Prediction of adolescent weight status by machine learning: a population-based study.

BACKGROUND: Adolescent weight problems have become a growing public health concern, making early prediction of non-normal weight status crucial for effective prevention. However, few temporal prediction tools for adolescent four weight status have been developed. This study aimed to predict the short- and long-term weight status of Hong Kong adolescents and assess the importance of predictors. METHODS: A population-based retrospective cohort study of adolescents was conducted using data from a territory-wide voluntary annual health assessment service provided by the Department of Health in Hong Kong. Using diet habits, physical activity, psychological well-being, and demographics, we generated six prediction models for successive weight status (normal, overweight, obese and underweight) using multiclass Decision Tree, Random Forest, k-Nearest Neighbor, eXtreme gradient boosting, support vector machine, logistic regression. Model performance was evaluated by multiple standard classifier metrics and the overall accuracy. Predictors' importance was assessed using Shapley values. RESULTS: 442,898 Primary 4 (P4, Grade 4 in the US) and 344,186 in Primary 6 (P6, Grade 6 in the US) students, with followed up until their Secondary 6 (Grade 12 in the US) during the academic years 1995/96 to 2014/15 were included. The XG Boosts model consistently outperformed all other model in predicting the long-term weight status at S6 from P4 or P6. It achieved an overall accuracy of 0.72 or 0.74, a micro-averaging AUC of 0.92 or 0.93, and a macro-averaging AUC of 0.83 or 0.86, respectively. XG Boost also demonstrated accurate predictions for each predicted weight status, surpassing the AUC values obtained by other models. Weight, height, sex, age, frequency and hours of aerobic exercise were consistently the most important predictors for both cohorts. CONCLUSIONS: The machine learning approaches accurately predict adolescent weight status in both short- and long-term. The developed multiclass model that utilizing easy-assessed variables enables accurate long-term prediction on weight status, which can be used by adolescents and parents for self-prediction when applied in health care system. The interpretable models may help to provide the early and individualized interventions suggestions for adolescents with weight problems particularly.

Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains uncertain. OBJECTIVES: The aims of the study were to compare and rank the effect of different types of exercise on walking capacity, cardiorespiratory fitness, dialysis adequacy, and health-related quality of life (HRQOL) in patients undergoing MHD. METHODS: Eight databases (four English and four Chinese) were searched from inception to January 1, 2022. Randomized controlled trials evaluating the efficacy of different exercises for patients undergoing MHD were included. Two independent reviewers screened the literature, extracted data, assessed the risk of bias, and evaluated the certainty of evidence. A frequentist random-effect network meta-analysis was conducted. RESULTS: Ninety trials with 4,084 participants comparing 15 types of exercise were included, reporting on the six-minute walking test (45 trials), peak oxygen uptake (22 trials), dialysis adequacy (30 trials), and HRQOL (23 trials). Network meta-analysis showed that the most effective intervention for walking capacity was intradialytic aerobic exercise combined with blood flow restriction with a mean difference and 95% confidence interval of 97.35 (11.89-182.81), for peak oxygen uptake it was non-intradialytic combined aerobic and resistance exercise with a value of 4.35 (2.25-6.44), for dialysis adequacy it was intradialytic combined aerobic and resistance exercise with a value of 0.17 (0.06-0.28), for the physical component summary of HRQOL it was intradialytic aerobic exercise with a value of 4.93 (2.31-7.54), and for the mental component summary of HRQOL it was non-intradialytic combined aerobic and resistance exercise with a value of 6.36 (0.45-12.27). Ultimately, intradialytic combined aerobic and resistance exercise could improve all the above outcomes compared to usual care. CONCLUSIONS: This study concluded that intradialytic combined aerobic and resistance exercise is optimal for MHD patients due to its significant positive effects on multiple outcomes. Walking capacity can be further enhanced by combining blood flow restriction with exercise. For improving dialysis adequacy, intradialytic exercise proves to be more effective than non-intradialytic exercise. Further well-designed clinical trials are needed to investigate the effects of exercise with varying durations, intensities, and frequencies.

Validation of the adapted female sexual function index among Chinese cisgender heterosexual women and sexual and gender minority women.

BACKGROUND: The Female Sexual Function Index (FSFI) remains the most widely used scale for assessing female sexual function. However, while an adapted version of the FSFI has been proven to be suitable for Western sexual minority women, it has yet to be used in China. AIM: This study aimed to validate the Mandarin Chinese version of the adapted FSFI among Chinese cisgender heterosexual women and sexual and gender minority women, and evaluate its psychometric properties. METHODS: A cross-sectional online survey was conducted. The modified scoring method related to zero responses was examined, and structural validity, internal consistency, internal reliability, convergent validity, and known-group validity were evaluated. OUTCOMES: The primary measure was the adapted FSFI, and the Positive Sexuality Scale and the New Sexual Satisfaction Scale-Short Form were used to test convergent validity. RESULTS: A total of 431 Chinese adult women were recruited, including 193 cisgender heterosexual women and 238 sexual and gender minority women. Confirmatory factor analysis using the original scores supported the original 6-factor model. Using both Cronbach's α and McDonald's ω, the results showed that the values of the total scale and 6 subscales were in the 0.76 to 0.98 and 0.83 to 0.98 ranges, respectively, indicating satisfactory reliability. Moderate-to-strong correlations among the total FSFI scores and positive sexuality and sexual satisfaction were found (r = 0.32-0.71), supporting good convergent validity. CLINICAL IMPLICATIONS: The adapted FSFI facilitates the use of more inclusive language in the clinical setting, allowing for a more comprehensive and unbiased assessment of sexual function in all women. STRENGTHS AND LIMITATIONS: This study recruited both cisgender women of varied sexual orientations and gender minorities who were assigned female at birth, demonstrating that the adapted FSFI could be suitably applied to sexual minority populations. However, from a fully inclusive perspective of sex and gender, there is no research on how to accurately evaluate transgender women with female external genitalia or appropriately assess those with a female reproductive system but who do not self-identify as female. Therefore, more in-depth research is needed to further revise the FSFI for better use in the wider female population. CONCLUSION: This Chinese version of the adapted FSFI has good psychometric properties and is a reliable and valid instrument to assess female sexual function. Furthermore, the modified scoring method could be an effective alternative among samples of sexually inactive women.

Trajectories of fasting glucose and glycated haemoglobin in obese and non-obese incident diabetes: Results from two large cohort studies.

AIMS: Diabetes development mechanisms vary by weight status. We aimed to compare cardiometabolic risk and characterize fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) trajectories before diagnosing type 2 diabetes in individuals with/without obesity. METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA) were analysed. Participants without diabetes and with a body mass index of 18.5-40 kg/m2 at baseline were included. Incident diabetes was ascertained by self-reported physician diagnosis and/or antidiabetic drug use, FPG ≥126 mg/dl and/or HbA1c ≥6.5%. The difference in the FPG/HbA1c trajectory before the diabetes diagnosis in participants with/without obesity was examined using mixed-effects models. RESULTS: Among 11 925 eligible participants, 1361 incident diabetes cases (mean age: 61.4 years; male: 46.2%) were identified within 15 years of follow-up. Obese diabetes showed higher levels of diastolic blood pressure and C-reactive protein at diagnosis than non-obese diabetes. Mixed-effects models indicated the difference in the FPG trajectory before diagnosis by weight status was non-significant with a slope difference of 0.149 mg/dl (SE = 0.642, p = .816, CHARLS) and 0.013 mg/dl (SE = 0.013, p = .337, ELSA). However, obese diabetes showed a steep increase in HbA1c before diagnosis with a slope difference of 0.036% (SE = 0.016, p = .021) in the CHARLS and 0.032% (SE = 0.014, p = .027) in the ELSA, respectively. Sex-stratified analyses showed that the difference in HbA1c trajectory before the diabetes diagnosis by weight status was only significant in males. CONCLUSIONS: Obese and non-obese diabetes developments may share a similar FPG but distinct HbA1c trajectory. Obese diabetes interventions require more attention to cardiometabolic risks. Moreover, studies addressing weight/sex-related differences in diabetes aetiologies and treatments are warranted.

The impact of unmet needs for assistance with activities of daily living on the self-rated health and life satisfaction of Chinese community-dwelling older adults.

OBJECTIVES: This study examined the associations of change in unmet needs for assistance with Activities of Daily Living (ADLs) with the self-rated health and life satisfaction of community-dwelling Chinese older adults. METHODS: Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of change in unmet ADL needs with self-rated health and life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 ADL-limited older adults. Change in unmet ADL needs was categorized into 'Persistently Unmet,' 'Unmet at T1 Only,' 'Unmet at T2 Only,' and 'Never Unmet.' Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographics, health conditions, and social support. RESULTS: Older adults whose ADL needs were 'Persistently Unmet,' 'Unmet at T2 Only,' or 'Never Unmet,' showed a significant decline in self-rated health, but those whose ADL needs were 'Unmet at T1 Only' exhibited a significant rise at follow-up. While life satisfaction was stable among older adults with 'Persistently Unmet' or 'Never Unmet' ADL needs, it significantly decreased among those with 'Unmet at T2 Only' ADL needs and increased among those with 'Unmet at T1 Only' ADL needs. CONCLUSION: Unmet needs may play an even more significant role in negatively impacting life satisfaction than the ADL limitation itself. Unmet ADL needs' effects on self-rated health and life satisfaction appeared to be short-term rather than long-term. Thus, it is never too late to adequately meet older adults' ADL needs.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2045563.

Preferences for end-of-life care: A cross-sectional survey of Chinese frail nursing home residents.

AIM AND OBJECTIVES: To assess (1) the experience, knowledge and preferences of end-of-life care among frail nursing home residents and (2) the preferences of residents' family caregivers. BACKGROUND: Globally, nursing homes are becoming an important place where many older people will receive their end-of-life care. Thus, assessing the end-of-life care preferences among nursing home residents is crucial. DESIGN: Cross-sectional survey. METHODS: Residents aged ≥65 years, with frail or pre-frail status (n = 286) in 34 nursing homes were interviewed using a structured questionnaire. Descriptive statistics were used to describe the outcomes and regression analyses were used to evaluate factors related to the outcomes. Kappa statistics were used to examine the agreement between the preferences among 21 residents and their family caregivers. The manuscript was guided by the STROBE checklist. RESULTS: 5.9% and 10.5% of the participants had heard of advance care planning and advance directive respectively. After explanations of the terms by the research team, 42.3% of the participants preferred advance care planning, whereas 22.0% preferred advance directive. The top reason for not preferring advance care planning/advance directive is perceiving them as 'not necessary'. Nursing homes were the most preferred place to receive end-of-life care (41.6%). Whereas hospitals were the most preferred place for death (36.0%). The agreement among resident and family caregiver dyads ranged from none to minimal in most outcomes. CONCLUSIONS: This study revealed the lack of awareness around advance care planning and advance directive among frail nursing home residents. Future research should focus on developing effective educational interventions to enhance the residents' awareness of these topics. RELEVANCE TO CLINICAL PRACTICE: To increase awareness among nursing home residents, more educational programs should be implemented. Frail older residents might not see the relevance of advance care planning; interventions need to include both current and future care to increase its relevance.

Association of weight status and the risks of diabetes in adults: a systematic review and meta-analysis of prospective cohort studies.

Obesity is a known risk factor for type 2 diabetes mellitus (T2DM); however, the associations between underweight and T2DM and between weight status and prediabetes have not been systematically reviewed. We aimed to estimate the relative risks (RRs) of prediabetes/T2DM in underweight/overweight/obesity relative to normal weight. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to December 8, 2021. Prospective cohort studies with a minimum 12-month follow-up period reporting the association between baseline body mass index (BMI) categories and risk of prediabetes/T2DM in adults were included. Study quality was assessed using the Newcastle-Ottawa Scale. The main analyses of T2DM risk were performed using the ethnic-specific (Asian/non-Asian) BMI classification and additional analyses of prediabetes/T2DM risk by including all eligible studies. Random-effects models with inverse variance weighting were used. Subgroup analyses and meta-regression were conducted to explore the potential effects of pre-specified modifiers. The study protocol was registered with PROSPERO (CRD42020215957). Eighty-four articles involving over 2.69 million participants from 20 countries were included. The pooled RR of prediabetes risk was 1.24 (95% CI: 1.19-1.28, I2 = 9.7%, n = 5 studies) for overweight/obesity vs. normal weight. The pooled RRs of T2DM based on the ethnic-specific BMI categories were 0.93 (95% CI: 0.75-1.15, I2 = 55.5%, n = 12) for underweight, 2.24 (95% CI: 1.95-2.56, I2 = 92.0%, n = 47) for overweight, 4.56 (95% CI: 3.69-5.64, I2 = 96%, n = 43) for obesity, and 22.97 (95% CI: 13.58-38.86, I2 = 92.1%, n = 6) for severe obesity vs. normal weight. Subgroup analyses indicated that underweight is a protective factor against T2DM in non-Asians (RR = 0.68, 95% CI: 0.40-0.99, I2 = 56.1%, n = 6). The magnitude of the RR of T2DM in overweight/obesity decreased with age and varied by region and the assessment methods for weight and T2DM. Overweight/obesity was associated with an increased prediabetes/T2DM risk. Further studies are required to confirm the association between underweight and prediabetes/T2DM, particularly in Asian populations.

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

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

Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis.

PURPOSE: To summarize the current evidence regarding the effectiveness of intradialytic exercise (IDE) on the health-related quality of life (HRQOL) of patients undergoing maintenance haemodialysis. METHODS: Five English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and ScienceDirect) and four Chinese databases (VIP, WAN FANG, CNKI, CBM) were comprehensively searched from their inception to 18 March 2021. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected the papers and extracted the details of each study therein. Only randomized controlled trials were included. The risk of bias tool version 2.0 was used to evaluate the risk of bias of the included studies. A random-effects meta-analysis was conducted to pool the effect size. RESULTS: Thirty-three eligible studies with 1481 participants were included. For the generic HRQOL, assessed by the Medical Outcomes Study Short-Form survey, IDE significantly improved most domains and the physical component summary compared with the control group. Furthermore, aerobic exercise alone significantly improved more domains compared to resistance exercise, combined aerobic and resistance exercise, and other types of exercise. Regarding the kidney-specific HRQOL, IDE improved three of eleven domains, including the symptom/problem list, the effect of kidney disease, and the quality of social interaction. No significant effect was found on other domains of kidney-specific HRQOL. CONCLUSION: Intradialytic exercise could benefit patients undergoing haemodialysis in improving most domains of generic HRQOL, but the effect on most domains of kidney-specific HRQOL is insufficient.

Patient-centred, self-administered acupressure for Chinese advanced cancer patients experiencing fatigue and co-occurring symptoms: A pilot randomised controlled trial.

OBJECTIVES: To evaluate the feasibility and potential effects of patient-centred self-administered acupressure for alleviating fatigue and co-occurring symptoms among Chinese advanced cancer patients receiving treatment. METHODS: Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4-week patient-centred self-administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue-sleep disturbance-pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy. RESULTS: Twenty-four participants (80%) completed the study. Adherence to self-administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post-intervention in the intervention group. Among these outcomes, only the between-group difference in anxiety post-intervention was significant. The group × time interaction effect was nonsignificant for all outcomes. CONCLUSIONS: Patient-centred self-administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect.

Prevalence and predictors of advance directive among terminally ill patients in Taiwan before enactment of Patient Right to Autonomy Act: a nationwide population-based study.

BACKGROUND: Signing advance directives (ADs) ensures that terminally ill patients receive end-of-life care, according to their wishes, thereby promoting human dignity and sparing them from unnecessary suffering. Despite the enactment of the Hospice Palliative Care Act in Taiwan in 2000, the completion rates of ADs have been found to be low among patients with chronic illness conditions. To date, limited existing research is available regarding the factors associated with AD completion in terminally ill patients in Taiwan. To explore signed AD characteristics, compare differences in signing ADs between patients with and without cancer, and examine the factors associated with signing ADs in terminally ill patients. METHODS: A nationwide study was conducted using data collected via a retrospective review of medical death records from 18 randomly selected hospitals in the northern, central, and southern parts of Taiwan. We collected 200 records, including both cancer and non-cancer-related deaths, from each hospital. Univariate and multivariate logistics regressions were conducted to examine factors associated with signing advance directives among all patients- with and without cancer. RESULTS: Among the 3004 reviewed medical records, 79% had signed ADs, with most (95%) being signed by patients' caregivers. A higher education level (OR = 1.52, 95% CI = 1.10, 2.08, p = 0.010); cancer diagnosis (OR = 2.37, 95% CI = 1.79, 3.16, p < 0.001); having family members (OR = 5.62, 95% CI = 2.95, 10.69, p < 0.001), care homes (OR = 4.52, 95% CI = 1.97, 10.38, p < 0.001), friends, or maids (OR = 3.82, 95% CI = 1.76, 8.29, p = 0.001) as primary caregivers; and patients knowing about their poor prognosis (OR = 15.39, 95% CI = 5.66, 41.83, p < 0.001) were associated with a higher likelihood of signing ADs. CONCLUSIONS: Patients with non-malignant chronic illnesses were less likely to have ADs signed by either patients or family caregivers than those with cancer, with the lowest likelihood observed in patients with cardiovascular diseases. Whenever possible, primary caregivers should be involved in discussing ADs with patients, and the importance of truth telling should be reinforced. Following these principles, each patient's end-of-life care preferences can be respected, thereby promoting quality of care before the patient's death.

Visits to the accident and emergency department in hot season of a city with subtropical climate: association with heat stress and related meteorological variables.

BACKGROUND: Literature reporting the association between heat stress defined by universal thermal climate index (UTCI) and emergency department visits is mainly conducted in Europe. This study aimed to investigate the association between heat stress, as defined by the UTCI, and visits to the accident and emergency department (AED) in Hong Kong, which represents a subtropical climate region. METHODS: A retrospective study involving 13,438,846 AED visits in the public sector from May 2000 to September 2016, excluding 2003 and 2009, was conducted in Hong Kong. Age-sex-specific ANCOVA models of daily AED rates on heat stress and prolonged heat stress, adjusting for air quality, prolonged poor air quality, typhoon, rainstorm, year, day of the week, public holiday, summer vacation, and fee charging, were used. RESULTS: On a day with strong heat stress (32.1 °C ≤ UTCI ≤ 38.0 °C), the AED visit rate (per 100,000) increased by 0.9 (95% CI: 0.5, 1.3) and 1.7 (95% CI: 1.3, 2.1) for females and males aged 19-64 and 4.1 (95% CI: 2.7, 5.4) and 4.1 (95% CI: 2.6, 5.6) for females and males aged ≥ 65, while keeping other variables constant. On a day with very strong heat stress (38.1 °C ≤ UTCI ≤ 46.0 °C), the corresponding rates increased by 0.6 (95% CI: 0.1, 1.2), 2.2 (95% CI: 1.7, 2.7), 4.9 (95% CI: 3.1, 6.7), and 4.7 (95% CI: 2.7, 6.6), respectively. The effect size of heat stress associated with AED visit rates was negligible among those aged ≤ 18. Heat stress showed the greatest effect size for males aged 19-64 among all subgroups. CONCLUSION: Biothermal condition from heat stress was associated with the health of the citizens in a city with a subtropical climate and reflected in the increase of daily AED visit. Public health recommendations have been made accordingly for the prevention of heat-related AED visits.

Lived experience of neuropsychiatric symptoms among females with mild cognitive impairment: A phenomenological study.

AIMS: To explore the lived experience of neuropsychiatric symptoms (NPS) among females with mild cognitive impairment (MCI). DESIGN: A phenomenological study using individual, semi-structured, telephone-based interviews was conducted to explore how the NPS are aroused, evolve, and affect the overall well-being, illness perception and the corresponding coping responses adopted by females with MCI. METHODS: Twenty-nine participants with MCI were recruited from the community setting in Hong Kong between March and October 2020. Interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological analysis approach and constant comparison strategy. RESULTS: Three themes were identified: (1) living vigilant lives with threats and uncertainty, (2) snowballing into further negative emotions and (3) seeking outlets for negative emotions. Our findings suggested that the participants' cognitive, functional and social challenges aroused intense emotional responses such as depression, agitation and anxiety. These noting negative emotions were further perpetuated by maladaptive coping responses, unrealistic expectations from coping strategies and overwhelming disease burden. Various internal and external strategies were adopted to enhance emotional adaptation, of which adopting a positive attitude appeared to be the most promising strategy. CONCLUSION: This study shed light on the challenging experience of MCI. The cognitive afflictions and the resultant impacts on various life domains evoked a cluster of NPS. Support services need to enhance emotional adjustment through alleviating the various life stressors and strengthening the coping resources. IMPACT: Elucidating the lived experience of NPS provides important insights into the development of a more effective, comprehensive and person-centred care planning for the population with MCI. Holistic care planning should extend beyond cognitive health optimization into enhancing disease knowledge, improve emotional coping, rebuild self-identity and bolstering social supports among this preclinical cohort.

Health-related quality of life among Chinese primary care patients with different lower urinary tract symptoms: a latent class analysis.

PURPOSE: No previous study has used a data-driven approach to explore symptom subclasses among patients with lower urinary tract symptoms (LUTS). The objectives of this study were to use latent class analysis (LCA) to identify distinct classes of LUTS among primary care patients and to assess the class differences in health-related quality of life (HRQOL). METHODS: In this cross-sectional study, 500 patients were randomly recruited, and 18 symptoms according to the International Continence Society 2002 criteria were assessed. Classes were identified by LCA. Patient HRQOL was measured using the 12-item Short Form Health Survey (version 2), the modified Incontinence Impact Questionnaire-Short Form and the HRQOL item from the International Prostate Symptom Score. RESULTS: Six distinct LUTS classes were identified: "asymptomatic" (26.0%), "mild symptoms" (22.6%), "moderate multiple symptoms" (17.0%), "urgency symptoms" (13.8%), "urinary incontinence" (12.0%) and "severe multiple symptoms" (8.6%). Multinomial regression analysis found differences in the gender distribution and prevalence of heart diseases across classes, and multiple linear regression found that patients with "severe multiple symptoms" and "urinary incontinence" had the poorest HRQOL. CONCLUSION: Almost three quarters of the primary care patients in this study were suffering from varying degrees of LUTS. The poor HRQOL in "severe multiple symptoms" and "urinary incontinence" implies that patients in these classes require additional attention and treatments.

Developing and testing of an interactive internet-based intervention to reduce sexual harm of sexualised drug use ('chemsex') among men who have sex with men in Hong Kong: a study protocol for a randomised controlled trial.

BACKGROUND: Sexualised drug use, known as 'chemsex' or 'chemfun,' is the practice of intentionally using illicit drugs before or during sexual activates to enhance sexual arousal and pleasure. International and local data have both suggested that chemsex is common among men who have sex with men (MSM). Chemsex is generally seen with the engagement of risky sexual activities and therefore poses a threat regarding the potentially increased spread of human immunodeficiency virus and other sexually transmitted infections. However, little work has been done on the primary prevention of chemsex among MSM. Therefore, the aim of this study is to develop and evaluate an interactive internet-based intervention in reducing the sexual harms of chemsex among MSM in Hong Kong, METHODS: A two-armed, randomised, parallel-group trial with a three-month follow-up period will be conducted. 250 MSM aged 18 years or the above will be recruited through local non-governmental organisations, social media and by snowballing in Hong Kong. Participants will be randomly allocated into either the intervention (n = 125) or control group (n = 125). The interactive internet-based intervention will be developed based on the theory of planned behaviours. Participants in the control group will receive a web-based intervention without any sexual health information and without any interactive components. The primary outcomes will be self-efficacy in refusing risky sexual behaviours and chemsex, as measured by the Drug Avoidance Self-Efficacy Scale, the Self-Efficacy for Sexual Safety and the Condom Self-Efficacy Scale. Subjects in both groups will be evaluated at baseline and 3 months after baseline. DISCUSSION: To the best of our knowledge, this will be the first interactive internet-based intervention to specifically target chemsex among MSM. This project can help in the development and testing of culturally relevant health promotion programmes that reduce chemsex among MSM. Using an online delivery mode, the intervention is capable of reaching a large population of targets at a relatively low cost and thus has the potential to reduce the public health burden of chemsex and other risky sexual behaviours among MSM in a cost-effective manner. TRIAL REGISTRATION: International standard randomized controlled trial number (ISRCTN) registry: ISRCTN20134522 registered on 17 March 2021.

Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study.

BACKGROUND: Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. OBJECTIVE: This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. METHODS: A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. RESULTS: A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9%) completed at least one follow-up. Additionally, 76.3% (103/135) of the participants could attend at least 70% of the proposed 18 sessions, and 72.5% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. CONCLUSIONS: A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients.

Effects of spiritual resilience on psychological distress and health-related quality of life in Chinese people with Parkinson's disease.

PURPOSE: Health-related quality of life (HRQOL) is an increasingly critical outcome of chronic illness care. However, its disease-independent attributes, particularly its spiritual resilient indicators, for people with Parkinson's disease (PD) have not been explicitly examined. This study aimed to (i) assess the associations between psychological distress, spiritual resilience and HRQOL, and (ii) examine the mediating effects of spiritual resilience on psychological distress and HRQOL amongst individuals with PD. METHODS: This is a secondary data analysis of the baseline data of a clinical trial that involved 138 individuals with PD. The subjects completed a structured questionnaire assessing psychological distress in terms of anxiety and depression, spiritual resilience in terms of perceived affliction and perceived equanimity, severity of motor symptoms and disease-specific HRQOL. RESULTS: Analysis by independent t test suggested that distressed individuals with PD demonstrated less spiritual resilience and presented poorer HRQOL than non-distressed individuals with PD. Multiple linear regression models revealed that high emotional distress was associated with low spiritual resilience and poor HRQOL. The mediation analysis found that after simultaneously controlling for the degree of perceived affliction and perceived equanimity, a significant reduction was observed in the direct effect between psychological distress and HRQOL. This result indicated the partially mediating roles of perceived affliction and equanimity in the pathways between psychological distress and HRQOL. CONCLUSION: In order to enhance HRQOL, PD interventions should address the spiritual resilience of patients in addition to providing psychological care and physical relief of symptoms.

The relative risk of developing type 2 diabetes among individuals with prediabetes compared with individuals with normoglycaemia: Meta-analysis and meta-regression.

AIMS: To assess the overall relative risk of diabetes in individuals with prediabetes based on updated diagnostic criteria, as compared with individuals with normoglycaemia; and to identify the study characteristics associated with the heterogeneity between studies. DESIGN: Meta-analysis, meta-regression. DATA SOURCES: PubMed, CINAHL, British Nursing Index. Search time frame: December 1998-December 2018. REVIEW METHODS: The pooled relative risk of developing diabetes among individuals with prediabetes compared with those with normoglycaemia was calculated under a random effects model. Studies reported the natural progression from prediabetes to diabetes were included in this review. Sources of study heterogeneity were examined by a meta-regression. RESULTS: Fifty-nine eligible studies were systematically identified. The pooled relative risk for diabetes among individuals with prediabetes as compared with normoglycaemia was 5.88 (95% CI: 5.02-6.89). The annualized incidence rate (per 1,000 person-year) for diabetes among individuals with prediabetes defined by different criteria varied from 2.20-212.15, with high heterogeneity between studies (I2  = 96.64%, Q test: p < .001). In the multivariable meta-regression analysis, Asian population significantly increased RR compare to Caucasians. Besides, people with 'elevated glycated haemoglobin A1c or impaired fasting glucose' had highest relative risk compare to people with other types of prediabetes. CONCLUSION: Individuals with prediabetes had higher risk of developing diabetes than those with normoglycaemia. Races and diagnostic criteria of prediabetes were associated with the magnitude of the estimated risk. IMPACT: Prediabetes is a precursor of diabetes. To screen people with prediabetes as early as possible, practitioners could consider haemoglobin A1c test as an alternative to fasting plasma glucose test. Nurses should educate people especially Asians with prediabetes for the prevention of progression to diabetes.

Seasonal pattern of single falls and recurrent falls amongst community-dwelling older adults first applying for long-term care services in Hong Kong.

BACKGROUND: few studies had investigated seasonal pattern of recurrent falls. OBJECTIVE: to examine seasonal pattern of both single and recurrent falls amongst community-dwelling older adults first applying for long-term care (LTC) services. METHODS: a cohort of 89,100 community-dwelling Hong Kong older adults aged 65 and over first applying for LTC services from 2005 to 2014 was obtained. Logistic regression models were used to examine seasonal pattern in single and recurrent falls, whilst controlling for gender, age and year. RESULTS: amongst 89,100 older adults, about 32% fell in past 90 days. Amongst the fallers, 34% fell recurrently. In 2014, the incidences of all fall, single fall and recurrent fall were 1.95, 0.80 and 1.15 per person-years, respectively. For single falls, the 90-day fall risk was highest during November to February with an odds ratio (OR) of 1.29 (95% confidence interval [CI] 1.19-1.41), compared with the lowest one during July to October. For recurrent falls, the highest OR for 90-day risk was highest during November to February (1.46, 95% CI 1.31-1.64) as well. CONCLUSIONS: single and recurrent falls both peaked during winter months. Interventions, such as implementing educational publicity and sending reminder to older adults in fall season, may be considered.

Meteorological factors to fall: a systematic review.

There existed systematic review on studies investigating the association between hip fractures and external risk factors including meteorological factors. Albeit the fact that most serious common fall injury is a hip fracture, it cannot account for all injuries forms of fall. There was a lack of systematic review covering all fall-related injury or deaths to thoroughly summarise meteorological aspects of fall. This study aimed to systematically review epidemiological studies of fall and fall-related circumstances without restriction to hip fracture. A systematic search in three databases, namely PubMed, CINAHL Plus and EMBASE, was performed. Searches in two Chinese databases named the Wanfang Med Online and the China Journal Net were done in addition. A total of 29 studies were identified. The study site, fall cases identification, meteorological factors and findings of all the selected studies were being extracted. The quality of the studies was critically appraised. We identified some of the environmental risk factors to fall among those studies. Ranging from the lower ambient temperature, the presence of snow cover, seasonal factors, and time of the day to location of fall, these factors have different levels of impact related to higher incidence or mortality of fall. To conclude, a better understanding of injury mechanisms is a prerequisite for preventive interventions.