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.

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.

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.

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.

The safe use of dating applications among men who have sex with men: a study protocol for a randomised controlled trial to evaluate an interactive web-based intervention to reduce risky sexual behaviours.

BACKGROUND: Notably, both international and local studies have found a high prevalence of sexually transmitted infections (STIs) and risky sexual behaviours, such as condomless anal sex, substance misuse in conjunction with sex ('chemsex') and group sex, among men who have sex with men (MSM) dating application (app) users. Although the use of dating apps is an emerging sexual risk factor, little effort has been expended on the promotion of safe sex and good sexual health among the users of those apps. Therefore, the aim of the proposed study is to develop and evaluate the effectiveness of an interactive web-based intervention in improving the sexual health of MSM dating app users in Hong Kong. METHODS: A two-armed randomised controlled trial will be conducted. Chinese MSM dating app users will be recruited and randomly allocated into either the intervention (n = 200) or control group (n = 200). Subjects in the intervention group will receive the web-based intervention containing interactive content that (1) encourages a positive attitude towards consistent condom use and HIV/STI testing and negative attitude towards chemsex and group sex; (2) positions condom use and regular HIV/STI testing as normative; and (3) targets improved perceived self-efficacy concerning condom use and negotiation and HIV/STI testing. The control group will receive only web-based information without sexual health components. Subjects in both groups will be evaluated at baseline and three and 6 months after baseline. The primary outcome will be the frequency of condomless anal sex in the past 3 months. DISCUSSION: The proposed study will aid development of culturally relevant health promotion programmes aimed at minimising the potential harm of dating app use and promoting the sexual health of MSM dating app users. The web-based intervention, if found successful, will have important clinical and policy implications, as it can be adopted by the government and non-governmental organisations targeting MSM. Moreover, the proposed intervention can reach many MSM at relatively low cost, and thus has the potential to check the burgeoning HIV/STI epidemic among MSM in Hong Kong in a cost-effective manner. TRIAL REGISTRATION: International standard randomized controlled trial number (ISRCTN) registry: ISRCTN16681863 registered on 28 April 2020.

Impact of National Containment Measures on Decelerating the Increase in Daily New Cases of COVID-19 in 54 Countries and 4 Epicenters of the Pandemic: Comparative Observational Study.

BACKGROUND: Coronavirus disease (COVID-19) is a worldwide epidemic, and various countries have responded with different containment measures to reduce disease transmission, including stay-at-home orders, curfews, and lockdowns. Comparative studies have not yet been conducted to investigate the impact of these containment measures; these studies are needed to facilitate public health policy-making across countries. OBJECTIVE: The aim of this study was to describe and evaluate the impact of national containment measures and policies (stay-at-home orders, curfews, and lockdowns) on decelerating the increase in daily new cases of COVID-19 in 54 countries and 4 epicenters of the pandemic in different jurisdictions worldwide. METHODS: We reviewed the effective dates of the national containment measures (stay-at-home order, curfew, or lockdown) of 54 countries and 4 epicenters of the COVID-19 pandemic (Wuhan, New York State, Lombardy, and Madrid), and we searched cumulative numbers of confirmed COVID-19 cases and daily new cases provided by health authorities. Data were drawn from an open, crowdsourced, daily-updated COVID-19 data set provided by Our World in Data. We examined the trends in the percent increase in daily new cases from 7 days before to 30 days after the dates on which containment measures went into effect by continent, World Bank income classification, type of containment measures, effective date of containment measures, and number of confirmed cases on the effective date of the containment measures. RESULTS: We included 122,366 patients with confirmed COVID-19 infection from 54 countries and 24,071 patients from 4 epicenters on the effective dates on which stay-at-home orders, curfews, or lockdowns were implemented between January 23 and April 11, 2020. Stay-at-home, curfew, and lockdown measures commonly commenced in countries with approximately 30%, 20%, or 10% increases in daily new cases. All three measures were found to lower the percent increase in daily new cases to <5 within one month. Among the countries studied, 20% had an average percent increase in daily new cases of 30-49 over the seven days prior to the commencement of containment measures; the percent increase in daily new cases in these countries was curbed to 10 and 5 a maximum of 15 days and 23 days after the implementation of containment measures, respectively. CONCLUSIONS: Different national containment measures were associated with a decrease in daily new cases of confirmed COVID-19 infection. Stay-at-home orders, curfews, and lockdowns curbed the percent increase in daily new cases to <5 within a month. Resurgence in cases within one month was observed in some South American countries.

Association between early-term birth and breastfeeding initiation, duration, and exclusivity: A systematic review.

BACKGROUND: Infants born early-term, between 37 weeks, 0 days and 38 weeks, 6 days of gestation, are more likely to have adverse health outcomes and to undergo interventions that could pose barriers to breastfeeding. The objectives of this review are to examine the effect of early-term birth on breastfeeding initiation and the duration of any and exclusive breastfeeding. METHODS: We systematically searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and Scopus, from January 2007 to June 2017, for studies examining the associations between early-term birth and rates of breastfeeding initiation and the duration of any and exclusive breastfeeding. RESULTS: Nine studies were included in the review, of which four assessed breastfeeding initiation rates, eight assessed any breastfeeding duration and two assessed exclusive breastfeeding duration. Two studies found that early-term birth was associated with a lower rate of breastfeeding initiation and five studies reported an association between early-term birth and breastfeeding cessation. One study found that early-term birth was associated with a shorter duration of exclusive breastfeeding. CONCLUSION: Although the majority of the reviewed studies reported that early-term infants were less likely to be breastfed and were more likely to be breastfed for a shorter duration, study quality varied and the duration of follow-up was short. Further research with longer follow-up would be beneficial to better understand the effect of early-term birth on breastfeeding.

Accessing health care: Experiences of South Asian ethnic minority women in Hong Kong.

The aim of the present qualitative study was to understand the experiences of South Asian ethnic minority women in accessing health-care services in Hong Kong, a Chinese-oriented society. Levesque's framework (2013) was adopted to conduct and analyze focus group discussions among 30 South Asian women aged between 21 and 72 years, who came from India, Nepal, and Pakistan. The overarching theme was identified as disengagement between South Asian women and the health-care system, with the following five themes: attitude and awareness, sociocultural factors, time constraints, financial burdens, and inadequate interaction. These were linked to barriers affecting South Asian women's ability to access health care, the common challenges encountered being those related to language, culture, and communication. Lengthy waiting periods discourage these women from seeking health care in Hong Kong. Enhancing accessibility to appropriate health-care-related information and culturally-informed patient-provider interaction can improve knowledge, trust, and satisfaction among these women, thereby enhancing their engagement with the health-care system.

The impact of immigration on the breastfeeding practices of Mainland Chinese immigrants in Hong Kong.

BACKGROUND: Researchers have found breastfeeding disparities between immigrant and native-born women in many countries. However, most studies on immigration and breastfeeding practices have been in Western countries. The aim of this study was to examine the effect of length of time since immigration on the breastfeeding practices of Mainland Chinese immigrants living in Hong Kong. METHODS: We recruited 2704 mother-infant pairs from the postnatal wards of four public hospitals in Hong Kong. We examined the effect of migration status on the duration of any and exclusive breastfeeding. RESULTS: Breastfeeding duration was progressively shorter as the time since immigration increased. When compared with mothers who had lived in Hong Kong for <5 years, Hong Kong-born participants had a 30% higher risk of stopping any breastfeeding (hazard ratio [HR] 1.34 [95% confidence interval {CI} 1.10-1.63]) and exclusive breastfeeding (HR 1.33 [95% CI 1.11-1.58]). In both Hong Kong-born and immigrant participants, breastfeeding cessation was associated with return to work postpartum and the husband's preference for infant formula or mixed feeding. Intention to exclusively breastfeed and to breastfeed for >6 months, and previous breastfeeding experience substantially reduced the risk of breastfeeding cessation for both Hong Kong-born and immigrant participants. CONCLUSIONS: Health care professionals should consider immigration history in their assessment of pregnant women and provide culturally adapted breastfeeding support and encouragement to this population.

Mental health and health-related quality of life of Chinese college students who were the victims of dating violence.

PURPOSE: The aim of the study is to evaluate the mental health and health-related quality of life (HRQOL) of Chinese college students who were the victims of dating violence. METHODS: Six hundred and fifty-two subjects were included in the data analysis. Subjects completed a structured questionnaire containing the Woman Abuse Screening tool, the Hospital Anxiety and Depression Scale, the 10-item version of the Perceived Stress Scale (PSS-10) and the World Health Organization Quality of Life-BREF Instrument (WHOQOL-BREF). RESULTS: Analysis by independent t test suggested that victims of dating violence had more severe depressive, anxiety and stress symptoms and poorer HRQOL than non-victims. Multiple linear regression models found that more severe dating violence victimization was associated with more severe depressive, anxiety and stress symptoms. The mediation analysis found that after simultaneously controlling for the degree of depressive, anxiety and stress symptoms, the direct effect between dating violence severity and HRQOL, as measured by overall HRQOL and the global health, physical and environment domains of the WHOQOL-BREF, was statistically insignificant, supporting a full-mediation model. The relationship between dating violence severity and the social domain of HRQOL was partially mediated by the degree of depressive, anxiety and stress symptoms. CONCLUSION: Victims of dating violence had poorer mental health and HRQOL than non-victims. The study findings affirm the importance of assessing depressive, anxiety and stress symptoms in victims and the need to improve their depressive, anxiety and stress symptoms to diminish the negative effects of dating violence, which are apparent in their HRQOL.

Association Between Using Smartphone Dating Applications and Alcohol and Recreational Drug Use in Conjunction With Sexual Activities in College Students.

BACKGROUND: The association between using smartphone dating applications (apps) and substance use in conjunction with sexual activities was only examined in homosexual men. This association was poorly understood in heterosexual samples. OBJECTIVE: To explore the association between using dating apps and alcohol, and use of recreational drug in conjunction with sexual activities in college students. DESIGN: 666 students from four universities in Hong Kong were recruited in this cross-sectional study in the year 2015. Outcome measures included the use of dating apps, sexual history, and drug and alcohol use. Multivariable logistic regressions were employed. RESULTS: The use of dating apps for more than 1 year was found to be associated with recreational drug use in conjunction with sexual activities (adjusted odds ratio: 7.23). Other risk factors of recreational drug use in conjunction with sexual activities included being bisexual/homosexual male, a smoker, and having one's first sexual intercourse at the age of less than 16 years. The use of dating apps was not a risk factor for alcohol consumption in conjunction with sexual activities. Risk factors for alcohol consumption in conjunction with sexual activities included being older, having monthly income more than HKD5,000, and a smoker. Furthermore, risk factors for alcohol consumption in conjunction with the last sexual activity included currently being in a dating relationship, a smoker, and having sex with a casual partner. CONCLUSIONS: Using dating apps is an emerging risk factor of drug misuse. Interventions for practising safe sex and preventing drug use should be targeted at dating app users.

Measurement properties of the chinese weinstein noise sensitivity scale.

CONTEXT: Noise sensitivity may mediate or moderate the influences of noise exposure on health, and it needs to be reliably evaluated. The 21-item Weinstein's noise sensitivity scale (WNSS) has been the most popular scale for assessing noise sensitivity, but it is not yet available in traditional Chinese. AIMS: This study aimed to conduct linguistic and psychometric performance of WNSS in Hong Kong (HK) Chinese. SETTINGS AND DESIGN: A population-based telephone survey with 1-week follow-up. MATERIALS AND METHODS: The HK Chinese WNSS was obtained after forward-backward translation from the original English version and cognitive debriefing in five Chinese adults. Its measurement properties were assessed in 569 Chinese adults aged 18 years or above. STATISTICAL ANALYSIS USED: The sample was randomly split into two halves. The first half was used to explore a scale structure of the WNSS by exploratory factor analysis (EFA) with the number of factors determined by the optimal comparison data technique and tested for being artifactual. The second half was used for confirmatory factor analysis. Convergent validity and test-retest validity were also assessed. RESULTS: EFA identified two unipolar factors and removed three items poorly associated with the factors. The factors were likely artifactual and a unidimensional structure was assessed in CFA, which showed a satisfactory fit (root mean square error of approximation = 0.055; comparative fit index = 0.904; standardized root mean square residual = 0.061). The HK Chinese WNSS had good internal consistency (Cronbach's α = 0.83) and test-retest reliability (intraclass correlation coefficient = 0.87). Furthermore, it confirmed the expected association with extraversion (r = -0.14, P < 0.001) and neuroticism (r = 0.28, P < 0.001). CONCLUSION: The 18-item HK Chinese WNSS was reliable and valid for assessing noise sensitivity in the Chinese population.

The effect of a family-based mindfulness intervention on children with attention deficit and hyperactivity symptoms and their parents: design and rationale for a randomized, controlled clinical trial (Study protocol).

BACKGROUND: About 4 % of children in Hong Kong have attention deficit hyperactivity disorder (ADHD). The parents of children with ADHD report higher levels of stress and show more negative parenting behavior. Medication and behavior training are evidence-based treatments, but both show significant limitations. In short, medical treatment is not suitable for preschool children and would suppress growth, whereas parents under stress may not be capable of consistently applying behavior management skills. Mindfulness training can improve attention and facilitate cognitive development and overall functioning. It has been widely adopted as a treatment option in health care, but its application in a family context is limited. In this context, a family-based mindfulness intervention (FBMI) has been developed to promote the attention and mental health of children with attention symptoms and to reduce the stress experienced by their parents. This article describes the design and conduct of the trial. METHODS/DESIGN: A multicenter, 8-week, waitlist, randomized controlled trial of FBMI is currently being conducted in Hong Kong (from mid-2015 to mid-2016). Its effectiveness will be examined by comparing the participants who receive treatment to those in a waitlist control group. The study population consists of one hundred twenty children with ADHD, or with symptoms of inattention and hyperactivity, between 5 and 7 years of age and their parents. To be included in the study, the children are required to meet or exceed the borderline cutoff score of the Chinese version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors Rating Scale (SWAN-C). The primary outcome measures are the children's ADHD symptoms and behavior and the parents' stress. The secondary outcome measures include the children's overall behavioral problems and performance on the Attention Network Test, the parents' ADHD symptoms, the parents' mindful parenting scores, and heart rate variability of parents. DISCUSSION: This study is probably the first randomized controlled trial of FBMI for young children and their caregivers. A rigorous design and multiple outcome measures are used to examine the effectiveness of FBMI. If the hypotheses are confirmed, FBMI may serve as an additional treatment option for children with ADHD. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry (reference number: ChiCTR-IOR-15007292 ). Registered 28 October 2015.

Changes in heart-rate variability of survivors of nasopharyngeal cancer during Tai Chi Qigong practice.

[Purpose] To explore the changes in heart-rate variability (HRV) of survivors of nasopharyngeal cancer (NPC) before, during, and after a Tai Chi (TC) Qigong exercise. [Subjects and Methods] Eleven survivors of NPC participated voluntarily in the study. The heart rate of each participant was measured continuously for 1 minute before the TC Qigong intervention, during the 5-minute TC Qigong intervention, and for 1 minute after the intervention, using a Polar heart-rate monitor. Spectral HRV was expressed in terms of normalised low frequency (LF) power, normalised high frequency (HF) power, and the low frequency/high frequency (LF/HF) power ratio. [Results] Both the LF-power and the HF-power components had significant time effects. However, the time effect of the LF/HF power ratio was not significant. Post hoc contrast analysis revealed a significant decrease in LF power and a concomitant increase in HF power during the 4th minute and 5th minute of the TC Qigong exercise. [Conclusion] Five minutes of TC Qigong exercise was found to improve HRV by increasing HF power and decreasing LF power, but these effects were transient. TC Qigong might be an appropriate exercise for improving the ANS function and psychological and cardiac health of survivors of NPC.

The Functional Living Index-Cancer is a reliable and valid instrument in Chinese cancer patients.

PURPOSE: To evaluate the linguistic and psychometric properties of the Functional Living Index-Cancer (FLIC) in assessing the quality of life of Chinese cancer patients. METHODS: The English FLIC was translated into Traditional Chinese by the standard forward-backward procedure. After cognitive debriefing, a Traditional Chinese FLIC was administered to 500 cancer patients in a major public hospital in Hong Kong. Of which, 200 were invited to complete the questionnaire in 2 weeks. To identify a scale structure appropriate to Chinese, exploratory and confirmatory factor analyses were performed on two randomly split halves of the sample. RESULTS: We identified five scales of the Traditional Chinese FLIC which assess the physical, psychological, hardship, nausea and social aspects. These five scales and the overall scale demonstrated satisfactory fit and had the alpha coefficient ranged from 0.68 to 0.92. The intra-class correlation coefficient ranged from 0.67 to 0.88. In addition, all FLIC scales were negatively associated with the Eastern Cooperative Oncology Group performance status and, also except for the psychological scale, had lower scores in patients who were treated by chemotherapy. CONCLUSIONS: The Traditional Chinese FLIC is an appropriate health indicator for Chinese cancer patients.

The Effect of the COVID-19 Pandemic on Non-COVID-19 Deaths: Population-Wide Retrospective Cohort Study.

BACKGROUND: Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non-COVID-19 deaths. OBJECTIVE: This study aimed to measure the impact of hospital avoidance on excess non-COVID-19 deaths in public hospitals in Hong Kong. METHODS: This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. RESULTS: Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non-COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non-DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. CONCLUSIONS: We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences.

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

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

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

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

Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol.

Studies have consistently showed that informal caregivers have worse health, more medical consultations, anxiety and depression, and lower quality of life than those who do not provide such care. Positive outcomes of psychoeducation interventions have been found, but many of them are relatively long in duration, making them less cost-effective in implementation. The proposed study is a multi-site, three-arm randomized controlled trial of a mindfulness-based intervention for Chinese family caregivers. Effects of the intervention will be compared with those of an evidence-based psychoeducation program and treatment-as-usual. Two hundred forty cross-generational caregivers of frail older adults with moderate to severe levels of frailty will be recruited and randomly assigned to mindfulness-based intervention, psychoeducation, and treatment-as-usual experimental conditions. Program effectiveness will be analyzed on measures of caregiver burden, depression, anxiety, positive caregiving experience, spirituality, family conflict, and the biomarker of heart rate variability. Measures on coping styles, experiential avoidance, and self-efficacy will be explored to see if they mediate the changes to participant improvements in outcomes. Six-month follow-up will be included to investigate the maintenance effects. This study will provide evidence on mindfulness-based interventions on caregivers of frail older adults and expand the existing models of intergenerational caregiving in Chinese culture.