Assessment of the general public's knowledge of atrial fibrillation through social media: a cross-sectional study.

BACKGROUND: Early detection and timely treatment of atrial fibrillation (AF) remains pivotal to preventing AF-related complications. Public involvement in recognising potential AF symptoms and managing AF is vital for early detection and treatment of AF. OBJECTIVE: The aim of the study is to assess the general public's knowledge of AF using an online survey, disseminated via social media. METHODS: A cross-sectional online survey of the general public was conducted between November to December 2021. The survey's URL was shared on National University Heart Centre, Singapore's official Facebook page. Digital marketing strategies were employed to recruit members of the public. The 27-item survey assessed public's knowledge across five domains: basic information about AF, risk factors of AF, detection of AF, prevention of AF, and management of AF. RESULTS: The survey involved 620 participants. Approximately two-thirds were between the ages 21 to 40 years (64.5%), female (60%) and had at least a degree (64.7%) as their highest level of education. Participants obtained a mean percentage score of 63.3 ± 26.0 for their AF knowledge. One-way ANOVA was done to examine the associations between the participants' characteristics and their knowledge of AF. There were no statistically significant differences in the AF knowledge scores across the various sociodemographic subgroups. CONCLUSIONS: Members of the public recruited from Facebook and via digital marketing had moderately good knowledge of AF. However, public awareness pertaining to preventing AF has potential for improvement. The utility of social media in reaching the general public was illustrated through this study.

Pooled prevalence of depressive symptoms among medical students: an individual participant data meta-analysis.

BACKGROUND: The methodological choice of aggregated estimates for meta-analysis may be notable for some common drawbacks, including variations in the cut-off values of depression, and lower statistical power for analyzing the associated factors. The study aimed to refine the precision of previous findings on the prevalence of depressive symptoms among medical students, through gathering individual participant data (IPD) as identified from our previous reviews. MATERIAL AND METHODS: In the present study, we searched MEDLINE, EMBASE, PsycINFO, WanFang, Scielo and LILACS to identify published systematic reviews and meta-analyses up to March 2018, then individual data was requested for further analysis (PROSPERO registration: CRD42018091917). The participants' age, sex, year of study, scores for depressive symptoms, and other predictor variables were requested. To pool the prevalence from the included studies, random-effects model (two-step method) was used. Multiple linear regression was used to examine the associated factors on the depression z-scores (one-step method). RESULTS: Of the 249 studies, the datasets of 34 studies were included. The crude prevalence was 19.4% (95% CI: 18.8%, 19.9%) by one-step method and the pooled prevalence was 18.1% (95% CI: 14.1%, 22.1%) by two-step method. Multiple linear regression revealed that being a female, older age, and senior year of study were significantly associated with the z-score. CONCLUSION: The pooled prevalence of depressive symptoms from the Individual Participant Data (IPD) meta-analysis was lower than the previous meta-analyses using aggregated data. Age, sex, and year of study were significantly associated with the depression z-score. IPD meta-analysis may provide a more accurate estimation of disease burden, and allow verification of associated factors.

Modeling Research Topics for Artificial Intelligence Applications in Medicine: Latent Dirichlet Allocation Application Study.

BACKGROUND: Artificial intelligence (AI)-based technologies develop rapidly and have myriad applications in medicine and health care. However, there is a lack of comprehensive reporting on the productivity, workflow, topics, and research landscape of AI in this field. OBJECTIVE: This study aimed to evaluate the global development of scientific publications and constructed interdisciplinary research topics on the theory and practice of AI in medicine from 1977 to 2018. METHODS: We obtained bibliographic data and abstract contents of publications published between 1977 and 2018 from the Web of Science database. A total of 27,451 eligible articles were analyzed. Research topics were classified by latent Dirichlet allocation, and principal component analysis was used to identify the construct of the research landscape. RESULTS: The applications of AI have mainly impacted clinical settings (enhanced prognosis and diagnosis, robot-assisted surgery, and rehabilitation), data science and precision medicine (collecting individual data for precision medicine), and policy making (raising ethical and legal issues, especially regarding privacy and confidentiality of data). However, AI applications have not been commonly used in resource-poor settings due to the limit in infrastructure and human resources. CONCLUSIONS: The application of AI in medicine has grown rapidly and focuses on three leading platforms: clinical practices, clinical material, and policies. AI might be one of the methods to narrow down the inequality in health care and medicine between developing and developed countries. Technology transfer and support from developed countries are essential measures for the advancement of AI application in health care in developing countries.

The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis.

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2-38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety-a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

A One-Year Prospective Follow-Up Study on the Health Profile of Hikikomori Living in Hong Kong.

Background: A prospective cohort study was conducted to follow-up on 104 participants on their changes of social, psychological and physical health as exposed to the hikikomori lifestyle. Methods: Participants were interviewed at baseline, 6 months and 12 months by administering a set of questionnaires and anthropometric measurements. Results: All three health domains of hikikomori were significantly improved over the follow-up period as evidenced by: (1) increased social network scores from 2.79 ± 1.80 to 3.09 ± 1.87, (2) decreased perceived stress scores from 21.18 ± 5.87 to 20.11 ± 5.79, and (3) reduced blood pressure levels from 118/75 to 115/71 and waist-to-hip ratios. Almost half of the participants have recovered from hikikomori by returning to the workforce in society; however, the health improvements were dominant in those that remained as hikikomori and were associated with the gradual swapping of exercise practices from light to moderate level strength. Conclusions: With intended exposure to social worker engagement, physical assessments of the cohort study triggered the social workers to encourage participants to do more exercises, which in turn enhanced their awareness of health modification towards a better health. Engagement of social workers could be considered as part of the intended exposure for all participants, which suggested social work intervention was effective in helping hikikomori recovery.

Gender inequality and depression among medical students: A global meta-regression analysis.

Depression is a serious mental health problem with a high prevalence among medical students. It is unclear whether a gender disparity of depression exists in this population, and whether gender inequality influences depression estimates by gender. We conducted a systematic search for published systematic reviews or meta-analyses in six databases and primary studies were obtained from those records. Studies were included if they contained original data on the prevalence of depression among male and female medical students. The Gender Inequality Index (GII) and the Human Development Index (HDI) were obtained from the United Nations Development Programme website. A random effects meta-analysis of the odds ratio for depression between females and males was conducted. Meta-regression analyses were conducted to assess the association of GII and prevalence of depression. The HDI was later incorporated in a multivariable model. We included a total of 106 studies and 84,119 students from 32 different countries. Female medical students are at higher odds of depression (OR = 1.30, 95% CI 1.17-1.44, p < 0.01). A significant correlation was found between GII and prevalence of depression for female (ß = 0.24, p = 0.02) medical students, but not for male medical students. This association remained significant after adjusting for HDI. The female gender was associated with higher prevalence of depression in this population. The gender disparity in depression may be explained by the effect of gender inequality.

Prevalence of Depression in the Community from 30 Countries between 1994 and 2014.

The prevalence of depression may be affected by changes in psychiatric practices and the availability of online mental health information in the past two decades. This study aimed to evaluate the aggregate prevalence of depression in communities from different countries between 1994 and 2014 and to explore the variations in prevalence stratified by geographical, methodological and socio-economic factors. A total of 90 studies were identified and met the inclusion criteria (n = 1,112,573 adults) with 68 studies on single point prevalence, 9 studies on one-year prevalence, and 13 studies on lifetime prevalence of depression. A random-effects model meta-analysis that was performed to calculate the aggregate point, one-year and lifetime prevalence of depression calculated prevalences of 12.9%, 7.2% and 10.8% respectively. Point prevalence of depression was significantly higher in women (14.4%), countries with a medium human development index (HDI) (29.2%), studies published from 2004 to 2014 (15.4%) and when using self-reporting instruments (17.3%) to assess depression. Heterogeneity was identified by meta-regression and subgroup analysis, and response rate, percentage of women and year of publication, respectively, were determined contribute to depression prevalence. This meta-analysis allows benchmarking of the prevalence of depression during the era when online health information emerged, facilitating future comparisons.

Is the information of systematic reviews published in nursing journals up-to-date? a cross-sectional study.

BACKGROUND: An up-to-date systematic review is important for researchers to decide whether to embark on new research or continue supporting ongoing studies. The aim of this study is to examine the time taken between the last search, submission, acceptance and publication dates of systematic reviews published in nursing journals. METHODS: Nursing journals indexed in Journal Citation Reports were first identified. Thereafter, systematic reviews published in these journals in 2014 were extracted from three databases. The quality of the systematic reviews were evaluated by the AMSTAR. The last search, submission, acceptance, online publication, full publication dates and other characteristics of the systematic reviews were recorded. The time taken between the five dates was then computed. Descriptive statistics were used to summarize the time differences; non-parametric statistics were used to examine the association between the time taken from the last search and full publication alongside other potential factors, including the funding support, submission during holiday periods, number of records retrieved from database, inclusion of meta-analysis, and quality of the review. RESULTS: A total of 107 nursing journals were included in this study, from which 1070 articles were identified through the database search. After screening for eligibility, 202 systematic reviews were included in the analysis. The quality of these reviews was low with the median score of 3 out of 11. A total of 172 (85.1%), 72 (35.6%), 153 (75.7%) and 149 (73.8%) systematic reviews provided their last search, submission, acceptance and online published dates respectively. The median numbers of days taken from the last search to acceptance and to full publication were, respectively, 393 (IQR: 212-609) and 669 (427-915) whereas that from submission to full publication was 365 (243-486). Moreover, the median number of days from the last search to submission and from submission to online publication were 167.5 (53.5-427) and 153 (92-212), respectively. No significant association were revealed between the time lag and those potential factors. CONCLUSION: The median time from the last search to acceptance for systematic reviews published in nursing journals was 393 days. Readers for systematic reviews are advised to check the time taken from the last search date of the reviews in order to ensure that up-to-date evidence is consulted for effective clinical decision-making.

The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review.

BACKGROUND: The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes. OBJECTIVES: The objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings. REVIEW METHODS: A comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools. RESULTS: Narrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings. CONCLUSIONS: Capitalizing on nurses in advanced practice to increase patients' access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.

A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome.

Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (-14324, -13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings.

Associated Demographic Factors of Instrumental and Emotional Feeding in Parents of Hong Kong Children.

BACKGROUND: Instrumental and emotional feeding have been associated with obesogenic dietary behaviors and obesity in children. Therefore, identifying parents who are more likely to use detrimental feeding styles may be helpful for tailoring interventions. OBJECTIVE: This study examines the demographic variation of instrumental and emotional feeding by using a sample of the Hong Kong population. DESIGN: A cross-sectional research is presented. Instrumental and emotional feeding styles were assessed. PARTICIPANTS: A total of 3,742 Hong Kong parents from 27 kindergartens, with children aged 2 to 7 years old, were enrolled in this study. MAIN OUTCOME MEASURES: Instrumental and emotional feeding styles were assessed by a validated Parental Feeding Style Questionnaire. STATISTICAL ANALYSIS: Differences among the demographic characteristics in parental feeding styles were compared by independent t test or analysis of variance. Multiple linear regressions were performed to determine the associated demographic factors. RESULTS: A greater tendency to adopt instrumental feeding was associated with younger children (ß=-.07), feeding a daughter (ß=.05), and a mother having a full-time job (ß=.10). By contrast, a greater tendency to adopt emotional feeding was associated with younger children (ß=-.07), feeding a daughter (ß=.06), a mother having a full-time job (ß=.16), or a lower parental education level (ß=-.11). CONCLUSIONS: Parents with full-time jobs, lower education levels, or who were nurturing a younger child may be more likely to use unhealthy feeding styles. Researchers should consider developing intervention strategies that focus on decreasing emotional and instrumental feeding styles for full-time employed or less-educated parents of younger children, particularly daughters.

Assessment of simulated lesions on primary teeth with near-infrared imaging.

Previous studies have demonstrated that the structural changes on enamel due to demineralization and remineralization can be exploited through optical imaging methods such as QLF, thermal and NIR imaging. The purpose of this study is to investigate whether PS-OCT and NIR reflectance imaging can be utilized to assess lesion structure in artificial enamel lesions on the smooth surfaces of primary teeth exposed to fluoride. The smooth coronal surfaces of primary teeth (n=25) were divided into 4 windows: sound, demineralization, demineralization with remineralization and APF with demineralization. Windows were treated with either acidulated phosphate fluoride (APF) for 1 minute, a demineralization solution for 4 days, and/or an acidic remineralization solution for 12 days. The samples were imaged using PS-OCT, QLF and NIR reflectance at 1400-1700 nm wavelengths. This study demonstrated that both PS-OCT and NIR reflectance imaging were suitable for assessing lesion structure in the smooth surfaces of primary dentition.

Psychometric evaluation of the Chinese version of the Subjective Happiness Scale: evidence from the Hong Kong FAMILY Cohort.

BACKGROUND: With China's rapid economic growth in the past few decades, there is currently an emerging focus on happiness. Cross-cultural validity studies have indicated that the four-item Subjective Happiness Scale (SHS) has high internal consistency and stable reliability. However, the psychometric characteristics of the SHS in broader Chinese community samples are unknown. PURPOSE: We evaluated the factor structure and psychometric properties of the SHS in the Hong Kong general population. METHODS: The Chinese SHS was derived using forward-backward translation. Of the Cantonese-speaking participants aged ≥15 years, 2,635 were randomly selected from the random sample component of the FAMILY Cohort, a territory-wide cohort study in Hong Kong. In addition to the SHS, a single-item overall happiness scale, the Patient Health Questionnaire-9 (PHQ-9), the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR) scale, and the Medical Outcomes Study 12-item short-form version 2 (SF-12) mental and physical health scales were administered. RESULTS: Exploratory and confirmatory factor analyses supported a single factor with high loadings for the four SHS items. Multiple group analyses indicated factor invariance across sex and age groups. Cronbach's alpha was 0.82, and 2-week test-retest reliability (n = 191) was 0.70. The SHS correlated significantly with single-item overall happiness (Spearman's rho [ρ] = 0.57), Family APGAR (ρ = 0.26), PHQ-9 (ρ = -0.34), and mental health-related quality of life (ρ = 0.40) but showed a lower correlation with physical health (ρ = 0.15). A regression model that included the PHQ-9 and Family APGAR scores explained 37% of the variance in SF-12 mental health scores; adding the SHS raised the variance explained to 41 %. CONCLUSIONS: Our results support the reliability and validity of the SHS as a relevant component in the measurement battery for mental well-being in a Chinese general population.

The impact of cutting alcohol duties on drinking patterns in Hong Kong.

AIM: In an effort to promote Hong Kong as a global wine hub, the government eliminated duties on wine and beer in 2008. The changes in alcohol consumption patterns are examined. METHODS: Anonymous, cross-sectional telephone surveys on a random sample of Chinese male and female residents aged 18-70 were carried out in 2011 (n = 4800) and 2012 (n = 1001). These data were compared with those of a 2006 (n = 9896) baseline survey conducted before the excise tax elimination. RESULTS: Prevalence of those ever drinking alcohol significantly increased from the 2006 baseline level of 66.6% to 82.0% in 2011 and to 85.2% in 2012. Of note, 10.2% of ever drinkers within the 2012 sample reported consuming alcohol for the first time in or after 2008. Younger, more educated or more affluent parts of the population are more likely to be ever drinkers. Unexpectedly, prevalence of binge drinking in the population decreased slightly from the 2006 baseline of 9.0% to 7.1% in 2011 and to 7.3% in 2012. Quantity of alcohol reportedly consumed by individuals did not change, while alcohol abuse and alcohol dependence levels decreased. However, binge drinking prevalence among the unemployed has increased. Logistic regression showed that those with lower educational achievement and the unemployed have higher likelihood of binge drinking. CONCLUSION: The government appears to have achieved its objective of making Hong Kong a world center for alcohol trade. However, the resulting access locally to cheaper alcohol has been associated with an increase in the numbers of those drinking alcohol. There has been a trend toward more adults drinking alcohol and greater risk of harm to some disadvantaged groups.

Piloting electronic self report symptom assessment - Cancer (ESRA-C) in Hong Kong: a mixed method approach.

PURPOSE: The benefits of utilizing computerized assessment in clinical settings have been reported in studies over the last three decades and more recently in the oncology settings. This study aimed to assess the feasibility and acceptability of using an electronic self report symptom assessment tool among Chinese oncology patients. METHODS AND SAMPLE: The tool, developed by The University of Washington, Distributed Health Assessment and Intervention Research (DHAIR) group was translated into Chinese. The adapted web-based survey platform, the Electronic Self Report Assessment - Cancer (ESRA-C), was tested in a local cancer resource center in Hong Kong. Participants' perceptions of the acceptability and feasibility of the symptom assessment process were assessed using the Acceptability E-scale as well as observation and qualitative interview data. Demographic data were also collected through the touch screen computer system. A convenience sample of 30 (11 male and 19 female) oncology patients was recruited to use the touch-screen computer to assess participants' symptoms using ESRA-C. RESULTS: The acceptability scale indicated moderately high acceptability in each subscale (mean score of 3.32-4.71). On average, participants took 17.5 min (SD: 8.9) to complete the ESRA-C. The qualitative interview data revealed that the majority (25 participants) asserted that the ESRA-C was useful and effective in reporting personal health conditions. CONCLUSIONS: The study suggested that electronic assessment can offer a feasible, attractive, and viable means of implementing regular and comprehensive symptom assessment, which can lead to better symptom management in cancer patients.

A longitudinal study of serial BODE indices in predicting mortality and readmissions for COPD.

INTRODUCTION: BODE index comprises Body mass index, Obstruction of the airway [FEV(1)], Dyspnoea score [modified Medical Research Council questionnaire] and Exercise capacity [6 min walk test]. This study assessed the role of serial changes in BODE index in predicting mortality and readmissions of COPD patients. METHODS: A prospective cohort study involving 243(208 males) COPD patients hospitalized for acute exacerbations of COPD [AECOPD]. BODE index was assessed at 6 weeks(baseline), 6, 12, 18 and 24 months post hospital discharge. Mortality and readmissions in the subsequent 3 years were recorded. All the patients were managed by usual care without additional intervention. RESULTS: The mean (SD) age and FEV(1)% predicted were 74.2(7.8) yrs and 51.7(21.6)% respectively. Over the 3 years, 25.1% died whereas 76.5% had at least 1 readmission for AECOPD. Baseline BODE index was predictive of both the survival and readmissions to hospital for AECOPD by Cox regression analysis (p < 0.001 for both survival and readmissions). Over 24 months, 71(40.1%), 94(53.1%), 12(6.8%) patients had increased (>1 point), no change, and decreased in BODE (>1 point) index respectively. Serial changes in BODE index at 6 month was marginally associated with mortality, but not at 12-, 18- and 24-month. The 6-, 12- and 24-month BODE indices were predictive of the readmissions for AECOPD when compared to baseline. CONCLUSION: Baseline BODE index could predict both survival and readmissions for AECOPD, whereas serial BODE indices were not predictive of survival at 3 years. Single rather than serial measurements of BODE index is sufficient for prediction of survival and readmissions for patients treated with usual care.

Effectiveness of a Tai chi Qigong program in promoting health-related quality of life and perceived social support in chronic obstructive pulmonary disease clients.

PURPOSE: This paper evaluates the effectiveness of a 3-month Tai chi Qigong (TCQ) program in promoting the psychosocial functional health of clients with chronic obstructive pulmonary disease (COPD) in Hong Kong. METHODS: This study employed a single-blind, randomized controlled trial. Two hundred and six COPD clients were randomly assigned into three groups, namely, TCQ group, exercise group, and control group. Subjects in the TCQ group received a TCQ program, consisting of two 60-min sessions each week for 3 months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group received their usual care. Data collections were performed at baseline, on the sixth week and on the third month. The primary outcomes were health-related quality of life using St. George Respiratory Questionnaire-Hong Kong Chinese version and perceived social support using the Multidimensional Scale of Perceived Social Support-Chinese version. RESULTS: The TCQ group showed greater improvements in the symptom (F4, 404=3.351, P=0.010) and activity domains (F4, 404=2.611, P=0.035). No differences were detected in perceived social support among the three groups. CONCLUSIONS: Tai chi Qigong promoted health outcomes with respect to clients' perception of their respiratory symptoms. Moreover, TCQ decreased disturbances to their physical activities.