Prevalence and Factors Associated With Willingness to Sustain Pandemic-Induced Digital Work in the General Population and Moderating Effects of Screen Hours: Cross-Sectional Study.

BACKGROUND: The pandemic has accelerated digital work transformation, yet little is known about individuals' willingness to sustain such digital modes and its associated factors. A better understanding of this willingness and its drivers is crucial for guiding the development of future digital work infrastructure, training programs, and strategies to monitor and prevent related health issues. OBJECTIVE: This study aims to quantify the general population's willingness to sustain pandemic-induced digital work, identify its associated factors, and examine how screen time moderates these relationships. METHODS: A cross-sectional study was conducted targeting Hong Kong residents aged ≥18 years who have increased engagement in digital work since the pandemic. Data were collected through self-reported, web-based surveys. Descriptive statistics determined prevalence rates, while structured multiphase logistic regression identified associated factors and explored the moderating effects of screen hour levels. RESULTS: This unfunded study enrolled 1014 participants from May 2 to June 24, 2022, and completed data analysis within 3 months after data collection. A total of 391 (38.6%; 95% CI 35.6%-41.6%) participants expressed willingness to sustain digital work. Positive factors associated with this willingness included being an employee (odds ratio [OR] 3.12, 95% CI 1.59-6.45; P=.001), being health professionals (OR 3.32, 95% CI 1.49-7.82; P=.004), longer screen hours (OR 1.09, 95% CI 1.03-1.15; P=.002), and higher depression levels (OR 1.20, 95% CI 1.01-1.44; P=.04). Conversely, negatively associated factors included older age (OR 0.87, 95% CI 0.81-0.94; P=.001), extroversion (OR 0.66, 95% CI 0.51-0.86; P=.002), higher eHealth literacy (OR 0.96, 95% CI 0.93-0.98; P<.001), perceived greater susceptibility to COVID-19 (OR 0.84, 95% CI 0.74-0.96; P=.009), residence in a high-severity COVID-19 community (OR 0.73, 95% CI 0.63-0.84; P<.001), having infected individuals in the immediate social circle (OR 0.64, 95% CI 0.46-0.88; P=.006), higher BMI (OR 0.94, 95% CI 0.90-0.99; P=.02), feelings of being out of control (OR 0.96, 95% CI 0.93-0.98; P=.002), and higher fear of COVID-19 (OR 0.96, 95% CI 0.94-0.98; P=.001). In addition, a moderating effect of screen hour level (high: >8 h/d; low: ≤8 h/d) influenced the association among 10 factors related to willingness to sustain pandemic-induced digital work, including age, education level, household size, needs for regular medical care, BMI, frequency of both vigorous and moderate physical activities, perceived COVID-19 severity, immediate social circle COVID-19 presence, and fear of COVID-19 (all P values for interaction <.05). CONCLUSIONS: The substantial willingness of the general population to sustain digital work after the pandemic highlights the need for robust telework infrastructure, thorough monitoring of adverse health outcomes, and the potential to expand telehealth services among this group. The identification of factors influencing this willingness and the moderating role of screen hours inform the development of personalized strategies to enhance digital work acceptance where needed.

Building a baby-friendly community: Development, strategy, implementation and evaluation of a BFCI program.

AIM: The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community. DESIGN: Quasi-experimental research design. METHOD: The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women. RESULTS: A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1. CONCLUSION: In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families. IMPACT: What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding. What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community. Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families. REPORTING METHOD: This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way. TRIAL AND PROTOCOL REGISTRATION: No protocol.

Effectiveness of group cognitive behavioral therapy for depression in adults: a systematic review and meta-analysis of delivery by different healthcare professionals.

This study addresses the gap in understanding the varied effectiveness of group cognitive behavioral therapy (gCBT) delivered by different professionals. This study aims to address this gap by conducting a systematic review of randomized controlled trials (RCTs) that evaluate gCBT and compare it to inactive controls in adults with a clinical diagnosis of depression. A total of 33 RCTs were included for analysis. In the overall analysis, 'profession of gCBT deliverer' was not a significant moderator in the meta-regression model (p = 0.57). For people without comorbidity, the overall effect size estimate was -0.69 (95% CI, -1.01. to -0.37, p = 0.03). Among gCBT deliverers, psychologists and nurses/psychiatric nurses demonstrated significant effectiveness, with psychologists showing a large effect size of -0.78 (95% CI, -1.25 to -0.30, p < 0.01) and nurses/psychiatric nurses showing a medium effect size of -0.45 (95% CI, -0.85 to -0.05, p = 0.03). The certainty of evidence for both professionals was moderate. These results have significant implications for the delivery of mental healthcare, as nurses/psychiatric nurses may be more accessible and cost-effective than psychologists in some settings. However, further research is necessary to determine the effectiveness of gCBT delivered by a broader range of healthcare professionals for patients with depression and other comorbidities.

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.

Perceptions and experiences of sexual violence among Chinese men who have sex with men in Hong Kong.

AIM: This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong. DESIGN: The study adopted a qualitative descriptive design with thematic analysis. METHODS: Thirty-one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive sampling. Individual semi-structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach. RESULTS: Four themes were identified: (1) different forms of sexual violence, from physical to virtual; (2) inner struggles with fears and worry; (3) low awareness and perceived risk of sexual violence - 'it has nothing to do with me' and (4) dilemma towards sexual violence prevention. CONCLUSION: The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image-based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence. IMPACTS: This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.

Post-traumatic responses to workplace violence among nursing professionals: a collaborative and comparative study in South Korea and Hong Kong.

BACKGROUND: Workplace violence has had a significant and negative psychological impact on nursing professionals worldwide. Concerted worldwide efforts to improve work environments have not yet removed nursing professionals from the threat of violence. It is highly essential to conduct comparative research in various working environments where the nurses of each country have unique experiences of workplace violence. The aim of this study was to examine the differences in the rate, associated factors, and post-traumatic responses to workplace violence between South Korean and Chinese nurses in Hong Kong among East Asian countries. METHODS: A cross-sectional, correlational study design recruited a total of 471 registered nurses (319 South Korean nurses and 152 Chinese nurses in Hong Kong; overall response rate = 78.5%) at online communities in South Korea and Hong Kong. The data were collected by conducting a Qualtrics survey from January 15, 2020, to July 24, 2021. A structured questionnaire was administered for data collection, including rate of workplace violence, perception of workplace violence, attitudes toward workplace violence, coping styles, post-traumatic cognitions, post-traumatic stress disorder, post-traumatic growth, and mental health indicators (depression, anxiety, and stress). T-test, chi-squared, and binary logistic regression analyses were conducted. RESULTS: In our sample, 30.7% South Korean nurses and 31.6% Chinese nurses in Hong Kong had experienced workplace violence. South Korean and Chinese nurses in Hong Kong with experience of workplace violence had lower perceptions of it. Nurses with experience of workplace violence reported lower levels of mental health, and this trend was more prominent among South Korean nurses. CONCLUSIONS: Our study findings showed a positive association between workplace violence and post-traumatic responses in both settings. We found that the close monitoring of post-traumatic responses associated with workplace violence could be improved by enhancing nurses' perception of workplace violence.

Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study.

STUDY OBJECTIVE: We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong. METHODS: We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality. RESULTS: ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality. CONCLUSION: A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.

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.

COVID-19 related fear and depression of pregnant women and new mothers.

OBJECTIVE: To explore factors associated with depression and COVID-19 related fear among pregnant women and new mothers. DESIGN: A cross-sectional survey was conducted in China from July 2020 to July 2021. SAMPLE: A total of 3027 pregnant and new mothers were recruited. MEASUREMENT: Sociodemographic characteristics and the perceptions of the COVID-19 pandemic were collected. The Patient Health Questionnaire-9 (PHQ-9) and the Fear Scale was used to assess the depressive and fear level towards the COVID-19 pandemic, respectively. RESULTS: Approximately 17.2% of the participants had depression (PHQ-9 ≥10). In Hong Kong, participants who perceived that they have increased knowledge to prevent infection were less likely to have depression (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.74-0.94). There was no association between perceived severity if infected and severity of spread and the depression level in our sample. An inverse relationship was found between the COVID-19 related fear level and perceived knowledge to prevent infection (Beta-coefficient [ß] = -0.20; 95% CI = -0.38 to -0.02). CONCLUSION: Public health nurses need to promote accurate and up to date COVID-19 related information at clinical and community settings and implement effective screening for depression and fear symptoms to identify these high-risk groups to improve women's psychological well-being.

The English and Chinese language versions of the Short Form 12-item Health Survey are equivalent.

BACKGROUND: The Short Form 12-item Health Survey (SF-12v2) was originally developed in English, but it is also available in Hong Kong (HK) Chinese. While both language versions had their measurement properties well assessed in their respective populations, their measurement invariance in scores has not been examined. Therefore, we aimed to assess their measurement invariance. METHODS: We conducted a cross-sectional study on individuals aged 18 years or older at a university campus. Those who were bilingual in English and Chinese were randomly assigned to self-complete either the standard English or the HK Chinese SF-12v2. Measurement invariance of the two components and eight scales of the SF-12v2 was concluded if the corresponding 90% confidence interval (CI) for the difference between the two language versions entirely fell within the minimal clinically important difference of ± 3 units. Multiple-group confirmatory factor analysis (CFA) was also performed. RESULTS: A total of 1013 participants completed the SF-12v2 (496 in English and 517 in HK Chinese), with a mean age of 22 years (Range 18-58), and 626 participants (62%) were female. There were no significant differences in demographics. Only the physical and mental components and the mental health (MH) scale had their 90% CIs (0.21 to 1.61, - 1.00 to 0.98, and - 0.86 to 2.84, respectively) completely fall within the ± 3 units. The multiple-group CFA showed partial strict invariance. CONCLUSIONS: The English and HK Chinese versions of the SF-12v2 can be used in studies with their two components and MH scores pooled in the analysis.

Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong.

INTRODUCTION: Health information about COVID-19 has been circulating in social networking sites, including unproven claims that smoking and alcohol drinking could protect against COVID-19. We examined if exposure to such claims was associated with changes in tobacco and alcohol consumption. METHODS: We conducted a population-based, landline and mobile phone survey of 1501 randomly sampled adults aged 18 years or older (47.5% male) in Hong Kong in April 2020. Respondents reported if they had ever seen claims that 'smoking/alcohol drinking can protect against COVID-19' from popular social networking platforms. Current tobacco and alcohol users reported if they had increased or reduced their consumption since the outbreak. Prevalence data were weighted by sex, age and education of the general adult population. RESULTS: 19.0% (95% CI 16.8% to 21.4%) of all respondents reported having seen claims that 'smoking/alcohol drinking can protect against COVID-19' from social networking sites. Multinomial logistic regression showed that exposure to the claims was significantly associated with increased tobacco use (OR 2.37, 95% CI 1.08 to 5.20) in current tobacco users (N=280) and increased alcohol use (OR 4.16, 95% CI 2.00 to 8.67) in current drinkers (N=722), adjusting for sex, age, education level, alcohol/tobacco use status, home isolation, anxiety and depressive symptoms, and survey method. CONCLUSION: Our results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic.

Autonomous motivation explains interprofessional education outcomes.

OBJECTIVES: In response to the observations that interprofessional education (IPE) is seemingly atheoretical or under-theorised, this quantitative research seeks to uncover students' motivational mechanisms which could explain their behavioural and collaborative outcomes using self-determination theory (SDT). While SDT has been studied in various contexts, its applicability to IPE remains underexplored. This study aims to integrate a new perspective in understanding students' motivation in IPE by exploring how the fulfilment of a need for sense of autonomy, competence and relatedness is linked to desirable IPE outcomes. METHODS: Utilising quantitative methods, we involved 255 health care students in Hong Kong from the medical, nursing and pharmacy disciplines enrolled in IPE anticoagulation therapy module. They were invited to respond to the Psychological Need Satisfaction Questionnaire and other measures as part of the post-test. RESULTS: Sense of autonomy emerged as the strongest positive predictor of behavioural (collective dedication, behavioural engagement) and collaboration outcomes (team effectiveness, goal achievement). There were no significant program-level differences across these outcomes except for behavioural engagement for which nursing students had a higher perception than medicine students. CONCLUSIONS: We were able to demonstrate that SDT is a meaningful framework in understanding behavioural and collaboration outcomes in IPE. The major theoretical contribution of this study refers to the ability of students' motivation to explain variance in their behavioural outcomes. That is, sense of autonomy consistently predicted team effectiveness, collective dedication, behavioural engagement and goal achievement. Autonomous motivation among a sample of health care students can explain behavioural outcomes. Theoretical, methodological and practical implications are discussed.

Noise sensitivity associated with nonrestorative sleep in Chinese adults: a cross-sectional study.

BACKGROUND: Nonrestorative sleep is a common sleep disorder with a prevalence ranging from 1.4 to 35%, and is associated with various psychological and physical health issues. Noise exposure and noise sensitivity have been proposed to contribute to nonrestorative sleep. This study aimed to examine the relationships among noise, noise sensitivity, nonrestorative sleep, and physiological sleep parameters in Chinese adults. METHODS: A cross-sectional household survey was conducted with randomly selected Chinese adults based on a frame stratified by geographical districts and types of quarters in Hong Kong. We administered a battery of questionnaires, including the Nonrestorative Sleep Scale, the Weinstein Noise Sensitivity Scale, the ENRICHD Social Support Instrument, the Patient Health Questionnaire, and the Perceived Stress Scale to assess nonrestorative sleep, noise sensitivity, social support, somatic symptoms and stress, respectively. Anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale while sociodemographic and lifestyle characteristics were assessed with an investigator-developed sheet. Nocturnal noise level and physiological sleep parameters were measured during nighttime for a week by noise dosimetry and actigraphy, respectively. A structured multiphase linear regression was conducted to estimate associations. RESULTS: A total of 500 adults (66.4% female) with an average age of 39 years completed this study. Bivariate regressions showed that age, marital status, occupation, family income, season, exercise, cola and soda consumption, social support, somatic symptoms, stress, depression, noise sensitivity, total sleep time, and awakenings were associated with nonrestorative sleep. In the multivariable analysis, family income, season, exercise, social support, somatic symptoms, stress, and depression remained associated with nonrestorative sleep. Specifically, a one-unit increase of noise sensitivity was associated with 0.08 increase in nonrestorative sleep (95% confidence interval [CI]: 0.01, 0.15, p = 0.023). Nocturnal noise was negatively associated with time in bed (b = - 1.65, 95% CI: - 2.77, - 0.52, p = 0.004), total sleep time (b = - 1.61, 95% CI: - 2.59, - 0.62, p = 0.001), and awakenings (b = - 0.16, 95% CI: - 0.30, - 0.03, p = 0.018), but was not associated with nonrestorative sleep. CONCLUSIONS: Nonrestorative sleep was predicted by noise sensitivity in addition to family income, season, exercise, social support, somatic symptoms, stress, and depression.

Indoor nocturnal noise is associated with body mass index and blood pressure: a cross-sectional study.

BACKGROUND: Studies have demonstrated that noise is associated with various health problems, such as obesity and hypertension. Although the evidence of the associations of noise with obesity and hypertension is inconsistent, there seems to be a stronger association of the latter. This study aimed to investigate the associations of noise with body mass index (BMI) and blood pressure in adults living in multi-story residential buildings. METHODS: A cross-sectional study was conducted in Hong Kong from February 2018 to September 2019. The Weinstein Noise Sensitivity Scale, Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered to the participants. BMI and blood pressure were assessed. Nocturnal noise exposure and total sleep duration were measured for a week. RESULTS: Five hundred adults (66.4% female), with an average age of 39 years (range: 18-80), completed the study. The average levels of nocturnal noise, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 51.3 dBA, 22.2 kg/m2, 116.0 mmHg, and 75.4 mmHg, respectively. After adjusting for sociodemographic characteristics, nocturnal noise was associated with BMI (b = 0.54, 95% CI: 0.01 to 1.06, p = 0.045) and SBP (b = 2.90, 95% CI: 1.12 to 4.68, p = 0.001). No association was detected between nocturnal noise and DBP (b = 0.79, 95% CI: - 0.56 to 2.13, p = 0.253). Specifically, higher nocturnal noise was associated with higher BMI (b = 0.72, 95% CI: 0.07 to 1.38, p = 0.031) and SBP (b = 3.91, 95% CI: 2.51 to 5.31, p < 0.001) in females but only higher SBP (b = 3.13, 95% CI: 1.35 to 4.92, p < 0.001) in males. The association between noise and SBP remained significant (b = 2.41, 95% CI: 0.62 to 4.20, p = 0.008) after additionally adjusting for lifestyle, diagnosis of hypertension, psychometric constructs, and sleep. CONCLUSIONS: Indoor nocturnal noise was associated with BMI and blood pressure in females but only blood pressure in males. It is important to control nocturnal noise or use soundproofing materials in buildings to reduce noise exposure.

Effects of Social Networking Service (SNS) Addiction on Mental Health Status in Chinese University Students: Structural Equation Modeling Approach Using a Cross-sectional Online Survey.

BACKGROUND: Although social networking services (SNSs) have become popular among young people, problematic SNS use has also increased. However, little is known about SNS addiction and its association with SNS use patterns and mental health status. OBJECTIVE: This study aims to test the mediating role of SNS addiction between SNS use patterns and mental health status among Chinese university students in Hong Kong (HK). METHODS: An online cross-sectional survey was conducted using a convenience sampling method. In total, 533 university students (323 [66.9%] female, mean age [SD]=20.87 [2.68] years) were recruited from February to March 2019. Multiple linear regression was used to assess the association between SNS use and SNS addiction. Structural equation modeling (SEM) was performed to examine the pathways and associations among SNS use, SNS addiction, psychosocial status, and mental health status (including anxiety and depressive symptoms). RESULTS: A longer time spent on SNSs per day (>3 h), a longer time spent on each SNS access (≥31 min), a higher frequency of SNS access (≤every 30 min), a longer duration of SNS use before sleeping (≥61 min), and a shorter duration from waking to first SNS use (≤5 min) were significantly associated with a higher level of SNS addiction (adjusted beta [aß]=6.03, 95% CI 4.66-7.40; aß=4.99, 95% CI 3.14-6.83; aß=5.89, 95% CI 4.14-7.64; aß=5.92, 95% CI 4.19-7.65; and aß=3.27, 95% CI 1.73-4.82, respectively). SEM showed a significant mediating effect of SNS addiction in the relationship between SNS use and psychosocial status, and mental health status, including an indirect effect (ß=0.63, 95% CI 0.37-0.93) and the total effect (ß=0.44, 95% CI 0.19-0.72), while the direct effect was insignificant (ß=-0.19, 95% CI -0.49 to 0.08). CONCLUSIONS: SNS use patterns were associated with SNS addiction, and SNS addiction mediated the associations between SNS use, psychosocial status, and mental health status of Chinese university students in HK. The findings suggest that screening for and addressing excessive SNS use are needed to prevent SNS addiction and mental distress among young people.

Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study.

BACKGROUND: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. OBJECTIVE: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. METHODS: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. RESULTS: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. CONCLUSIONS: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic.

An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial.

BACKGROUND: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. OBJECTIVE: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called "Smart Girlfriend" for female Chinese university students. METHODS: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses. RESULTS: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI -1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI -5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02). CONCLUSIONS: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach. TRIAL REGISTRATION: ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679.

The development of a shortened, Korean version of the Anticipated Turnover Scale for hospital nurses.

This study was a psychometric validation of a Korean version of the Anticipated Turnover Scale (ATS) involving translation, transcultural adaptation, and validation. We used data from a cross-sectional online survey of 287 Korean practicing nurses in hospitals. Confirmatory factor analysis (CFA) assessed the validity of the one-factor structure that was hypothesized in the original version. We removed any items that did not enhance the scale's reliability and validity. Test and retest reliability was performed on 206 of the nurses who completed the survey again two weeks later. The mean age of the 287 nurses was 33 years, and 278 (97%) of them were female. The final 6-item Korean version of the ATS demonstrated a satisfactory model fit in the CFA (χ2 = 22.67; degree of freedom = 9; goodness-of-fit index= 0.97; comparative fit index = 0.98; Tucker-Lewis Index = 0.97; root mean square error of approximation = 0.07; and standard root mean residual = 0.03). The intraclass correlation coefficient with the test-retest reliability for the 2-week interval was 0.81, with a good internal consistency (Cronbach's alpha = 0.85; McDonald's omega coefficient reliability = 0.92). The 6-item revised ATS is a reliable and valid scale to assess the turnover intention of Korean nurses who work in hospitals. It can be used in an acute setting and predict the anticipated turnover rate for monitoring purposes.

Prevalence and morphological characteristics of disto-lingual roots in mandibular first molars: a cone beam CT study with diagnostic and therapeutic implications.

OBJECTIVES: High prevalence of disto-lingual roots (DLR) at the mandibular molar in Chinese can complicate the management of periodontitis. This study assessed the prevalence and morphological features of mandibular first molar DLR and furcation entrances in a Hong Kong population by analysis of cone beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT including the mandibular 1st molar region were identified from the Prince Philip Dental Hospital archive and analyzed by a single investigator. Morphologic features and location of DLR were studied and presented as 95% confidence intervals. RESULTS: A total of 398 CBCTs with 716 mandibular first molars were analyzed. The prevalence of DLRs in mandibular first molars on subject based was 20.1% (95% C.I. 16.2-24%). DLR was located 44.5° ± 8.9° (95% C.I. 42.8-46.1°) to the mid-lingual of the mandibular first molar, with a bucco-lingual width 3.3 mm ± 0.5 mm (95% C.I. 3.2-3.4 mm). The mesial furcation entrance was located 4.0 mm ± 0.9 mm (95% C.I. 3.8-4.2 mm) apical to the cemento-enamel junction (CEJ) while the distal was 5.2 mm ± 1.3 mm (95% C.I. 5.0-5.4 mm) from the CEJ. The surface area of the DLR was 106.9 mm2 ± 41.2 mm2 (95% C.I. 98.9-114.8 mm2). CONCLUSIONS: Chinese population has a high prevalence of DLRs. The present information is critical for understanding the morphological features of DLR and guide diagnosis and treatment of stage III periodontitis as well as for secondary prevention and supportive care of stage II periodontitis. CLINICAL RELEVANCE: Little is known about the location and morphology of disto-lingual roots of mandibular 1st molars, yet they are frequently present in patients with Chinese ethnic background, thus complicating diagnosis and treatment. The present study utilized CBCT to analyze the prevalence and morphological features of the mandibular first molar DLR and furcation entrance. It is the first study reporting on the position of the DLR, degree of separation of the furcation, and the surface area of the DLR.

Exploring the role of simulation to foster interprofessional teamwork among medical and nursing students: A mixed-method pilot investigation in Hong Kong.

Effective teamwork is a critical component of maintaining patient safety. However, there is lack of clarity on the best teaching approach to interprofessional teamwork training in medical and nursing curricula. This study aimed to compare the effects of blended classroom plus clinical simulation versus clinical simulation alone on teamwork attitudes, perceptions and performance in medical and nursing students in Hong Kong. This was a pilot study with a mixed-method research design, with both quantitative and qualitative evaluations. Students who studied medicine or nursing courses at a university in Hong Kong were invited to this study. They were assigned into two groups: clinical simulation alone versus blended classroom plus clinical simulation. The primary outcome was attitudinal change related to teamwork behaviours, which was measured using the Human Factors Attitude Survey. The secondary outcomes were perceptions of team-based learning and teamwork performance, which were accessed by the Team-Based Learning Student Assessment Instrument and Ottawa Global Rating Scale, respectively. Four focus group interviews were conducted after the training sessions. Conventional content analysis using inductive coding was performed with the qualitative data. Forty-six students participated in this study. There was a significant increase in the participants' positive attitudes on teamwork for both groups (intervention: MD = 5.36 and control: MD = 3.6, p <.05); however, there was no significant difference on increasing positive attitudes between the groups (estimate = 1.76, 95% CI [-8.59, 5.06], p = .61). Qualitative analysis identified four themes: (1) reconsidering professional roles in managing patients; (2) embodying the experience to share responsibility and complement each other's skills; (3) realizing the importance of trust and communication; and (4) engaging to achieve the mission within a limited time. This pilot study found that a blended classroom did not further improve teamwork attitudes, perceptions and performance in medical and nursing students compared with clinical simulation alone. Qualitative findings showed that students had reconsidered their professional roles in managing patients and realized the importance of teamwork in caring patients.