Effects of a structured Tai Chi program on improving physical activity levels, exercise self-efficacy and health outcomes among pregnant women: study protocol for a randomised controlled trial.

INTRODUCTION: Tai Chi is a traditional Chinese martial art developed over 300 years ago. Although studies report that Tai Chi benefits practitioners' cardiovascular health, respiratory system and psychological outcomes, only limited studies have evaluated the effects of Tai Chi on pregnant women. More evidence is needed to examine the effects of a Tai Chi exercise programme among pregnant women. METHODS AND ANALYSIS: This is a randomised controlled trial to investigate the effects of a 12-week theory-based Tai Chi programme on improving physical activity levels, exercise self-efficacy and health outcomes among pregnant women. A total of 136 low-risk pregnant women (68 per group) were recruited and randomly assigned to receive usual care or usual care with the Tai Chi programme consisting of two group-based educational sessions and three Tai Chi sessions over 3 months. A Tai Chi video was provided to the participants to facilitate self-practice at home. Outcomes including physical activity levels, exercise self-efficacy, weight gain, prenatal depressive symptoms and prenatal anxiety symptoms were evaluated at baseline (T0), 6th week after intervention commencement (T1) and 1 week after intervention completion (ie, post-intervention) (T2). Intention-to-treat analysis and generalised estimating equations model will be used to analyse repeated outcome measures. ETHICS AND DISSEMINATION: The study has been approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (Ref. 2022.043-T). Written consent was obtained from each participant. The findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: ChiCTR2200059920.

Tailored Sitting Tai Chi Program for Subacute Stroke Survivors: A Randomized Controlled Trial.

BACKGROUND: The initiation of exercise during rehabilitation at the subacute stage could provide stroke survivors with an approach to recovery that capitalizes on unique physiological conditions and promotes spontaneous recovery. We aimed to examine the effects of a tailored sitting Tai Chi program on recovery outcomes among subacute stroke survivors. METHODS: We conducted a 12-week assessor-blind randomized controlled trial in China. Subacute stroke survivor-caregiver dyads were recruited and randomly assigned to either the sitting Tai Chi group (n=80) or attention control group (n=80). Outcomes including upper limb function (Fugl-Meyer Assessment Upper Extremity & Wolf Motor Function Test), balance control (Berg Balance Scale), sitting balance control (Trunk Impairment Scale), depressive symptoms (Geriatric Depression Scale Short Form), shoulder range of motion, shoulder pain (ShoulderQ), activities of daily living (Modified Barthel Index), and quality of life (Stroke Specific Quality of Life Scale) were measured at baseline, in-process, immediately post, and 4-week postintervention. RESULTS: Immediately postintervention, the sitting Tai Chi group (n=69) showed significant upper limb function improvement in the primary outcomes including the performance time (regression coefficient of the group-by-time interaction, B=-21.415 [95% CI, -31.000 to -11.831]) and functional ability (B=10.146 [95% CI, 4.886-15.406]) domains of the Wolf Motor Function Test, balance control (B, 4.972 [95% CI, 1.356-8.588]), and sitting balance control (B=4.397 [95% CI, 2.699-6.096]). Compared with the control group (n=65), improvements were also observed in secondary outcomes including depressive symptoms (B=-1.626 [95% CI, -2.304 to -0.948]), shoulder extension (B=4.518 [95% CI, 0.893-8.144]), activities of daily living (B=5.510 [95% CI, 0.450-10.569]), and quality of life (B=15.680 [95% CI, 7.255-24.105]). CONCLUSIONS: The results support the effectiveness of a tailored sitting Tai Chi program in improving recovery outcomes among subacute stroke survivors and provide additional knowledge to support the clinical implementation of such a program. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04138407.

Perioperative enhanced recovery programmes for women with gynaecological cancers.

BACKGROUND: Gynaecological cancers account for 15% of newly diagnosed cancer cases in women worldwide. In recent years, increasing evidence demonstrates that traditional approaches in perioperative care practice may be unnecessary or even harmful. The enhanced recovery after surgery (ERAS) programme has therefore been gradually introduced to replace traditional approaches in perioperative care. There is an emerging body of evidence outside of gynaecological cancer which has identified that perioperative ERAS programmes decrease length of postoperative hospital stay and reduce medical expenditure without increasing complication rates, mortality, and readmission rates. However, evidence-based decisions on perioperative care practice for major surgery in gynaecological cancer are limited. This is an updated version of the original Cochrane Review published in Issue 3, 2015. OBJECTIVES: To evaluate the beneficial and harmful effects of perioperative enhanced recovery after surgery (ERAS) programmes in gynaecological cancer care on length of postoperative hospital stay, postoperative complications, mortality, readmission, bowel functions, quality of life, participant satisfaction, and economic outcomes. SEARCH METHODS: We searched the following electronic databases for the literature published from inception until October 2020: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PubMed, AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, and four Chinese databases including the China Biomedical Literature Database (CBM), WanFang Data, China National Knowledge Infrastructure (CNKI), and Weipu Database. We also searched four trial registration platforms and grey literature databases for ongoing and unpublished trials, and handsearched the reference lists of included trials and accessible reviews for relevant references. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared ERAS programmes for perioperative care in women with gynaecological cancer to traditional care strategies. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for inclusion, extracted the data and assessed methodological quality for each included study using the Cochrane risk of bias tool 2 (RoB 2) for RCTs. Using Review Manager 5.4, we pooled the data and calculated the measures of treatment effect with the mean difference (MD), standardised mean difference (SMD), and risk ratio (RR) with a 95% confidence interval (CI) to reflect the summary estimates and uncertainty. MAIN RESULTS: We included seven RCTs with 747 participants. All studies compared ERAS programmes with traditional care strategies for women with gynaecological cancer. We had substantial concerns regarding the methodological quality of the included studies since the included RCTs had moderate to high risk of bias in domains including randomisation process, deviations from intended interventions, and measurement of outcomes. ERAS programmes may reduce length of postoperative hospital stay (MD -1.71 days, 95% CI -2.59 to -0.84; I2 = 86%; 6 studies, 638 participants; low-certainty evidence). ERAS programmes may result in no difference in overall complication rates (RR 0.71, 95% CI 0.48 to 1.05; I2 = 42%; 5 studies, 537 participants; low-certainty evidence). The certainty of evidence was very low regarding the effect of ERAS programmes on all-cause mortality within 30 days of discharge (RR 0.98, 95% CI 0.14 to 6.68; 1 study, 99 participants). ERAS programmes may reduce readmission rates within 30 days of operation (RR 0.45, 95% CI 0.22 to 0.90; I2 = 0%; 3 studies, 385 participants; low-certainty evidence). ERAS programmes may reduce the time to first flatus (MD -0.82 days, 95% CI -1.00 to -0.63; I2 = 35%; 4 studies, 432 participants; low-certainty evidence) and the time to first defaecation (MD -0.96 days, 95% CI -1.47 to -0.44; I2 = 0%; 2 studies, 228 participants; low-certainty evidence). The studies did not report the effects of ERAS programmes on quality of life. The evidence on the effects of ERAS programmes on participant satisfaction was very uncertain due to the limited number of studies. The adoption of ERAS strategies may not increase medical expenditure, though the evidence was of very low certainty (SMD -0.22, 95% CI -0.68 to 0.25; I2 = 54%; 2 studies, 167 participants). AUTHORS' CONCLUSIONS: Low-certainty evidence suggests that ERAS programmes may shorten length of postoperative hospital stay, reduce readmissions, and facilitate postoperative bowel function recovery without compromising participant safety. Further well-conducted studies are required in order to validate the certainty of these findings.

Sarcopenia risk and associated factors among Chinese community-dwelling older adults living alone.

Sarcopenia, defined as a progressive loss of muscle mass and reduced muscle strength and functional capacity, is common among older adults. This study aimed to assess the proportion of people at risk of sarcopenia and probable sarcopenia among Chinese community-dwelling older adults living alone and to identify the associated factors. A total of 390 older adults were included in this study. Sarcopenia and probable sarcopenia were defined according to the criteria of the Asian Working Group for Sarcopenia 2019. Data on socio-demographic characteristics, health status, health behaviours and lifestyle characteristics, nutritional status, physical activity level, and depressive symptoms were collected. The association between these characteristics and sarcopenia risk was analysed using a multivariate ordinal logistic regression. The proportion of subjects at risk of sarcopenia and probable sarcopenia was found to be 57.7% and 30%, respectively. Older age, being malnourished and being at risk of malnutrition were significantly associated with sarcopenia risk. Being educated to secondary level or above, being overweight or obese and higher physical activity level were associated with decreased sarcopenia risk. Our results showed that older adults living alone were at high risk of developing sarcopenia and probable sarcopenia. These results emphasise the urgent need to initiate aggressive screening and holistic lifestyle therapeutic intervention strategies for this high-risk population.

Effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome: A systematic review.

OBJECTIVES: This systematic review evaluated the effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome (MetS). METHODS: Randomized controlled trials (RCTs) were searched in 10 databases. Data were statistically pooled for meta-analysis. RESULTS: Twenty RCTs were included. One study involved adults with MetS, and the other 19 studies involved adults with at least one risk factor for MetS. Tai Chi was found to reduce waist circumference and increase high-density lipoprotein cholesterol in obese adults. Tai Chi also reduces waist circumference, body mass index, blood glucose level, insulin resistance, and increases the quality of life (QoL) in adults with elevated blood glucose/type 2 diabetes (T2DM). Among participants with hypertension, Tai Chi improves blood pressure, lipid profiles, anxiety, depression, and physical QoL. CONCLUSIONS: Tai Chi may be effective for enhancing the physiological and psychosocial wellbeing of community-dwelling adults at risk of MetS. Further RCTs are needed to examine its effects in adults with MetS and identify optimal regimes.

Psychometric Properties of the Translated Tai Chi Exercise Self-Efficacy Scale for Chinese Adults with Coronary Heart Disease or Risk Factors.

Tai Chi is an effective exercise option for individuals with coronary heart disease or its associated risk factors. An accurate and systematic assessment of a Mandarin-speaking adults' self-efficacy in maintaining Tai Chi exercise is lacking. Mandarin Chinese has the most speakers worldwide. This study aimed to translate the Tai Chi Exercise Self-Efficacy scale and examine its psychometric properties. The 14-item Tai Chi Exercise Self-Efficacy scale was translated from English into Mandarin Chinese using a forward-translation, back-translation, committee approach, and pre-test procedure. Participants with coronary heart disease or risk factors (n = 140) enrolled in a cross-sectional study for scale validation. Confirmatory factor analysis indicated a good fit of the two-factor structure (Tai Chi exercise self-efficacy barriers and performance) to this sample. The translated scale demonstrated high internal consistency, with a Cronbach's α value of 0.97, and good test-retest reliability, with an intra-class correlation coefficient of 0.86 (p < 0.01). Participants with prior Tai Chi experience reported significantly higher scores than those without (p < 0.001), supporting known-group validity. A significant correlation was observed between the translated scale and total exercise per week (r = 0.37, p < 0.01), providing evidence of concurrent validity. The Mandarin Chinese version of the Tai Chi Exercise Self-Efficacy scale is a valid and reliable scale for Chinese adults with coronary heart disease or risk factors.

The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility: A systematic review and meta-analysis.

BACKGROUND: Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in negative consequences on an individual's physical and psychosocial functions. Sitting Tai Chi, a derivative form of traditional Tai Chi, has been found to increase the flexibility of all joints involved and enhance the ability to perform physical activity. However, the evidence of sitting Tai Chi on physical and psychosocial health outcomes on individuals with impaired physical mobility is limited. OBJECTIVES: To critically synthesize evidence that evaluates the effects of sitting Tai Chi on health outcomes among individuals with impaired physical mobility and to identify implementation strategies for the sitting Tai Chi intervention. METHODS: Searches were performed across 11 English and two Chinese databases systematically from inception to January 2020. Randomised controlled trials and non-randomised controlled trials, written in English or Chinese were included. Two independent reviewers screened all eligible studies, appraised risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were performed where meta-analysis was inappropriate. The certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool. This study was registered in PROSPERO. RESULTS: A total of 1,446 records were generated and 11 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favouring sitting Tai Chi on depressive symptoms (SMD: -1.53, 95% CI: -2.81 to -0.21, 2 studies; very low quality), heart rate (MD: -5.72, 95% CI: -11.16 to -0.29, 2 studies; low quality) and social domain of quality of life (MD: 1.42, 95% CI: 0.66 to 2.19, 3 studies; low quality). CONCLUSIONS: Sitting Tai Chi was found to have favourable effects on depressive symptoms, heart rate, and social domain of quality of life of individuals with impaired physical mobility. Very low to low quality evidence does not support the effectiveness of sitting Tai Chi on dynamic sitting balance, handgrip strength, and the physical and psychological domains of quality of life. There was limited evidence to suggest the best implementation strategies for the sitting Tai Chi intervention. It is anticipated that more well-designed studies will continue developing high quality evidence in this field.

Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke.

BACKGROUND: The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke. METHODS: A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test-retest reliability, internal consistency, equivalence, and content, criterion, and construct validity. RESULTS: Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs = 0.81, p < 0.001) or Modified Barthel Index (rs = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke. CONCLUSIONS: The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.

Translation and validation of the Traditional Chinese version of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (Version 2).

BACKGROUND: Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. This study aimed to translate the COST-FACIT (Version 2) [COST-FACIT-v2] instrument into traditional Chinese (COST-FACIT-v2 [TC]) and evaluate its psychometric properties. METHODS: The Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. The translated version was reviewed by an expert panel and by 20 cancer patients for content validity and face validity, respectively, and 640 cancer patients, recruited from three oncology departments, completed the translated scale. Its reliability was evaluated in terms of internal consistency and test-retest reliability. Confirmatory factor analysis has been used to evaluate the one- and two-factor structures of the instrument reported in the literature. The convergent validity was examined by the correlation with health-related quality of life (HRQoL) and psychological distress. Known-group validity was examined by the difference in the COST-FACIT-v2 (TC) total mean score between groups with different income levels and frequency of health care service use. RESULTS: The COST-FACIT-v2 (TC) showed good content and face validity and demonstrated high internal consistency (Cronbach's alpha, 0.86) and acceptable test-retest reliability (intraclass correlation coefficient, 0.71). Confirmatory factor analysis showed that the one- and two-factor structures of the instrument that have been reported in the literature could not be satisfactorily fitted to the data. Psychological distress correlated significantly with the COST-FACIT-v2 (TC) score (r = 0.47; p < 0.001). HRQOL showed a weak to moderate negative correlation with the COST-FACIT-v2 (TC) score (r = - 0.23 to - 0.46; p < 0.001). Significant differences were seen among the COST-FACIT-v2 (TC) scores obtained in groups of different income level and frequency of health care service use. CONCLUSIONS: The COST-FACIT-v2 (TC) showed some desirable psychometric properties to support its validity and reliability for assessing cancer patients' level of financial toxicity.

The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility.

BACKGROUND: Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS: Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS: A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION: This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER: CRD 42019142681.

The Role of Five Facets of Mindfulness in a Mindfulness-Based Psychoeducation Intervention for People With Recent-Onset Psychosis on Mental and Psychosocial Health Outcomes.

Objective: This study aimed to examine how five facets of mindfulness may be associated with the changes in psychotic patients' health outcomes after participating in a mindfulness-based psychoeducation group (MBPEG) program. Methods: Longitudinal follow-up data from two pragmatic randomized controlled trials of MBPEG for psychotic patients were used for this study. A total of 124 patients who completed the MBPEG program were included in this analysis. Patient outcomes (psychotic symptoms, functioning, insight into illness/treatment, subjective recovery) and five facets of mindfulness were assessed at baseline and six, 12 and 24 months post-intervention. Areas under the curve of individual outcomes in repeated-measures were computed using trapezoidal method, rescaled to the original possible range of the underlying variable and used for correlation and regression analyses. Results: All mean scores of the five facets increased across time and were significantly correlated with the improvements in all patient outcomes (p-values ranged from <0.001 to <0.05), except "non-judging" facet and symptom severity. Regression analyses revealed that only "observing" and "acting with awareness" were significantly associated with positive changes across all outcomes (increase in adjusted R 2 ranged from 5.9% to 24.2%, p < 0.001). Conclusions: Two facets of mindfulness, "observing" and "acting with awareness," were related to positive outcomes of psychotic patients after participating in the MBPEG. More efforts in addressing these two facets of mindfulness can be considered to increase the efficacy of mindfulness-based interventions in psychosis.

The effectiveness of a nurse-led short term life review intervention in enhancing the spiritual and psychological well-being of people receiving palliative care: A mixed method study.

BACKGROUND: A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists. OBJECTIVES: This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression. DESIGN: A sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment. SETTINGS: The study was conducted in three publicly funded regional hospitals in Hong Kong. PARTICIPANTS: The target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team. METHODS: Two sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants. RESULTS: A total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen's d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8%) and participated in the intervention (79.6%). The participants described the intervention process as 'comfortable', 'relaxing' and 'interesting', and felt enlightened, with raised self-awareness, after it. CONCLUSION: The nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses' performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice.

Effects of therapeutic play on children undergoing cast-removal procedures: a randomised controlled trial.

OBJECTIVES: To examine (1) the effectiveness of therapeutic play in reducing anxiety and negative emotional manifestations among children undergoing cast-removal procedures and (2) the satisfaction of parents and cast technicians with cast-removal procedures. DESIGN: A randomised controlled trial. SETTING: An orthopaedic outpatient department of a regional teaching hospital in Hong Kong. PARTICIPANTS: Children (n=208) aged 3-12 undergoing cast-removal procedure were invited to participate. INTERVENTIONS: Eligible children were randomly allocated to either the intervention (n=103) or control group (n=105) and stratified by the two age groups (3-7 and 8-12 years). The intervention group received therapeutic play intervention, whereas the control group received standard care only. Participants were assessed on three occasions: before, during and after completion of the cast-removal procedure. OUTCOME MEASURES: Children's anxiety level, emotional manifestation and heart rate. The satisfaction ratings of parents and cast technicians with respect to therapeutic play intervention were also examined. RESULTS: Findings suggested that therapeutic play assists children aged 3-7 to reduce anxiety levels with mean differences between the intervention and control group was -20.1 (95% CI -35.3 to -4.9; p=0.01). Overall, children (aged 3-7 and 8-12) in the intervention groups exhibited fewer negative emotional manifestations than the control group with a mean score difference -2.2 (95% CI -3.1 to -1.4; p<0.001). Parents and technicians in the intervention group also reported a higher level of satisfaction with the procedures than the control group with a mean score difference of 4.0 (95% CI -5.6 to 2.3; p<0.001) and 2.6 (95% CI 3.7 to 1.6; p<0.001), respectively. CONCLUSION: Therapeutic play effectively reduces anxiety and negative emotional manifestations among children undergoing cast-removal procedures. The findings highlight the importance of integrating therapeutic play into standard care, in particular for children in younger age. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-15006822; Pre-results.

Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review.

BACKGROUND: Poststroke shoulder pain limits stroke survivors' physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain. METHODS: Fourteen English and Chinese databases were searched for data from January 2009 to August 2017. The review included adult participants with a clinical diagnosis of ischemic or hemorrhagic stroke who had developed shoulder pain and had undergone conventional acupuncture, electroacupuncture, fire needle acupuncture, or warm needle acupuncture. The participants in the comparison group received the usual stroke care only. RESULTS: Twenty-nine randomized controlled trials were included. Most studies were assessed as having a substantial risk of bias. Moreover, due to the high heterogeneity of the acupuncture therapies examined, pooling the results in a meta-analysis was not appropriate. A narrative summary of the results is thus presented. The review showed that conventional acupuncture can be associated with benefits in reducing pain and edema and improving upper extremity function and physical function. The effects of conventional acupuncture on improving shoulder range of motion (ROM) are in doubt because this outcome was only examined in two trials. Electroacupuncture might be effective in reducing shoulder pain and improving upper extremity function, and conclusions on the effects of electroacupuncture on edema, shoulder ROM, and physical function cannot be drawn due to the limited number of eligible trials. The evidence to support the use of fire needle or warm needle acupuncture in stroke survivors with shoulder pain is also inconclusive due to the limited number of studies. CONCLUSION: Although most studies reviewed concluded that conventional and electroacupuncture could be effective for management of shoulder pain after stroke, the very high potential for bias should be considered. Further work in this area is needed that employs standardized acupuncture treatment modalities, endpoint assessments, and blinding of treatments.

Media exposure related to the 2008 Sichuan Earthquake predicted probable PTSD among Chinese adolescents in Kunming, China: A longitudinal study.

OBJECTIVE: This study examined the prevalence and the psychosocial predictors of probable PTSD among Chinese adolescents in Kunming (approximately 444 miles from the epicenter), China, who were indirectly exposed to the Sichuan Earthquake in 2008. METHOD: Using a longitudinal study design, primary and secondary school students (N = 3577) in Kunming completed questionnaires at baseline (June 2008) and 6 months afterward (December 2008) in classroom settings. Participants' exposure to earthquake-related imagery and content, perceptions and emotional reactions related to the earthquake, and posttraumatic stress symptoms were measured. Univariate and forward stepwise multivariable logistic regression models were fit to identify significant predictors of probable PTSD at the 6-month follow-up. RESULTS: Prevalences of probable PTSD (with a Children's Revised Impact of Event Scale score ≥30) among the participants at baseline and 6-month follow-up were 16.9% and 11.1% respectively. In the multivariable analysis, those who were frequently exposed to distressful imagery had experienced at least two types of negative life events, perceived that teachers were distressed due to the earthquake, believed that the earthquake resulted from damages to the ecosystem, and felt apprehensive and emotionally disturbed due to the earthquake reported a higher risk of probable PTSD at 6-month follow-up (all ps < .05). CONCLUSION: Exposure to distressful media images, emotional responses, and disaster-related perceptions at baseline were found to be predictive of probable PTSD several months after indirect exposure to the event. Parents, teachers, and the mass media should be aware of the negative impacts of disaster-related media exposure on adolescents' psychological health. (PsycINFO Database Record

The Effect of Upper Limb Massage on Infants' Venipuncture Pain.

The purpose of the study was to investigate the effect of upper limb massage on relieving pain among infants undergoing venipuncture in Hong Kong. This study was a crossover, double-blind, randomized controlled trial. Eighty infants at the neonatal intensive care unit were randomly assigned to 2 groups in different order to receive interventions. The massage first group (N = 40) received 2-minute massage before venipuncture on the first occasion then received usual care (control) on the second occasion, and vice versa in the massage second group (N = 40). The infants' behavior and physiological responses were recorded on two occasions: (1) right after the intervention and (2) during the first 30 seconds of venipuncture procedure. The mean pain scores (Premature Infant Pain Profile) were significantly lower in infants who received massage (massage first: 6.0 [standard deviation = 3.3]; massage second: 7.30 [standard deviation = 4.4]) versus control (massage first: 12.0 [standard deviation = 4.3]; massage second: 12.7 [standard deviation = 3.1]). The crude and adjusted generalized estimating equations model showed that the infants had significantly lower pain score when receiving massage as compared to receiving the control treatment, and there were no significant time and carryover effects: -6.03 (95% confidence interval: -7.67 to -4.38), p < .001 and -5.96 (95% confidence interval: -7.56 to -4.36), p < .001, respectively. Upper limb massage may be effective in decreasing infants' venipuncture pain perception.

Effects of mind-body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: A systematic review and meta-analysis.

OBJECTIVES: The effects of mind-body exercises on individuals with chronic illnesses have attracted increasing attention. However, little effort had been made to systematically review the effects of these mind-body exercises on individuals with Parkinson's disease (PD). This review aimed to appraise the current evidence of the effects of mind-body exercises on the physiological and psychological outcomes for the PD population. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: Four English databases, namely, the EMBASE, Ovid Medline, Psych Info, and Cochrane Library, were searched on January 2016. REVIEW METHODS: Studies involving participants with idiopathic PD were included if mind-body exercises were applied and compared with a non-exercise control to improve physiological and psychosocial well-being. The Effective Public Health Practice Project quality assessment tool was used for quality appraisal. RevMan 5.3 was employed to perform this meta-analysis. A subgroup analysis regarding the types and the dose of intervention was conducted to explore the sources of heterogeneity. RESULTS: Ten studies met the inclusion criteria for quality appraisal. The overall methodological rating of these studies indicated that one study was strong; five studies were moderate; and four studies were weak. Nine articles comprising five Tai Chi, two yoga, and two dance studies were included in the meta-analysis. The results of this review showed that mind-body exercises had a large, significant beneficial effect in motor symptoms in terms of UPDRS III for people with mild to moderate PD [SMD=-0.91, 95% CI (-1.37, -0.45), p<0.05]. Significant subgroup differences were found among various types of mind-body exercises (p=0.001). Yoga demonstrated the largest and most significant beneficial effect in reducing UPDRS III scores [SMD=-2.35, 95% CI (-3.21, -1.50), p<0.01]. The pooled meta-analysis results showed that mind-body exercises had a large, significant effect in improving postural instability in terms of the Berg Balance Scale [SMD=1.48, 95% CI (0.91, 2.06), p<0.01] and Timed Up and Go test [SMD=-0.97, 95% CI (-1.46, -0.47), p<0.01] and moderate, significant effect in improving functional mobility in terms of the Six-minute Walk test [SMD=0.78, 95% CI (0.35, 1.21), p<0.05]. CONCLUSIONS: This review found that mind-body exercises demonstrated immediate moderate to large beneficial effects on motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD. However, the effects of mind-body exercises on psychosocial well-being had not been amply investigated, especially for yoga intervention. Future research should address the psychosocial effects of mind-body exercises on the PD population.

Examining the Cervical Screening Behaviour of Women Aged 50 or above and Its Predicting Factors: A Population-Based Survey.

Under-screening may increase the risk of cervical cancer in middle-aged women. This study aimed to investigate cervical cancer screening behaviour and its predictors among women aged 50 years or above. A population-based sample of 959 women was recruited by telephone from domestic households in Hong Kong, using random methods, and a structured questionnaire developed to survey participants. Multivariable logistic regressions were performed to examine the factors independently associated with cervical screening behaviour. Nearly half the sample (48%) had never had a cervical smear test. Multivariable analyses showed that age, educational level, marital status, family history of cancer, smoking status, use of complementary therapy, recommendation from health professionals, and believing that regular visits to a doctor or a Chinese herbalist were good for their health were predictors of cervical screening behaviour. Misconceptions concerned with menopause may reduce women's perceived susceptibility to cervical cancer, especially if they are 50 or above, and exert a negative effect on their screening behaviour. Healthcare professionals should actively approach these high-risk groups-older unmarried women, smokers, those less educated and who are generally not much concerned with their health.

Comparison Study of Uptake of Colorectal Cancer Testing between Ethnic Minorities and the General Population in Hong Kong.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers. This study aimed to compare the uptake of CRC testing in the general public and in ethnic minorities in Hong Kong. MATERIALS AND METHODS: This cross-sectional survey covered 2,327 South Asian and Chinese adults aged over 50, recruited from two separate studies. A structured questionnaires were administered by research staff over the telephone or in face- to-face interviews. RESULTS: The uptake rate of CRC testing among South Asians was significantly lower than that of the general population in Hong Kong. Factors associated with the uptake rate were health professional's recommendation, perception of regular visits to doctor, use of complementary therapy, ethnicity, perceived susceptibility to cancer, presence of chronic illness, and education level. In addition, a significant interaction (p<0.05) between ethnicity and health professionals' recommendations was found, after adjustment for the main independent factors identified. CONCLUSIONS: Older people with lower educational attainment, without chronic illness and those have lower perceived susceptibility to cancer may be targeted for CRC testing promotion in the society. In addition, health professionals can play a highly influential role in promoting such testing, particularly among ethnic minorities.

Uptake of prostate cancer screening and associated factors among Chinese men aged 50 or more: a population-based survey.

OBJECTIVE: To investigate the uptake rate of prostate specific antigen (PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test. METHODS: A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis. RESULTS: A total of 1,002 men aged 50 or above took part in the study (response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing. CONCLUSION: The uptake rate of PSA testing in the study population was very low. Among all the factors identified, recommendations from health professionals had the strongest association with the uptake of PSA testing, and they should therefore take an active role in educating this population about cancer prevention and detection.