initial diagnostic phase. This study prospectively documents RTW-rate, time-to-RTW, work productivity loss, and activity impairment, within the first-year post-surgery among Chinese women with breast cancer (BCW) and identify potential causal co-variants. Methods: This observational longitudinal study followed 371 Chinese BCW who were employed/self-employed at the time of diagnosis at 4-week post-surgery (baseline). RTW-status and time-to-RTW were assessed at baseline (T1), 4-month (T2), 6-month (T3), and 12-month (T4) post-baseline. WPAI work productivity loss and activity impairment were assessed at T4. Baseline covariates included demographics, medical-related factors, work satisfaction, perceived work demand, work condition, RTW self-efficacy, B-IPQ illness perception, COST financial well-being, EORTC QLQ-C30 and QLQ-BR23 physical and psychosocial functioning, and HADS psychological distress. Results: A 68.2% RTW-rate (at 12-month post-surgery), prolonged delay in RTW (median = 183 days), and significant proportions of T4 work productivity loss (20%), and activity impairment (26%), were seen. BCW who were blue-collar workers with lower household income, poorer financial well-being, lower RTW self-efficacy, poorer job satisfaction, poorer illness perception, greater physical symptom distress, impaired physical functioning, and unfavorable work conditions were more likely to experience undesired work-related outcomes. Discussion: Using a multifactorial approach, effective RTW interventions should focus on not only symptom management, but also to address psychosocial and work-environmental concerns. An organizational or policy level intervention involving a multidisciplinary team comprising nurses, psychologists, occupational health professionals, and relevant stakeholders in the workplace might be helpful in developing a tailored organizational policy promoting work-related outcomes in BCW.

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.

Post-Hospital Falls Among the Older Population: The Temporal Pattern in Risk and Healthcare Burden.

OBJECTIVES: Older adults are prone to falls following hospital discharge, resulting in healthcare utilization and costs. The fall risk might change over time after discharge. To fill research gaps in this area, this study examined the temporal pattern in incidence and healthcare burden of post-hospital falls in older adults. DESIGN: A territory-wide retrospective cohort study was conducted. SETTING AND PARTICIPANTS: Participants were Hong Kong adults aged ≥65 years and discharged from hospitals between January 2007 and December 2017. METHODS: The participants were followed for 12 months to identify fall-related inpatient episodes, accident and emergency department (AED) visits, and mortality after discharge. The post-hospital falls were further analyzed in 2 subcategories (1) only requiring AED visits and (2) requiring hospitalization. The incidence rate and faller incidence proportion for total falls and subcategories during the different periods were examined. The corresponding healthcare utilization and costs were calculated. RESULTS: Among the 606,392 older adults discharged from hospitals during the study period, 28,593 individuals (4.7%) experienced at least 1 post-hospital fall within 12 months, resulting in a total of 33,158 falls (57 per 1000 person-years). Out of post-hospital falls presenting to hospitals, one-third only required AED visits, and two-thirds required hospitalization. The fall incidence rate peaked in the first 3 weeks after discharge and gradually decreased to a stable level from the fourth to ninth week. The annual healthcare costs related to post-hospital falls exceeded USD 28.9 million in older adults, with the mean cost per faller and fall being USD 11,129 and USD 9596. CONCLUSIONS AND IMPLICATIONS: The fall-related healthcare utilizations after discharge impose a substantial economic burden on older adults. During the first 9 weeks, particularly the first 3 weeks, older adults were at high risk of falling. The efforts on resource allocation for fall prevention are suggested to prioritize this period.

A Web-Based Sexual Health Intervention to Prevent Sexually Transmitted Infections in Hong Kong: Model-Based Cost-Effectiveness Analysis.

BACKGROUND: Sexually transmitted infections (STIs) remain a significant public health concern, particularly among young adults, and Chlamydia trachomatis (CT) infections are the most common STIs in young women. One of the most effective ways to prevent STIs is the consistent use of condoms during sexual intercourse. There has been no economic evaluation of the interactive web-based sexual health program, Smart Girlfriend, within the Chinese population. OBJECTIVE: This study aimed to evaluate the long-term cost-effectiveness of Smart Girlfriend in preventing STIs in the Chinese population. The evaluation compared the program with a control intervention that used a 1-page information sheet on condom use. METHODS: A decision-analytic model that included a decision tree followed by a Markov structure of CT infections was developed since CT is the most prevalent STI among young women. The model represents the long-term experience of individuals who received either the intervention or the control. One-way and probabilistic sensitivity analyses were conducted. The main outcomes were the number of CT infections and the incremental cost as per quality-adjusted life year (QALY). RESULTS: A cohort of 10,000 sexually active nonpregnant young women initially entered the model in a noninfectious state (ie, "well"). In the base-case analysis, the implementation of the Smart Girlfriend program resulted in the prevention of 0.45% of CT infections, 0.3% of pelvic inflammatory disease, and 0.04% of chronic pelvic pain, leading to a gain of 70 discounted QALYs and cost savings over a 4-year time horizon, compared to the control group. With more than 4548 users, the intervention would be cost-effective, and with more than 8315 users, the intervention would be cost saving. A 99% probability of being cost-effective was detected with a willingness to pay US $17,409 per QALY. CONCLUSIONS: Smart Girlfriend is a cost-effective and possibly cost-saving program over a 4-year time horizon. This result was particularly sensitive to the number of website users; launching the website would be cost-effective if more than 4548 people used it. Further work is warranted to explore if the findings could be expanded to apply to women who have sex with women and in the context of other STIs. TRIAL REGISTRATION: ClinicalTrial.gov NCT03695679; https://clinicaltrials.gov/study/NCT03695679.

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention.

Importance: There is a lack of information regarding the impact of implementing a protocol-driven, team-based, multicomponent intervention in public primary care settings on hypertension-related complications and health care burden over the long term. Objective: To compare hypertension-related complications and health service use at 5 years among patients managed with Risk Assessment and Management Program for Hypertension (RAMP-HT) vs usual care. Design, Setting, and Participants: In this population-based prospective matched cohort study, patients were followed up until the date of all-cause mortality, an outcome event, or last follow-up appointment before October 2017, whichever occurred first. Participants included 212 707 adults with uncomplicated hypertension managed at 73 public general outpatient clinics in Hong Kong between 2011 and 2013. RAMP-HT participants were matched to patients receiving usual care using propensity score fine stratification weightings. Statistical analysis was conducted from January 2019 to March 2023. Interventions: Nurse-led risk assessment linked to electronic action reminder system, nurse intervention, and specialist consultation (as necessary), in addition to usual care. Main Outcomes and Measures: Hypertension-related complications (cardiovascular diseases, end-stage kidney disease), all-cause mortality, public health service use (overnight hospitalization, attendances at accident and emergency department, specialist outpatient clinic, and general outpatient clinic). Results: A total of 108 045 RAMP-HT participants (mean [SD] age: 66.3 [12.3] years; 62 277 [57.6%] female) and 104 662 patients receiving usual care (mean [SD] age 66.3 [13.5] years; 60 497 [57.8%] female) were included. After a median (IQR) follow-up of 5.4 (4.5-5.8) years, RAMP-HT participants had 8.0% absolute risk reduction in cardiovascular diseases, 1.6% absolute risk reduction in end-stage kidney disease, and 10.0% absolute risk reduction in all-cause mortality. After adjusting for baseline covariates, the RAMP-HT group was associated with lower risk of cardiovascular diseases (hazard ratio [HR], 0.62; 95% CI, 0.61-0.64), end-stage kidney disease (HR, 0.54; 95% CI, 0.50-0.59), and all-cause mortality (HR, 0.52; 95% CI, 0.50-0.54) compared with the usual care group. The number needed to treat to prevent 1 cardiovascular disease event, end-stage kidney disease, and all-cause mortality was 16, 106, and 17, respectively. RAMP-HT participants had lower hospital-based health service use (incidence rate ratios ranging from 0.60 to 0.87) but more general outpatient clinic attendances (IRR, 1.06; 95% CI, 1.06-1.06) compared with usual care patients. Conclusions and Relevance: In this prospective matched cohort study involving 212 707 primary care patients with hypertension, participation in RAMP-HT was associated with statistically significant reductions in all-cause mortality, hypertension-related complications, and hospital-based health service use after 5 years.

Psychometric evaluation of Korean version of COVID-19 fear scale (K-FS-8): A population based cross-sectional study.

COVID-19-related fear negatively affects the public's psychological well-being and health behaviours. Although psychological distress including depression and anxiety under COVID-19 is well-established in literature, research scarcely evaluated the fear of COVID-19 with a large sample using validated scale. This study aimed to validate a Korean version of fear scale(K-FS-8) using an existing fear scale(Breast Cancer Fear Scale; 8 items) and to measure the fear of COVID-19 in South Korea. A cross-sectional online survey was conducted with 2235 Korean adults from August to September 2020. The Breast Cancer Fear Scale was translated from English into Korean using forward-backward translation, and then face validity was assessed. Patient Health Questionnaire-4 and Primary Care Post-Traumatic Stress Disorder Screen for DSM-5 were used for assessing convergent validity of K-FS-8, and item response theory analysis was also conducted to further validate the K-FS-8. This study confirmed the validity and reliability of the K-FS-8. The validity of the scale was confirmed by convergent validity, known-group validity and item response theory analysis, and internal consistency was also examined(Cronbach's α coefficient = 0.92). This study also identified that 84.6% participants had high COVID-19 fear; whilst 26.3%, 23.2% and 13.4% participants had high risk of post-traumatic stress disorder, depressive and anxiety symptoms, respectively. The K-FS-8 showed the acceptability measuring the fear of COVID-19 in the Korean population. The K-FS-8 can be applied to screen for fear of COVID-19 and related major public health crises identifying individuals with high levels of fear in primary care settings who will benefit from psychological support.

Evaluating the diagnostic properties of the Whooley questionnaire as a case-finding instrument for depression among Chinese women during and after pregnancy.

Purpose: There is a rising prevalence in undetected perinatal depression in many countries, more effort in screening and early identification of perinatal depression is needed. While the Whooley questionnaire is the recommended case-finding strategy for perinatal depression, there is no validated Chinese version. The aim was to evaluate the diagnostic accuracy and stability of the translated Chinese Whooley questionnaire against gold standard measurement during and early after pregnancy.Materials and Methods: This observational study recruited 131 pregnant women from an antenatal clinic in Hong Kong from September 2019 to May 2020. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer-assessed diagnostic standard (DSM-IV criteria) in 107 women at 26-28 gestational weeks. We calculated sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis as the gold standard.Results: The Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4-93.9), a specificity of 97% (95% CI 90.4-99.3), a positive likelihood ratio of 23.2 (95% CI 7.4-72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1-0.5) in identifying perinatal depression.Conclusion: The translated Chinese Whooley questionnaire has an acceptable diagnostic accuracy in identifying perinatal depression. It can be implemented in health services among Cantonesespeaking Chinese population.

University-based behavioral interventions to promote safer sex practices: A systematic review and meta-analysis.

OBJECTIVE: This study aims to critically review the characteristics and effectiveness of university-based intervention to promote safer sex practice. PARTICIPANTS AND METHODS: The published studies were selected from 5 databases with the publication year restricted between 1974 and 2018. The data were then pooled using a random-effect meta-analysis. RESULTS: A total of 41 studies with 10,144 participants were included from 5,253 potentially relevant citations. Compared with minimal intervention, those people who participated in the intervention reported a statistically significant increase in the frequency of condom use (SMD 0.61; 95%CI 0.46-0.77, I2 = 9%). There was an insignificant change after the intervention (SMD 0.34; 95%CI -0.04-0.72, I2 = 72%) in communication with sexual partners and the heterogeneity existed in diversity of sessions of the intervention. CONCLUSION: Behavioral interventions can significantly increase in the frequency of condom use but not in communication with sexual partners. A standardized measurement is a necessary consideration for future studies.

Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment.

BACKGROUND: There is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. We aimed to assess the association between polysomnographic parameters and incident major adverse cardiovascular events (MACEs), and to investigate if the CPAP effect could be better delineated among clinical subgroups. METHODS: This sleep cohort study was conducted using a clinical database and territory-wide electronic health administration data in Hong Kong. Cox regressions were used to calculate HRs. Latent class analysis was used to cluster patients with OSA according to clinical and polysomnographic features. RESULTS: Of 1860 eligible Chinese subjects who underwent polysomnography (2006-2013), 1544 (83%) had OSA. Over median follow-up of 8.3 years, 278 (14.9%) experienced MACEs. Apnoea-hypopnoea index (AHI) did not predict MACEs (HR: 0.95; 95% CI 0.76 to 1.17), whereas sleep time with oxygen saturation <90% (TST90) (HR: 1.41; 95% CI 1.10 to 1.81) was an independent predictor of MACEs, as were wake and nocturnal heart rate. In moderate-severe OSA (n=1108) who were indicated for CPAP treatment, regular CPAP was not associated with reduction of incident MACEs. Further cluster analysis identified a subgroup (n=333) who was younger, more obese, had more severe OSA (higher AHI and TST90) and more cardiovascular risks, in whom regular CPAP was associated with a lower risk of MACEs (HR:0.49, 95% CI 0.25 to 0.95). CONCLUSIONS: OSA-related TST90 and mean heart rate, but not AHI, were robust predictors of MACEs. A clinical phenotype subgroup who demonstrated beneficial effect of CPAP treatment was identified.

Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women.

BACKGROUND: This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women. METHODS: Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity. RESULTS: Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I2 = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity. CONCLUSIONS: The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.

Average and individual differences between the 12-item MOS Short-form Health Survey version 2 (SF-12 V.2) and the veterans RAND 12-item Health Survey (VR-12) in the Chinese population.

BACKGROUND: The 12-item MOS Short-form Health Survey version 2 (SF-12v2) and the Veterans RAND 12-item Health Survey (VR-12) are generic health-related quality of life measures. They are fairly similar, but their differences in scores have not been assessed. Therefore, this study aimed to assess the differences between the SF-12v2 and the VR-12 in a Chinese population. METHODS: We conducted a household survey of 500 Chinese adults in Hong Kong. Both the SF-12v2 and the VR-12 were self-administered. The physical component summary score (PCS) and the mental component summary score (MCS) of each instrument were computed using well established algorithms. Their mean differences were assessed using 95% confidence interval (CI), and their individual differences were assessed by Bland-Altman analysis. RESULTS: The participants had a mean age of 38 years (range: 18-80 years). The mean PCS and MCS scores of the SF-12v2 were 50.3 (SD = 6.5) and 49.0 (SD = 9.0), while those of the VR-12 were 49.6 (SD = 6.2) and 49.7 (SD = 8.8), respectively. The corresponding paired differences (SF-12v2-VR-12) of the PCS and MCS were 0.8, 95% CI (0.4-1.1) and - 0.7, 95% CI (- 1.2 to - 0.2), respectively. All confidence limits fell within the minimal clinical important difference (MCID) of 3. The 95% limits of agreement were - 7.0, 8.5 for PCS and - 11.2, 9.9 for MCS, which fell outside the corresponding MCID for individual responses. CONCLUSION: The SF-12v2 and the VR-12 reached mean equivalence at the group sample level, but there was a range of individual differences.

Severity of SARS-CoV-2 Omicron BA.2 infection in unvaccinated hospitalized children: comparison to influenza and parainfluenza infections.

There has been a rapid surge of hospitalization due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants globally. The severity of Omicron BA.2 in unexposed, unvaccinated, hospitalized children is unknown. We investigated the severity and clinical outcomes of COVID-19 infection during the Omicron wave in uninfected, unvaccinated hospitalized children and in comparison with influenza and parainfluenza viral infections. This population-based study retrieved data from the HK territory-wide CDARS database of hospitalisations in all public hospitals and compared severe outcomes for the Omicron BA.2-dominant fifth wave (5-28 February 2022, n = 1144), and influenza and parainfluenza viruses (1 January 2015-31 December 2019, n = 32212 and n = 16423, respectively) in children 0-11 years old. Two deaths (0.2%) out of 1144 cases during the initial Omicron wave were recorded. Twenty-one (1.8%) required PICU admission, and the relative risk was higher for Omicron than influenza virus (n = 254, 0.8%, adjusted RR = 2.1, 95%CI 1.3-3.3, p = 0.001). The proportion with neurological complications was 15.0% (n = 171) for Omicron, which was higher than influenza and parainfluenza viruses (n = 2707, 8.4%, adjusted RR = 1.6, 95%CI 1.4-1.9 and n = 1258, 7.7%, adjusted RR = 1.9, 95%CI 1.6-2.2, p < 0.001 for both, respectively). Croup occurred for Omicron (n = 61, 5.3%) more than influenza virus (n = 601, 1.9%, adjusted RR = 2.0, 95%CI 1.5-2.6, p < 0.001) but not parainfluenza virus (n = 889, 5.4%). Our findings showed that for hospitalized children who had no past COVID-19 or vaccination, Omicron BA.2 was not mild. Omicron BA.2 appeared to be more neuropathogenic than influenza and parainfluenza viruses. It targeted the upper airways more than influenza virus.

Psychometric Evaluation of the Chinese Version of a Weight-Related Eating Questionnaire Using an Item Response Theory Approach.

Valid and reliable measures are needed to identify individuals at risk of dietary restraint, emotional and external eating, and to customize weight loss education for more effective weight management. This study aimed to develop and validate a Chinese version of the Weight-Related Eating Behavior Questionnaire (WREQ-C) for assessing dietary restraint, emotional eating, and external eating. In stage one, the linguistic validation of the original English version of the WREQ (WREQ-E) was conducted. In stage two, the psychometric properties of the WREQ-C were first evaluated by item response theory-based (IRT) analyses. The reduced scale was then examined for convergent validity, structural validity (using a confirmatory factor analysis), population invariance, and test-retest reliability. The study included 1007 adults aged between 18 and 71 years. The IRT analysis optimally shortened the original WREQ-E from 16 to 13 items. A convergent validity analysis showed significant correlations between the WREQ-C subscales and the Chinese version of the Dutch Eating Behavior Questionnaire subscales (r = 0.63-0.82). The 13-item WREQ-C demonstrated good reliability (Cronbach's α = 0.74-0.89) and validity for assessing the psychological aspects of eating behavior, including routine restraint, compensatory restraint, susceptibility to external cues, and emotional eating in Chinese adults.

Validating the use of the revised childbirth experience questionnaire in Hong Kong.

OBJECTIVE: To evaluate the psychometric properties of the traditional Chinese version of the Childbirth Experience Questionnaire (CEQ 2.0) and assess the childbirth experiences of Chinese women. METHODS: A cross-sectional survey was conducted in Hong Kong from July 2020 to February 2021. In total, 975 mothers, who could read traditional Chinese and gave birth in 2020 or 2021, were included in the analysis. Data were fitted into the model proposed by the original developers using the confirmatory factor analysis. The data were then randomly split into training and validation sets for exploratory and confirmatory factor analyses. Childbirth experiences were assessed. Factor structure, internal construct validity, internal consistency, and known-group validity were assessed. RESULTS: The originally proposed CEQ2.0 model showed a poor fit. An exploratory factor analysis identified a revised four-factor model (CEQ2.0-R) on a randomly split sample, which showed a satisfactory fit (CFI=0.912; TLI=0.884; SRMR=.053; RMSEA=0.072) on the other split sample. The revised scale comprised 13 items and four domains: (1)"Own capacity" (6 items), (2) "General support" (3 items), (3) "Perceived safety" (2 items), and (4) "Professional support" (2 items). CEQ2.0-R showed high internal construct validity and reliability. It can differentiate between participants with different characteristics, including parity, oxytocin augmentation, and companionship during labour. The childbirth experiences of the participants were merely positive, and participants reported that more support from midwives is needed. CONCLUSIONS: CEQ2.0-R can adequately describe the childbirth experiences of women in Hong Kong. The questionnaire is easy to be administer and can be used to assess several domains of the childbirth experiences. It may be useful to evaluate the aspects of support needed during childbirth.

Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study.

BACKGROUND: At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. OBJECTIVE: This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. METHODS: A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale ("Fear Scale") and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants' fear levels. RESULTS: A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. CONCLUSIONS: The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic.

Post-hospital falls incidence and risk factors among older adults: a systematic review and meta-analysis.

BACKGROUND: Post-hospital falls constitute a significant health concern for older adults who have been recently discharged from the hospital. OBJECTIVES: To systematically summarise existing evidence on the incidence and risk factors for post-hospital falls among older adults. METHODS: A systematic review and meta-analysis was conducted. Six electronic databases were searched to identify cohort studies investigating the incidence and risk factors for post-hospital falls in older adults. The incidence and risk factors for post-hospital falls were extracted. The meta-analysis was used to calculate pooled incidences and 95% confidence intervals (CI). The meta-regression and subgroup meta-analysis were conducted to explore sources of heterogeneity in incidence proportions across the eligible studies. A qualitative synthesis was performed for the post-hospital falls risk factors. RESULTS: Eighteen studies from eight countries (n = 9,080,568) were included. The pooled incidence proportion of any and recurrent post-hospital falls was 14% (95% CI: 13%-15%) and 10% (95% CI: 5%-14%), respectively. Follow-up period, study quality, study country, setting, percentage of female subjects, percentage of subjects with previous falls and the primary data collection method for falls significantly contributed to the 64.8% of the heterogeneity in incidence proportions. Twenty-six risk factors for post-hospital falls were identified in the eligible studies, where biological factors were the most commonly identified factors. The highest risks were reported for previous falls, previous fractures, delirium and neurological diseases. CONCLUSION: The findings of this study suggested future post-hospital falls prevention should prioritise the needs of older adults with the dominant risk factors. Further investigations into the period-specific incidence and socioeconomic and environmental risk factors for post-hospital falls are also required.

The Effect of Maternal Self-Regulated Motivation on Breastfeeding Continuation.

OBJECTIVE: Women frequently report breastfeeding problems in the early postpartum period. Women who have self-endorsed beliefs that breastfeeding benefits their babies and themselves are more likely to continue breastfeeding despite breastfeeding barriers. Maternal self-endorsed beliefs is a key component of maternal self-regulated motivation. The present study examined the association between maternal self-regulated motivation, breastfeeding duration and exclusivity in Chinese women. METHODS: This was a prospective cohort study, of which we recruited participants in postnatal maternity units of publicly funded hospitals in Hong Kong. Postpartum women were asked to fill in the validated breastfeeding self-regulation questionnaire (BSRQ) before hospital discharge and their breastfeeding status was assessed by telephone follow-ups at 6 and 12 weeks postpartum. Multiple logistic regression was used to study the relationship between breastfeeding self-regulated motivation and the duration of breastfeeding at follow-up. RESULTS: At 6 and 12 weeks postpartum, women who breastfed exclusively scored significantly higher in self-regulated motivation than those who formula-fed. The self-regulated motivation was associated with higher odds of exclusive breastfeeding at 6 weeks and any breastfeeding at 12 weeks postpartum. CONCLUSIONS FOR PRACTICE: The study found that self-regulated motivation was positively related to breastfeeding duration. Maternal self-regulated motivation toward breastfeeding could be enhanced by the availability of social support and breastfeeding-friendly facilities, resulting in longer breastfeeding duration.

The Experience of Using Dating Applications for Sexual Hook-Ups: A Qualitative Exploration among HIV-Negative Men Who Have Sex With Men in Hong Kong.

Men who have sex with men (MSM) use dating applications (apps) to explore various romantic and sexual relationships. This qualitative study aimed to describe HIV-negative MSM's experiences with app usage, the sexual activities arranged accordingly and their experiences in using dating apps to arrange sexual encounters. Thirty-one MSM who were sexually active and who used dating apps were recruited. Individual semi-structured interviews were conducted. Qualitative data were thematically analyzed to outline significant phenomena and perceptions. The factors associated with matching on apps included sex roles, human immunodeficiency virus serostatus and availability of a venue for meetup. Facilitated by these apps, diverse types of sexual encounters were arranged. Condoms were typically used for safer intercourse, except by people who were younger and inexperienced or when drugs were consumed before or during sex (chemsex). Extensive interest in non-penetrative sexual behaviors was expressed by our sample. Searching for post-exposure prophylaxis methods and/or sexual health screenings was common after exposure to risk of infections. Sexually abusive encounters were followed by changes in sex-searching habits and lowered trust in relationship formation. The results of this study are important for the development of appropriate interventions to promote safer sexual practices among HIV-negative MSM dating app users.